To get the best cooperation possible you need to think about every step with the unique needs if your client in mind

If you make them feel safe and secure then you're sure to get a better result

So, let's break down the steps

The six steps to oral care are

choosing when to brush

choosing where to brush

setting up the room

brushing

rinsing

and

cleaning up

As the assistant to the person

you need to decide how many of these tasks you need to assist with

For instance

it's quite possible that once you set up then the person might be quite independent

or

you may need to direct the person through some of the steps or perform some of the tasks with them

try to establish a daily routine to reinforce patterns of behavior

patterns make it happen

but

oral care does not have to be after a meal or before going to bed

the best time it when the person is relaxed

and agreeable

as dementia progresses the person's understanding changes

places can become unfamiliar and can be confronting

the person may not recognise you

and spatial perception changes

so a white basin over a white floor will be hard for them to distinguish

so the place to brush needs to be familiar and comfortable

and that may not be always be the bathroom

sometimes the kitchen table can be a better choice if the bathroom is problematic

ask some simple questions to make this decision

can the person stand or sit comfortably in the bathroom at the basin

can they easily reach to pick things up

and can they spit into the basin

do they seem lost, unsure or worried when they're in the bathroom

if you're assisting can you fit in the room at the same time

and when in the room can the person see your face

if the bathroom satisfies all of these needs then make the bathroom setting one that makes them feel safe and comfortable

because bathrooms are generally cooler than the other areas

it's often important to warm them up

and to have good lighting

you may even suggest installing a heated light source or sensor light that goes on when they enter the bathroom

points of reference and familiar items can help orientate the person so consider items of interest such as indoor plants and colorful towels

Stale or offensive odours can make the bathroom unpleasant to be in so think about air freshners

bathrooms have many hard surfaces that can cause sounds to echo making it difficult to hear and concentrate

consider reducing noise level such as turning off the noisy extractor fan

or use of background music

you may need to contrast the color the hand basin with the surrounding bench and floor

this can be done with a non-slip mat on the floor

if the bathroom floor is cold then the non- slip mat with also make it cozier

the occupational therapist may have input to design grab rails

a non-slip surface for the whole bathroom or a call bell

make sure the mirror is at a good height but keep in mind that for some people mirrors can be confusing

they may not recognise themselves in the mirror which can be confronting

you may choose the kitchen table for brushing where there's no mirror

make sure you have all that you need for the job

choose a toothbrush that's colorful and a different colour to the hand basin or table

you may need a handle adaptor to make it easy for the client to hold the brush

and you may have a second brush to help protract the cheek

if you've chosen in the kitchen table you'll need a basin that the person can spit into and a box of tissues to wipe their lips clean

it's preferable for your clients to spit and not rinse out the toothpaste but some will insist on rinsing

use a plastic cup of water preferably a coloured one so they can easily see it

if the client likes to wear there glasses make sure they are on as well as hearing aids if necessary

if they're seated you might find a chair with arm rests gives them a bit more security and stability

you'll need toothpaste of course and then your're ready for action

a person with dementia is often sensitive to non verbal forms of communication

such as facial expressions and posture

they usually have increased sensitivity to the emotions of others

and progressively increase their use and nonverbal communication

so how does that help us with brushing teeth

well the key worker and needs to engage the client to start with

you can achieve this by using the preferred name at the start of your sentences

position yourself where they can easily see you

and give them a big smile so they make a good emotional connection with you

gentle touching is also a good way of engaging the client but make sure they are the type of person that doesn't mind being touched

now you only want to assist where assistance is needed

it may be enough to just set everything up

if not stop by finding out if they are right-handed or left-handed

and make sure they have the toothbrush in the correct hand

if they're struggling to use the brush

you may just need to sit opposite them and brush your own teeth

they can mimic you as you move around your mouth

once again the kitchen table may be easier than the bathroom if they need you to model for them

you can also try a hand over hand technique where the client has some control

and you're guiding them to make sure they clean effectively

if your client needs full assistance and resists you go back and think about how you set up the kitchen table or bathroom

with closer attention to the setting the client is more likely to feel secure and safe

if there is abrupt resistance to your help

stop

ease off and give the client time to relax

rethink how you can engage them

make them feel safe and able to accept your help

try mimicking toothbrushing using gestures

and encourage them to try again

if resistance persists

think about how you can approach oral care in a different way next time

you now have lots of ideas about how to make the setting an easier place to achieve oral care

not rinsing and just spitting out the toothpaste

maybe be a bit odd for some of your clients to accept

it's a good practice because the chemicals in the toothpaste are great for your mouth

and it's a bit of a waste washing it down the sink

if a client just can't get used to that

try and get them to wipe a little toothpaste on their front teeth after they rinse

you may also want a tissue handy if they spit without rinsing to wipe there lips and chin clean

that toothbrush is now full of bacteria so make sure it is thoroughly rinsed

and stored in an open container to dry

remember we're not just aiming to keep teeth clean

we're helping the person to have fresh breath improve self esteem and keep the person socially acceptable

a well informed enthusiastic care worker can empower their client to achieve this goal