Oral care is extremely important for everyone, and older adults are no exception. Yet sometimes, after we help a behaviorally challenging resident get bathed and dressed, proper oral care can become an afterthought. It can also be one of the most difficult personal care activities to have a resident perform. Here are some tips to help you work with a resident with BPSD who needs assistance with oral care:

• If a resident is reluctant to brush her teeth or refuses when you initially ask, try to distract her with another brief enjoyable activity or conversation and then try again.
• Have supplies ready before you begin: toothbrush, toothpaste, cup, and mouthwash if using.
• If a resident will not open her mouth, ask her to say “eeeee” as this will naturally get her to open her mouth enough to sneak in a toothbrush. Or you can try singing together and sneak in the toothbrush then.
• Since teeth brushing can feel invasive and even threatening when done by a caregiver, encourage independence in this task. By role modeling in front of a mirror, while you stand beside the resident, you can cue the resident to engage in the task without having to touch him/her.
• If a resident is physically unable to brush his/her teeth independently, use the hand-under-hand technique so the resident is still participating in the activity with you and can maintain a sense of control. If the resident can’t hold the brush or resists, shake hands with him, turn your hand palm up so they only see their hand, use your skill fingers (thumb and first two fingers to hold the toothbrush and you can guide it in.  Those with significant dementia think they are doing it rather than you.  If a resident is able to hold the toothbrush and just needs some guidance, you can simply place your hand over their hand and help guide them.
• Some people don’t do well in the bathroom. Considering having residents brush their teeth while sitting on their bed.
• Lastly, keep in mind that the toothpaste is the least important factor. The friction from a damp toothbrush is the most important, and every brush helps!

This 3-minute video illustrates these tricks of the trade in action: http://www.functionfocusedcare.org/oral-care