Caregiving in the Time of Dementias

October 13, 2025

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, Joy understands medical conditions – and the subsequent issues revolving around them – supersede oral care.

Making The Best Decisions With The Knowledge We Have

Independence, Denial, And Picking the Best Care

The decision on where to live once diagnosed with one of the dementias can be frustrating at best. While wanting your loved one to stay as independent as possible, as time progresses, it often becomes necessary to keep a watchful eye to prevent self-harm.

I have seen denial by both parties at given times during this journey. Or, one family member may be resistant to a dementia diagnosis while another instantly becomes a “helicopter child” hovering over every move their loved one makes.

If the choice to stay in place seems to be the best, then the next step is perhaps choosing a caregiver to become a companion for your loved one.

Questions That Do Not Often Come Up – But Should – Are:

Do you have any experience with oral care?
Do you have any experience with denture care?
Do you feel comfortable in taking dentures in and out on a daily basis?
Do you feel comfortable in providing oral hygiene care (brushing teeth, using interdental brushes, rinsing with mouthwash, etc.)?

Many Have A Smiling Faces

It amazes me that most caregivers have no problems working below the waist, but have a severe loathing of any type of oral care. Usually stemming from a personal negative experience with a dentist in their past, this memory is then projected onto their client, making it difficult for them to provide basic oral care.

Having a caregiver come in only during the day means that a loved one will then have to provide oral care at night, which can become extremely difficult for one person to manage if sundowning has become a factor. Another problem that can arise is the caregiver may provide oral care one way and the family member another way, thus potentially creating confusion for the person living with dementia.

Having a caregiver stay overnight during the week but off on the weekends can also cause this same type of issue, which can also include how the loved one is bathed, clothed, and fed.

I have also experienced caregivers suggesting oral health care products that they personally use, but may not be the best option for their clients. One example is an older generation caregiver who felt that using the original Listerine was the best way to help prevent gingivitis because it is what she uses. It may be great for her, but for someone who may be suffering from dry mouth, that “sting” that comes from alcohol-based mouthwashes can create quite the aversion to any type of daily oral care. Any suggestions made by the caregiver should always go through a health care professional, including their dentist or house call dentist. Not every product is meant for everybody. This includes oral care products. That is why there are so many of them out there!

We Always Want To See Our Loved Ones Smiling!

That being said, it becomes hard when they become resistant to oral care, thereby choosing not to brush teeth at the end of the day in order to not create a fight. My recommendation in these cases is to follow an activity with another activity. Brushing teeth can be done right at the dinner table! If they wear a denture, take the denture out, have them rinse or drink some water, and brush their teeth right there and then. No one likes to brush their teeth when they are tired, let alone someone who sundowns.

At-home caregiving is one of the toughest jobs in the world. I have a neighbor whose older sister has recently gone into mid-stage Alzheimer’s and is constantly yelling for George to be in eyesight. After two weeks of trying to be all things for his sister, he finally hired a caregiver who helps him during the day. Fortunately, George is retired, but having another pair of hands to provide care allows George to also tend to things around the house and run errands while his sister is now preoccupied with her new companion.

In the state of IL, where I practice, loved ones can become trained and then paid for caregiving. One of my office dental assistants is a caregiver for her mom, who was diagnosed with dementia two years ago. Wednesdays – Saturdays 9-5. She helped one of our patients’ sons become a caregiver for his mom when he is in between construction gigs. Regardless, becoming a trained caregiver for a loved one and becoming certified as a dementia practitioner are wonderful ways to help provide the best at-home care possible.

Unfortunately, Neither Provides Oral Care Instructions

These are the recommendations I give family members who help take care of a loved one:

Forget the baby talk. Those living with a dementia at any stage still recognize themselves as adults. The brain may be functioning erratically, but it is rare for a person to revert back to childhood.
Try to make brushing teeth more fun!
1. Ask them what type of music they want to listen to
2. Have a variety of toothbrushes or toothpaste for them to choose from
  1. It could be the same toothbrush but in different colorsAlways be supportive, sympathetic and calm – this may be the hardest one!

Try to distinguish at what stage your loved one may be in:
1. Independent
2. Semi-independent
3. Completely dependent
What are the systemic or medical factors involved in helping keep good oral care?
1. Are they on blood thinners?
  1. If you see the gums bleeding, brush anyway! Its their way of saying “thank you”!
2. Do they have problems spitting and/or swallowing?
3. Do they need to be put on an easier diet?
  1. Regular -> Mechanical Soft
  2. Mechanical Soft -> Pureed
4. Are they resisting their electric toothbrush? Change to a manual one!
5. Do they have dentures? Is it getting harder for them to allow taking them in/out?
What are they capable of?
1. Can they remember to brush their own teeth twice daily after meals?
2. Can they find their toothbrush and/or toothpaste?
3. Can they still apply the toothpaste on the toothbrush?
4. Can they still brush their teeth thoroughly?
5. Will they brush their own teeth if monitored?
6. Will they allow you to place your hand over their hand for toothbrushing?
7. Will they allow you to brush their teeth?
How much autonomy do they have when it comes to Activities of Daily Living?
1. Can they feed themselves?
2. Do they need help finding the utensils?
3. Do they need help in defining what they are eating?
What is their new reality?
1. Ask questions about a loved one’s abilities with other loved ones/family members
2. Discuss with caregivers on any changes that may have occurred
  1. Are they now hoarding/squirreling/pocketing food instead of swallowing?

Why Is Oral Health So Important Anyway?

We don’t know what we don’t know. I share this slide all the time, whether I am lecturing dental professionals or other health professionals. We need to remember that oral health is a priority in overall health.

Questions/comments? Never hesitate to contact me!