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Helping a person with dementia to clean their teeth is complex with lots of steps involved
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To get the best cooperation possible you need to think about every step with the unique needs if your client in mind
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If you make them feel safe and secure then you're sure to get a better result
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So, let's break down the steps
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The six steps to oral care are
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choosing when to brush
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choosing where to brush
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setting up the room
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brushing
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rinsing
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and
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cleaning up
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As the assistant to the person
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you need to decide how many of these tasks you need to assist with
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For instance
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it's quite possible that once you set up then the person might be quite independent
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or
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you may need to direct the person through some of the steps or perform some of the tasks with them
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try to establish a daily routine to reinforce patterns of behavior
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patterns make it happen
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but
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oral care does not have to be after a meal or before going to bed
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the best time it when the person is relaxed
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and agreeable
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as dementia progresses the person's understanding changes
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places can become unfamiliar and can be confronting
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the person may not recognise you
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and spatial perception changes
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so a white basin over a white floor will be hard for them to distinguish
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so the place to brush needs to be familiar and comfortable
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and that may not be always be the bathroom
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sometimes the kitchen table can be a better choice if the bathroom is problematic
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ask some simple questions to make this decision
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can the person stand or sit comfortably in the bathroom at the basin
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can they easily reach to pick things up
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and can they spit into the basin
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do they seem lost, unsure or worried when they're in the bathroom
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if you're assisting can you fit in the room at the same time
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and when in the room can the person see your face
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if the bathroom satisfies all of these needs then make the bathroom setting one that makes them feel safe and comfortable
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because bathrooms are generally cooler than the other areas
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it's often important to warm them up
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and to have good lighting
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you may even suggest installing a heated light source or sensor light that goes on when they enter the bathroom
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points of reference and familiar items can help orientate the person so consider items of interest such as indoor plants and colorful towels
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Stale or offensive odours can make the bathroom unpleasant to be in so think about air freshners
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bathrooms have many hard surfaces that can cause sounds to echo making it difficult to hear and concentrate
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consider reducing noise level such as turning off the noisy extractor fan
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or use of background music
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you may need to contrast the color the hand basin with the surrounding bench and floor
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this can be done with a non-slip mat on the floor
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if the bathroom floor is cold then the non- slip mat with also make it cozier
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the occupational therapist may have input to design grab rails
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a non-slip surface for the whole bathroom or a call bell
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make sure the mirror is at a good height but keep in mind that for some people mirrors can be confusing
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they may not recognise themselves in the mirror which can be confronting
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you may choose the kitchen table for brushing where there's no mirror
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make sure you have all that you need for the job
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choose a toothbrush that's colorful and a different colour to the hand basin or table
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you may need a handle adaptor to make it easy for the client to hold the brush
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and you may have a second brush to help protract the cheek
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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
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it's preferable for your clients to spit and not rinse out the toothpaste but some will insist on rinsing
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use a plastic cup of water preferably a coloured one so they can easily see it
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if the client likes to wear there glasses make sure they are on as well as hearing aids if necessary
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if they're seated you might find a chair with arm rests gives them a bit more security and stability
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you'll need toothpaste of course and then your're ready for action
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a person with dementia is often sensitive to non verbal forms of communication
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such as facial expressions and posture
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they usually have increased sensitivity to the emotions of others
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and progressively increase their use and nonverbal communication
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so how does that help us with brushing teeth
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well the key worker and needs to engage the client to start with
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you can achieve this by using the preferred name at the start of your sentences
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position yourself where they can easily see you
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and give them a big smile so they make a good emotional connection with you
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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
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now you only want to assist where assistance is needed
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it may be enough to just set everything up
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if not stop by finding out if they are right-handed or left-handed
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and make sure they have the toothbrush in the correct hand
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if they're struggling to use the brush
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you may just need to sit opposite them and brush your own teeth
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they can mimic you as you move around your mouth
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once again the kitchen table may be easier than the bathroom if they need you to model for them
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you can also try a hand over hand technique where the client has some control
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and you're guiding them to make sure they clean effectively
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if your client needs full assistance and resists you go back and think about how you set up the kitchen table or bathroom
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with closer attention to the setting the client is more likely to feel secure and safe
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if there is abrupt resistance to your help
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stop
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ease off and give the client time to relax
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rethink how you can engage them
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make them feel safe and able to accept your help
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try mimicking toothbrushing using gestures
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and encourage them to try again
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if resistance persists
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think about how you can approach oral care in a different way next time
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you now have lots of ideas about how to make the setting an easier place to achieve oral care
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not rinsing and just spitting out the toothpaste
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maybe be a bit odd for some of your clients to accept
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it's a good practice because the chemicals in the toothpaste are great for your mouth
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and it's a bit of a waste washing it down the sink
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if a client just can't get used to that
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try and get them to wipe a little toothpaste on their front teeth after they rinse
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you may also want a tissue handy if they spit without rinsing to wipe there lips and chin clean
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that toothbrush is now full of bacteria so make sure it is thoroughly rinsed
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and stored in an open container to dry
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remember we're not just aiming to keep teeth clean
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we're helping the person to have fresh breath improve self esteem and keep the person socially acceptable
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a well informed enthusiastic care worker can empower their client to achieve this goal