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  • Helping a person with dementia to clean their teeth is complex with lots of steps involved

  • 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

Helping a person with dementia to clean their teeth is complex with lots of steps involved

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B1 client bathroom basin oral toothpaste brush

Dementia & oral care

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    林宜悉 posted on 2020/03/08
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