Helping Family Caregivers help provide Oral Care

October 1, 2024September 8, 2024

Submitted by Dr. Joy Poskozim DDS FSCD CDP

Founder of Joyful Dental Care – House Calls, Advocate, & Presenter

Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.

Having provided oral care for the geriatric community for over fifteen years, I understand medical conditions – and the subsequent issues revolving around them – supersede oral care.

Small Changes Can Become Big Healthcare Problems

Once someone becomes relatively stable, other, lesser conditions start to creep up.

Loved ones begin to notice bad breath, for example, or that one may no longer be able to put in and/or take out their dentures.

Questions such as, “how long has it been since Mom’s dentures were cleaned” become a priority and the answer is usually, “I don’t know, and I don’t know how to handle this.”

Maintaining one’s freedom is crucial for one’s mental well-being.

Included in one’s sense of independence is normal daily activities (ADL’s).

Brushing teeth – oral hygiene – twice daily is paramount in helping to keep one’s oral health safe, sound and secure.

So how can we help them help themselves?

Asking questions!

Caregivers most often not only know what medications are being taken, but also dosage, how long they have been taking them, and when they are supposed to be taken.

BUT do caregivers know if someone has a denture?

If they do, then do they know what type of denture it is?

(WAIT – there is more than one type of denture; not just upper and lower??!?!)

My first ever at-home patient was a female non-verbal stroke victim, and also the matriarch of the family.

When I first met her, Nona’s hair was perfectly coiffed, nails done, full makeup, and was dressed to the nines – propped up in bed.

Chief complaint: “Mom has bad breath.

We have been brushing her teeth twice daily for two years since the stroke.

She eats through a feeding tube.

Why does her breath smell?”

I didn’t know what to charge, I didn’t know what to bring, but I did know that if I could be a resource – an information provider of any kind – they would be ahead of the game and I could start Nona on a healthier path.

The first thing dentists do

The first thing dentists do after introducing themselves is explain that they are going to lift up their upper lip to see if there are any abscesses/swelling, and restorations in their mouth.

Nona had a complete upper denture meaning she had no upper teeth.

When I dropped her lower lip she had a corresponding lower complete denture. No lower teeth either.

Tears ensued from the daughter and granddaughter who had called me earlier that day.

Questions like, “Mom! Why didn’t you ever tell us?” came through their sadness.

Gotta admit; best denture I had ever seen. The teeth were so realistic Nona must have had gone to her dentist with a picture of a younger self and he had made the teeth exactly like her smile.

As a widow, her husband must have taken her secret to his grave.

Unfortunately, she had severe candida (thrush) that took not one but two heavy rounds of medication to get rid of – and she was not allowed to wear her dentures until they had been professionally cleaned by my office and the thrush had been cleared.

This took almost a month, but now the loved ones know how to take her dentures in and out every night, how to brush her gums, and what best oral care products to use for her conditions.

Her bad breath had not come from decaying food stuffs but her intense oral infection.

So, what type of questions should we ask?

In no particular order:

What type of toothpaste/toothbrush do you like to use?
1. They may no longer like their electric toothbrush, but then hasn’t been brushing because of this.
2. Providing them with a soft manual toothbrush may get them going again.
May I take you to your next dental appointment and we can do lunch/dinner after?
1. Ask if it is okay to sit in the operatory (dental room) with them, if nothing else, when they are getting their dental exam from the dentist
2. If no dental appt has been made, ask to make the appt for them, while also making an appt for yourself.
3. If they don’t have or remember their dentist anymore, ask if it is okay to bring them along to your dental next dental appt.
  1. If they don’t themselves request to make a dental appt with your dentist at this time, make it for them.

Mom, I noticed you haven’t been wearing your denture since you came back from the hospital. Is there a reason why? Help me help you with this.
1. They may not remember how to do so/which one is the upper denture and/or lower denture.
Dad, is there a reason why you don’t put your teeth in the morning? May I see what they look like?
1. They may no longer physically be able to put their dentures in
  1. Diabetic neuropathy
  2. Arthritis
Impairments due to stroke/falling

They may no longer want to put their dentures in
i) Apathy: they simply don’t care anymore
They don’t remember how to put them in anymore

Caregivers need to be educated on Dental history and prior history

Unless a caregiver has had their own history of dental issues or has had past clients with dentures, they may not know what to look for when it comes to oral issues.

If bringing them to a dentist is no longer possible, hiring a dentist to come to the home is your next best bet in making sure there are no issues that can become an even bigger future problem.

We don’t know what we don’t know

Knowing all about your loved ones – from head to toe – will prevent emergencies and even pain.

Questions/comments/concerns? Never hesitate to ask me !