When most of us think about the issues facing dementia patients, oral care generally is not one of the first things which springs to mind. But experts have found that a decline in regular oral care is one of the most common dementia symptoms, often appearing years before other symptoms.
Brushing one’s teeth is a surprisingly complex task from a neurological perspective. It requires a bunch of small actions which are otherwise rarely done, and they must be done in a fairly strict order. There’s also no particular feedback to the person when they don’t brush, unlike many other hygiene or sanitary functions. The toothbrush and toothpaste are still where they expect them to be, but since they don’t change their status doesn’t register on a neurological level. So you end up with cases where a person thinks they’ve brushed their teeth, when they really haven’t.
There are steps caregivers can take. Check toothbrushes and toothpaste regularly. Are they very dry? Have they been changed or replaced recently? Is there dust on the mouthwash bottle? All of these could be signs of diminishing oral self care, and the caregiver should start taking steps to make oral care more of a routine, even if it needs regular checking and reminders going forward. If the care recipient has arthritis or other hand issues, make sure they have ergonomic toothbrush handles, or assistive toothpaste dispensers. Put on a pair of thick, waterproof gloves and try your oral care routine. The actions you have trouble with will also likely be difficult for someone with bad hands, and you should take steps to make them easier.
As dementia progresses, the problem can shift from infrequency to one of inability. They simply no longer have the fine motor function of executive capacity to perform basic oral care, even if reminded to do so. At that point oral care becomes the responsibility of the caregiver, and they must learn how to brush, and otherwise care for, another person’s mouth.
On the other hand, this could be used as an early predictor of dementia. If your loved one seems to be having trouble with oral hygiene – even as young as their early 50s – it may be time to go see a neurologist and get an early diagnosis so preventative measures can be taken.
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