​Long term care residents with dementia deserve to have the following outcomes: comfort, dignity, safety, preserving function, and preventing new illnesses.

While every caregiver in long term care recognizes the importance of these five outcomes, their ties to good oral hygiene are not always obvious.

Among these five outcomes related to good daily oral hygiene are the following protocols:

  • Comfort: Clean, healthy tissue actually feels better. Every day everyone wakes up, has breakfast, and brushes their teeth and/or dentures. If they don’t, they have that grungy feeling. Good oral hygiene makes people feel better and more ready to face the day.
  • Dignity: Halitosis is offensive, and people with halitosis are likely to have poor oral hygiene. The anaerobic bacteria in gum disease produce offensive odors that make family members and friends want to keep their distance. Clean, healthy tissues smell better and support social relationships.
  • Safety: Broken or loose teeth and dentures or partials that don’t fit properly can be choking or safety hazards. By providing daily oral hygiene care, caregivers can identify safety issues early so that they can be remedied before becoming a serious safety issue. Thus, good daily oral hygiene promotes resident safety.
  • Preserving function: At a time when there are losses of function, preserving every capability is paramount. The ability to chew food so that it can be swallowed is one of these functions. Optimal oral health is supported by optimal oral hygiene. If the teeth, gums, and supporting structures are maintained, it is easier and more pleasant to chew.
  • Preventing new disease: Good oral hygiene helps to prevent new dental disease and the resultant pain and infection.

Residents with dementia must have an individualized daily oral care plan. If persons have natural teeth, the teeth must be cleaned twice daily for at least two minutes with a prescription fluoride gel (1.1 percent NaF gel). Prevident 5000™ is an example, but there are many others.

Flossing once each day would be a plus or use a small brush that cleans between the teeth. But brushing twice daily is essential. It is also important to concentrate on the gum line.

If the resident has dentures, dentures and oral tissues should be cleaned at least once daily.
Dentures and partials must be removed at night, cleaned, and stored in a cup of liquid. They should be rescrubbed in the morning, rinsed, and placed in the resident’s mouth.
Daily scrubbing of the dentures with an appropriate brush is what cleans the teeth. Denture cleaners added to the denture cup aid the process but don’t replace it. Denture cups need to be emptied and the water replaced daily.

Below are links to additional articles on oral health in long term care:

Judith Jones, DDS, is professor and chair of the Department of General Dentistry and director of the Center for Clinical Research, at Boston University Henry M. Goldman School of Dental Medicine, Boston. Jones can be reached at: judjones@bu.edu or (617) 414.1065.