Additional Resources Mentioned

Other episodes mentioned

Episode 15 here

Large cell granuloma picture here

These resources contain affiliate links so we may receive a small commission for purchases made at no additional cost to you.

• Oral swabs here
• Super soft toothbrush here
• Fresh Breath mouthwash here

 

 

Takeaways

From Episode 15: Dental Hygiene Strategies

• As early in their diagnosis as possible, get a thorough dental examination. If there is any dental work that’s important to be completed, do it while they still understand and can participate.
• Consider transitioning to a dentist specializing in disabilities.
• If possible increase dental visits to every three months.
• Start by reminding your care receiver and supervising their tooth brushing.
• Gradually take over the process - for example, begin by handing them their toothbrush, transition to handing them their toothbrush with toothpaste on it, then transition to beginning to brush their teeth.
• Use a soft-bristled toothbrush and less toothpaste to prevent swallowing.
• Consider using disposable oral swabs with mouthwash for additional cleaning.

 

Read More in This Blog here

 

Full Episode Transcript

Nancy Treaster 

My husband had some recent dental challenges and there are some things that I have learned that I wish I had known earlier and that I had done differently. So today in this episode, Sue and I are giving an update on dental hygiene. This episode is bringing three new tips that’ll complement dental hygiene, where we originally covered in the personal care episode, which was episode 15. So let’s get started.

 

Sue Ryan

All right, throughout our caregiving journeys, we’re continuously learning. With our commitment to bringing you practical tips and candid conversations, we recognize the importance of updating what we have to support you along your journey. And that’s where this episode comes in. We’re bringing you an update to something specific that recently happened where Nancy learned some valuable tips.

 

Nancy, let’s start by telling us what happened.

 

Nancy Treaster

I was brushing my husband’s teeth. I happened to run my finger along his gum and I discovered a growth on his gum that was only slightly smaller than a marble and just as round as one. We’ll put a picture in the show notes. I called the nurse. He has at-home care. So I called the nurse and she came and checked and took a picture, shared it with the doctor.

 

Sue Ryan

Wow.

 

Nancy Treaster 

and it was diagnosed as a giant granuloma.

 

Sue Ryan 

That’s a lot of word, Nancy.

 

Nancy Treaster

Who’s ever heard of a granuloma? But okay, whatever. Now we have and now all our listeners have. It’s really a kind of gum disease. And it is not something that a dentist can fix. It has to be fixed by a periodontist. And by fixed, I mean cut out. So, and if you don’t cut it out, it can cause damage to the bone, bone in their mouth. And so then you have obviously a whole bigger problem.

 

Sue Ryan 

Yes.

 

Nancy Treaster 

So it became clear that we needed to get this giant granuloma cut out of his mouth. Well, periodontists don’t come to your home. They have specialized equipment and they’re not coming to your home. So I had to find a periodontist that we could go to that was willing to deal with the fact that my husband had dementia. It took me three to find one who was open. Now, once I found the right one, they did not hesitate to take him and…

 

Sue Ryan

No they don’t.

 

Nancy Treaster 

And it was great. So in addition to finding a periodontist, we had to get him to the periodontist. This is a man with late stage dementia. He has no idea how to sit in the car. He has no idea barely how to sit in the chair and certainly not how to sit in a dental chair. So I coordinated with the doctor on what kind of sedative we need to get him so that we could get him there, get him through the procedure, which we did. And

 

I hired a caregiver who came with me. She and I both discussed it was like wrestling a bear all day because it was very difficult. This is definitely not something I could have done on my own, which is worth noting. I did get some advice from the nurse that if we, did not feel like I could get it done, get him there that there are transportation services that we could pay for that would specialize in transporting people who have disabilities, including dementia. And she would give me the name of someone I could contact for that. We did not have to do that, but that is something that I also learned. Now, the procedure went fairly well, and it was much more straightforward than I would have expected.

 

So I’m happy to report that the giant granuloma is gone.

 

Sue Ryan 

Well, Nancy, knowing all of this as you’ve gone through it, what would you have done differently had you known that and why would you have done it the way that, sorry, okay. Nancy, knowing all of this, what would you have done differently and why?

 

Nancy Treaster 

So I have three new tips. The first one is I have to say that when I thought of my husband’s dental care, I was very focused, exclusively focused on his teeth and how to brush his teeth and how, I mean, just almost obsessively focused if I’m honest, just the… Mm-hmm.

 

Sue Ryan

Well, and you really were Nancy, of people who I know, many people who have a care receiver, who have resistance to having their teeth brushed, they just stop. And you didn’t, you kept working at it. And even when there was resistance, you’d try it throughout the day. So you were really focused on making sure his teeth got brushed between you and the caregiver, that you got his teeth brushed on a regular basis. So this was not from a place of neglect of not brushing the teeth.

 

Nancy Treaster

No, absolutely I was obsessed. But, hey, here’s what I learned. His dental hygiene is not just his teeth. The gums are critical. Who knew? And we’ll talk about why. Well, actually I’ll talk about why right now. Because think about when you’re brushing your teeth. When you eat food and you brush your teeth and you rinse the toothpaste out of your mouth, you’re spitting. And when you spit, the food that’s caught between your gums and your cheeks is that you spit it out. So we don’t really think about gum care as its own thing. It’s part of just something that naturally happens when you brush your teeth. Well, once your care receiver is not brushing their teeth anymore, they’re not spitting. They’ve forgotten how to spit. I used to laugh, somebody say, is he gonna spit? And I’m like, yeah, I don’t think so. But now’s the time.

 

Now, I’m also admitting, as Sue said, when you’re in the messy middle, you’re just doing the best you can to get a toothbrush in there. And, you know, there I doubt I wouldn’t have risked my finger in his mouth when we were in the messy middle, because I’m not sure I’d have gotten it back.

 

Sue Ryan

Yeah, there’s some times when I couldn’t get my finger in or anything else in Jack’s mouth that he didn’t want. So give yourself a lot of grace. If your loved one is resistant, don’t give up. Keep trying periodically, but if you’re not able to brush their teeth every single day, give yourself grace on that.

 

Nancy Treaster

That is the truth. But once he became more compliant, now what I would do differently is I would run my fingers along his gum line and check his gums. I did that periodically now that he’s more compliant. I would have done it much earlier and much more thoroughly and think of his gums as part of his dental hygiene. And it’s not easy to do, but I definitely…

 

would begin to do that much sooner.

 

Sue Ryan

And the way that I did that, the thing that facilitated, made it easier for me, I do a lot of projects around the house and I have something called a headlamp, which is like wearing a flashlight. And I was able to lift his gums up both for my dad and my husband. was able to lift their gums or their lip up and look around in there and all, cause you can’t do all three. There’s not enough. It doesn’t look all that good, but you really are able to kind of see back in there and you can kind of.

 

Nancy Treaster

Lift their lips.

 

Sue Ryan

pull things out a little bit. And then you also learn some valuable lessons about oral swabs.

 

Nancy Treaster

Right, so tip two, we’re using oral swabs now fairly consistently, but I would use them much earlier in the process. And an oral swab we’ll put in the show notes. And we also talked about these in episode 15, but oral swabs are sponges, if you will, that are on a stick, and you swab the inside of their mouth between their gums and their cheeks and get the food out. Basically take the place of spitting. We started doing that you know, months ago, but I should have done it much, much earlier. As a matter of fact, if someone won’t let you brush their teeth, try just the oral swab as a backup plan. At least it’d be a step in the right direction.

 

Sue Ryan

And that’s what happens a lot of the time with my dad and my husband. I, know, part of me is bad on me for not sharing this. And this is also one of the reasons why we bring you these tips. When you’ve got a tip that you could help someone else with, share it with them. If you remember it while you’re doing something, share it. It would have been helpful for Nancy had I thought to share this tip sooner for her. I just didn’t know it wasn’t a part of the journey we had had a conversation about.

 

What we did with the oral swabs, when those first started becoming something, the first thing I was taught to do is put the oral swabs in my mouth first. So feel what they feel like in their mouth, the texture of them, and then how would you use them? Knowing that the oral swab’s gonna be what’s getting the food out, how does it feel to them? What kind of amount of pressure and the texture of it, and how do you use it? Like you use your toothbrush, how would you use that? The second thing is,

 

Sue Ryan 

it’s very helpful to have mouthwash associated with the oral swab to have something on there that is actually doing some of that protection. If your loved one has, like my husband had been using the same mouthwash since practically he was a kid, so there was no issue with that. My dad, not so much. And what we did with my dad is used a toothpaste that children like and the mouthwash that children like because they’ve got a sweet, good flavor.

 

Sue Ryan

you’ll know your loved one better to know whether they like things that are sweeter or not. But what you want is something that’s going to not taste objectionable to them so that they’re more likely to have you do it. So figure out what the pressure is, figure out how to use it to get things out of your teeth and use something that is interesting to children.

 

Nancy Treaster 

I like it. All right, third tip. You know, Sue, could you just have told me every single thing that would have been helpful, thank you. I don’t know, what were you thinking? All right, tip three, I have one additional tip. So it is important. I had gone to all the care communities once, we’ve talked about this, once the regular dentist going to the dentist goes away. Now remember, my husband’s at home.

 

Sue Ryan 

And Nancy, I apologize for not having told you sooner.

 

Sue Ryan Man, where was I?

 

Sue Ryan 

an important additional tip.

 

Nancy Treaster 

I had gone to all the care communities around me and found which mobile dentists came to the care community. And I called all of those mobile dentists and asked would they come to the home and none of them would. So I just gave up on mobile dentists and come to learn that you can call, once again, now I’ve learned this now, you can call hospice, one of the hospice organizations in your area.

 

and the social worker at Hospice knew mobile dentists that would come to my house and ones that had people who specialized in dementia. So I have new information now and I have a new best friend at a mobile dentist that I can take advantage of. So check Hospice. It’s a good way to check and see if you can find one that’ll come to your home.

 

Sue Ryan 

That’s great. And another tip on that, because people listening to the podcast, some of you are in larger communities, some of you are in smaller communities. If you’re in a smaller community, one of the things to do is widen your circle. Often when you’ve got someone that it’s a mobile optometrist, a mobile dentist, mobile x-rays, things like that, they’re used to traveling distances. They schedule it, but they come like this county, this day, things like that. So expand your search to

 

a larger city that’s kind of like in your area where there’s more likely to be someone and find out when and if they travel to your area. And if they haven’t, see if they could.

 

Sue Ryan

All right, so we’ve talked about, nevermind, that’s not me. Okay, nevermind. Now we’re gonna do the expanded clip. Yeah, yeah, yeah, yeah. We’re now bringing you an expanded clip from podcast episode 15 where we talked about personal hygiene and it’s the tip that spoke.

 

Sue Ryan

We’re now bringing you an expanded clip from podcast episode 15, where we focused on personal care. It’s tip three that focused specifically on dental hygiene.

Transcript from previous podcast episode 15 – personal care

Nancy Treaster 

Teeth so first let’s talk about the dentist. You’re gonna go to the dentist. Probably the normal dentist You would have gone every six months. I Would quickly tell the dentist what’s going on and when I did the dentist said you need to start coming every three months That is the most common thing that they’ll do because their dental care their ability your care receivers ability to maintain their dental didn’t Maintain their dental care the hygiene. Yeah, the dental hygiene

 

in any way that’s close to normal will decline fairly quickly. So you’ll start going to the dentist every three months. That will get more difficult. I did go to a webinar on dental care for people with dementia, and it was by a dentist who specializes in dental care for people with disabilities. And she said, in many cities, not all, but in many cities, there are dentists who specialize in people with disabilities and people with dementia fall into that category. So you may wanna try to transition to a dentist that focuses on people with disabilities, just so you can extend the dentist part of this process as long as possible. And we had, in the care community, they have dentists who will come in, they’re traveling dentists who will come in.

 

Sue

The other thing we did very, very early on with the diagnosis is get x -rays, find out if there are any cavities or anything else that’s dental work that needs to get done. Because Jack couldn’t figure out how to sit in the dentist’s chair. We literally took him to the dentist one day and we tried for the longest time. And he didn’t get upset about it, but he just didn’t know how, it’s an unusual chair. Just like with getting your hair cut, there are different kinds of chairs. They forget how to get into those. So make sure any dental work that needs to get done, you get done as soon in the diagnosis as possible. 

 

Nancy

The real story here is the actual dentist is going away. Yes, that is true. There will be at some point dental care is only done at home. And so everything I talk about from here on in is really how you’re going to the part of the dental care that you’re going to take ownership of. So don’t be shocked when they can’t get in the chair or the, last visit to the dentist, half his mouth was cleaned but he didn’t really understand what this woman was doing with her fingers in his mouth and he was done with it. And she let him get up and walk around a few times and he was not having it. So he left his last dental appointment with half of a mouth cleaned and that was it. So then you’re at home dental care, which is fine. We’re just gonna talk about the things you need to be prepared for at home. 

 

So let’s go to the home dental care. First thing, similar to everything we’ve talked about so far, you’re gonna start by reminding them to brush their teeth. Check to make sure they put toothpaste on their toothbrush. It’s like using the soap. It’s one of the first things to go. So when you remind them to brush their teeth, go back there with them and just watch and make sure that there’s toothpaste on the toothbrush when they brush their teeth. And as you said, brush your teeth at the same time. Model the way. So I would brush my teeth the exact same time and Stan sort of and brush them and make sure he was seeing me brush my teeth, modeling the way. So that’s a first transition. 

 

Second transition is you’ll get the toothbrush out and put the toothpaste on it yourself and hand it to them. Next transition, put the toothbrush out, put the toothpaste on it, and you will start the brushing process and then they’ll actually, muscle memory, right? They’ll take it over and finish brushing their teeth, all good. But eventually you’re going to be brushing their teeth. And when that time comes, take the tooth, get a soft, a very soft bristle toothbrush.

 

We’ll talk about electric toothbrushes in just a second. But you want a soft bristle toothbrush and you want much less toothpaste than you would normally put on because the spitting is gone. They don’t know how to spit anymore. Don’t understand it. So we’re going to put a small amount of toothpaste on the toothbrush and we’re going to rub it in to the the bristles because we don’t need it just to plop off in their mouth somewhere. So we’re going to rub it into the bristles and brush their teeth as best you can. You can also take a break from this, but this as in shaving goes through sort of a non -compliant phase where we don’t know why you’ve got this thing in my mouth and we don’t want to have anything to do with it and we’re gonna chew it and bite it and try to pull your hand out and all sorts of things. There was a point for probably a year, year and a half where if we just got the toothbrush in my husband’s mouth at one time during the day, we thought that was a win. Now we’re back to the other side, back to more compliant. We brush his teeth three times a day now.

 

You don’t have to give it up completely, but you do need to realize you’re going to go through a very difficult phase. middle. The messy middle. Now, one thing I didn’t learn about till later, we use these now, but I could have used them in the messy middle and Sue did use these, is oral swabs, disposable oral swabs. And you get mouthwash. We use the Advanced Dental Care Mouthwash for Gum Disease because I figure that’s just one more set of chemicals that can help in his mouth and brush his teeth and we put the oral swab in there and we clean inside his mouth behind. He kinda likes it. So, know, mouthwash, doesn’t taste bad. And get underneath his gums and everything. And there’s food that comes out when you do that. So an oral swab is an extra level of dental care that you can take advantage of. And I know you used those.

 

Sue

I did, they worked really great and Jack liked them and I also used them on his tongue.

 

Nancy

yes, that’s smart, I forgot you told me that. And you can also, if they’re open, you can get it in the roof of their mouth and yes, you can really do some with them. All right, so whatever method you use, remember back to what we say, just about everything. Put your best face on, smile, think about your body language, say thank you, give them instructions, tell them what you’re doing. Can we brush your teeth? Is it okay to brush your teeth right now?

 

Open your mouth, please. Let’s brush your teeth. 

 

Sue

And some people will still let you, the people who are our next door neighbors, they were able to use dental floss the whole time with their loved one.

 

Nancy Treaster 

And I think actually, think Mike’s mom, Kathy told me, think she actually in the process, she would sit there as entertainment and floss her own teeth. So let’s don’t give up on dental floss either. give up on dental floss either. 

 

Sue

But be prepared and just be patient and be flexible. But also don’t quit because as Nancy was saying, while they get very non -compliant for some of them, I mean, we don’t know everybody, but they’ll get non -compliant. And especially like if you try to use the electric toothbrush things like that It’s a season that you do get through and then they are more compliant and you can pick it back up again So I agree. 

 

All right, so let’s talk about some tips if you are brushing teeth, you know, try to create a calm environment Use simple instructions Put on your best body language and your nicest words and tell them what give them instructions Tell them what you’re doing model the way open your mouth and look like a fool if you need to.

 

Nancy Treaster 

Let’s summarize. In this episode, we brought you three new tips on dental hygiene to complement the dental hygiene discussion we had in episode 15. If you have tips on dental hygiene that you’d like to share, please go to our Facebook page or an Instagram page. Those links are in the show notes. If you like this podcast, please follow us or subscribe to it. We’d love to, if you like this podcast, please follow us or subscribe to it and feel free to make comments as well.

 

Sue Ryan 

We’re all on this journey together.

 

Nancy Treaster

Yes, we are.