Dementia effects everyone. Family members, caregivers, and healthcare providers all have to adapt to serve those with dementia. It doesn’t help that there are over 55 million people diagnosed with dementia in the world.
It’s okay to admit managing a patient with dementia is hard. The good news is that you are doing a great service. Even with all the medical advancements and support structures, these patients need all the help they can get.
I have treated seniors with memory loss and can tell you firsthand that it is not just about brushing and flossing. Behaviors will shift, communication will get stuck, and physical limitations will put a strain on your mobile setup. If you want the dental experience to enrich these patient’s lives, you’ll need to properly prepare.
I wanted to offer an informative and quick guide to help you do just that! Being new to the dental hygienist field doesn’t mean you cannot offer exceptional dental care for dementia patients.
Challenges When Seeing Patients with Dementia
Unfortunately, cognitive decline impacts far more than short or long-term memory. It is an underlying cause for lower motor function, speech impediments, balanced emotional regulation, and physical coordination.
From the moment you open your practice to senior patients, you’ll have to adjust to what may or may not “crop up” during a visit. I’ll let you in on a secret – it does make for some exciting days. Some issues could be:
- Poor Oral Hygiene: Daily oral care is one of the first things to get neglected during dementia. Confusion, fear, and forgetfulness all lead to “less than optimal” brushing or flossing.
- Increased Risk of Tooth Decay and Gum Disease: You’ve probably already guessed what happens next. Once dental hygiene drops, plague moves in and settles down for the long haul. Dietary changes and environmental stress lead to tooth decay (eventually periodontal issues). Toss in medication, and you don’t have a great recipe for quality dental health.
- Dry Mouth & Reduced Saliva Production: Many medications for treating Alzheimer’s and related conditions cause xerostomia (dry mouth). This creates an environment ripe for bacterial overgrowth, making oral health Alzheimer’s patients uniquely vulnerable.
- Difficulty Chewing & Swallowing: Dysphagia is a serious concern. Dementia often leads to poor mastication. That will impact nutrition and increase the chance of rocking. You should speak with the care team before providing dental care, in case dysphagia is already present.
- Challenges with Dentures: Patients may remove, misplace, or even reject their dentures due to discomfort or confusion. Ill-fitting prosthetics can cause sores, refusal to eat, and increased frustration. Even if they regularly use them, they may not “wear” them as recommended. They will need adjusting or “relearning.”
- Inability to Express Pain: It’s strange when a senior with dementia doesn’t know how to express pain. They may feel discomfort in the mouth, but cannot verbalize it. You’ll have to pay close attention to behavior changes, like withdrawal, aggression, or refusal to eat.
- Aggressiveness or Refusal: Sometimes, treating seniors with memory loss means encountering combative or fearful reactions. These behaviors are not personal. They are symptoms of the disease. Understanding how to work with them instead of against them is key to successful care.
I cannot repeat the idea enough that you’ll need to have a family member, legal guardian, or personal support agent there during the visit. The level of dementia will impact what societal support your patient may have, but a second pair of ears is always a good idea.
Communication Strategies & Gaining Consent
Communication is my most valuable tool when providing dental care for dementia patients, and it often starts long before picking up an instrument. Anyone with previous experience with dementia understands the great deal of patience and clarity that needs to happen for all parties to feel welcome and safe. Here are some of the tips that seem to work best.
Verbal Techniques
- Keep it simple. Use short, clear sentences that avoid medical jargon and rely on conversational terms and understanding.
- Give one instruction at a time. Too much information at once can quickly overwhelm your patient. They may shut down and miss important details.
- Use a calm, friendly tone. Your demeanor can help defuse the situation even if the patient is agitated. In most cases, they want to feel like they are safe and respected.
- Repeat as needed. Repetition helps with comprehension and predictability. Say the same instruction the same way. Marketers and comedians call this the “Rule of 3.” Repeat the most critical information three times in normal conversation so it sinks in a bit better.
Non-Verbal Strategies
- Maintain eye contact and smile gently like you would when working with a family member or friend you enjoy being around.
- Move slowly. Quick movements can appear threatening, especially if they feel “out of place” from being in your clinic and not in their usual surroundings.
- Position yourself at eye level. Never hover or stand over them. You want to appear as unthreatening as possible.
- I’ve relied on gestures many times to reinforce ideas like brushing, flossing, or taking medication. Sometimes body language does more than your words ever could. Just be sure to use the two-finger point and not one finger. That can be insulting, especially to patients of an older generation.
Gaining Consent
Informed consent remains a legal requirement, even if cognitive ability is impaired. For oral health Alzheimer’s patients, this may look different than a standard signature. In most states and regions, you have to have a patient’s full consent before proceeding with any procedure. Always ask for POA for any family member or caregiver upon arrival. I have saved many tense or challenging situations by having the POA readily available.
Here’s how to approach it:
- Assess capacity. Many patients in the early stages can still consent. Explain the treatment clearly and give them time to respond.
- If capacity is diminished, consult their Power of Attorney (POA) or legal guardian.
- Always document who gave consent, when, and under what conditions.
- Reinforce consent verbally during the appointment, asking for nods or affirmations before each step.
- Respect is the foundation of trust—even when memory fades. Show them you genuinely care for their well-being, and you’ll likely see a positive result.
Adjustments to Treatment Approach
Dementia care requires flexibility. You have to “move on your feet” a bit to overcome any concerns or sudden changes in your interactions with your older patients. For the most part, you’ll learn pretty quickly how to work with different patients over time, but in the beginning, try to follow these tips:
- Shorter, More Frequent Appointments: Many patients with dementia have limited attention spans or become fatigued quickly. Consider shorter, more focused sessions rather than doing everything in one visit.
- Reduce Stimulation: Avoid bright lights, loud music, or too much background activity. A calm, quiet environment helps reduce anxiety and confusion. You might even consider using noise-canceling headphones or offering a weighted lap blanket for comfort.
- Be Repetitive and Predictable: Create a routine that involves the same hygienist, the same introduction, and the same steps. Predictability builds a sense of safety.
- Use Familiar Items: If they have a preferred toothbrush or blanket, incorporate it. This can trigger comforting associations and ease transitions into care.
You should also consider modifying your more common tools. For example, electric brushes are fine, but be sure they have softer heads and work using minimal vibration. If you can avoid using ultrasonic scalers in the later stages, that will help with any gag reflexes or jaw coordination issues.
I try to use xylitol-based rinses whenever possible. These will help stimulate saliva gently and safely. Just try to keep everything efficient so the visit is short, but not rushed, so you still provide the best care possible.
Collaborating with Caregivers
Caregivers are your biggest allies in providing effective dental care for dementia patients. You need to develop a solid working rapport with this support structure. I like to start by asking for insights on patient preferences, behavioral triggers, medication updates, or what time of day is best for the patient to be alert.
While you learn more about the patient’s rhythm, work on providing education to caregivers. These hard-working individuals can feel just as overwhelmed as you or the patient. Offer visual step-by-step handouts or video links and product suggestions that will work with their loved one.
For example, you can direct them to my Free Guide to Senior Oral Care, as a fantastic starting point.
No matter what, stay connected with these individuals. Send brief updates after each visit. Let caregivers know what you observed, what was done, and when follow-up is needed. This builds trust and reinforces your role as a vital part of the care team. I’ve seen some practices use an online shared oral care journal if you prefer something “cloud-based” that is easier to access.
Final Thoughts
It’s incredibly personal when you treat a patient who’s experiencing dementia. An individualized level of care is what will guide you toward overcoming challenges and delivering fantastic care. I know it seems hard, but compassion combined with proper tools will get you there.
I recommend my continuing education course specifically to equip hygienists with the real-world skills needed to confidently provide oral health Alzheimer’s care. Join my CE course today and get the insights you need in proper oral care.
There are also one-on-one opportunities for coaching with me directly. That will help you build your practice, develop more skills, and reach senior patients on a better level so you can improve the quality of care at each step.
When it comes to treating seniors with memory loss, a confident, informed hygienist can be the calm in the storm—and the hero behind every healthy smile. Get the resources you need from my platform and provide the help seniors require for a healthier, happier dental environment.
