Oral Care for Persons with Dementia - Doctor Q&A

Providing good oral care when caring for a loved one with dementia: Why it matters more than you think 

When you're supporting a loved one with dementia, brushing their teeth may seem like a minor task compared to the many challenges you're managing.

But here's something many caregivers don’t realise: good oral care can significantly impact your loved one's overall health. 

Poor dental hygiene doesn't just lead to bad breath or toothache — though these can certainly affect comfort and quality of life. For people with dementia, poor oral health can become dangerous.

Bacteria from unclean teeth and gums can enter the lungs and lead to aspiration pneumonia, a serious and potentially life-threatening condition. People with dementia often have weaker immune systems, hence they’re at even greater risk. 

But let's be honest —  knowing oral care is important doesn’t make it easy. Helping someone with dementia brush their teeth can feel overwhelming. They might not understand what you're trying to do, resist your attempts, or struggle to swallow safely. Many caregivers feel frustrated, worried about causing distress, or simply not sure where to start. 

The good news? There are practical ways to make oral care safer, simpler, and less stressful for both patient and caregivers. 

If you have questions about providing oral care to persons with dementia, send in your questions now! 

Clin Asst Prof Yang Jingrong will share proven strategies that work in real life — from gentle approaches that reduce resistance to adaptive tools designed to make cleaning easier.

Whether you're a family member, professional caregiver or healthcare worker, these tips can help you provide effective oral care while preserving the comfort, dignity, and establishing a connection with your loved one .

Clinical Assistant Professor Yang Jingrong is a senior consultant with the Periodontics Unit, Department of Restorative Dentistry at NDCS.

She is the current Lead for the Oral Health Promotion and Disease Prevention Committee under the Office of Population Oral Health.

As the previous Head of the Special Care Dentistry Unit from 2019-2025, she has championed the Oral Health Education Programme since 2019, an education programme to train non-dental healthcare professionals on providing oral care to persons requiring special assistance.

She is also the Programme Director of the Building Resources for Improving Dementia Caregiver Education (BRIDGE), which aims to provide oral care education to caregivers of persons living with dementia.

1. Question by Susie

Hi Dr,

Is it ok to just give gargle? If yes is there a gargle that is harmless when swallowed?

Answer by Clin Asst Prof Yang

It is important to perform brushing using a nylon toothbrush in order to effectively remove plaque (soft deposits that accumulate daily).

Plaque contains bacteria that causes oral diseases such as tooth decay and gum disease. Gargles or mouthrinses serve as a supplement to brushing, but not as an entire substitute of toothbrushing.

Mouthrinses containing chlorhexidine and fluoride can serve as supplements to reduce gum inflammation and prevent tooth decay.

In persons living with dementia, we usually recommend using a cotton gauze soaked in the mouthrinse to apply over the teeth surfaces, after toothbrushing, to prevent accidental swallowing.

2. Question by Dino

Dear Dr Yang,

Is there an alternative way to make an elderly with dementia take care of his oral hygiene as he does not brush his teeth? Thank you!

Answer by Clin Asst Prof Yang

Rejection of oral care is common amongst persons living with dementia (PLWD).

This can stem from fear of being touched, or a change in caregiver, or the manifestation of oral diseases, such as gum infections and toothache.

It is also important to engage the PLWD on oral care when he is relaxed and able to focus on the task. 

Choosing the correct place to perform the oral care is also important.

The bathroom may not be the best place for oral care because perceptions may change in those with dementia. The mirror may be confusing for some as they may not recognize themselves. It may be difficult for person with dementia to distinguish if the basin is surrounded by white tiles.

In addition, the toilet may give rise to echo, which makes it hard for the PLWD to hear the instructions. Consider other places such as the kitchen table, where you can prepare a basin or a plastic cup of different colour for the patient to spit into and cloths/tissues to provide the oral care.

You can start by giving him cues to brush his own teeth by describing and showing him the toothbrush. Ask if he is left or right handed and give him the toothbrush to hold. You can sit opposite him and brush your own teeth, for him to mimic you.

If the PLWD does not initiate brushing, gently bring the person’s hand holding onto the toothbrush to his mouth and describe what he needs to do, while encouraging him to do it himself.

Alternatively, you may place your hand over the individual’s hand and start brushing together with him.

This gives the individual some control while you guide him to ensure he cleans effectively.

If that fails, distraction can be considered, for example, you can give the individual an item to hold or play his favourite music.

3. Question by Angela

Dear Dr,

May I know how do we get persons with dementia to brush their teeth and what type of toothpaste is recommended? My mom always swallows the toothpaste after brushing without spitting it out.

Thank you for your advice.

Answer by Clin Asst Prof Yang

Rejection of oral care is common amongst persons living with dementia (PLWD).

This can stem from fear of being touched, or a change in caregiver, or the manifestation of oral diseases, such as gum infections and toothache.

It is also important to engage the PLWD on oral care when she is relaxed and able to focus on the task. 

Choosing the correct place to perform the oral care is also important.

The bathroom may not be the best place for oral care because perceptions may change in those with dementia. The mirror may be confusing for some as they may not recognize themselves. It may be difficult for person with dementia to distinguish if the basin is surrounded by white tiles.

In addition, the toilet may give rise to echo, which makes it hard for the PLWD to hear the instructions. Consider other places such as the kitchen table, where you can prepare a basin or a plastic cup of different colour for the patient to spit into and cloths/tissues to provide the oral care.

You can start by giving her cues to brush his own teeth by describing and showing her the toothbrush. Ask if she is left or right handed and give her the toothbrush to hold. You can sit opposite him and brush your own teeth, for her to mimic you.

If the PLWD does not initiate brushing, gently bring the person’s hand holding onto the toothbrush to her mouth and describe what she needs to do, while encouraging her to do it herself.

Alternatively, you may place your hand over the individual’s hand and start brushing together with her.

This gives your mom some control while you guide her to ensure she cleans effectively.

If that fails, distraction can be considered, for example, you can give the individual an item to hold or play his favourite music.

For toothpaste, we recommend the usage of a pea-sized amount of fluoridated toothpaste that is applied onto a toothbrush.

For persons with swallowing difficulties (dysphagia), the use of a non-sodium lauryl sulfate (SLS) containing fluoridated toothpaste can help to reduce the foaming and the subsequent amounts swallowed.

In persons living with dementia who may have swallow the mouthrinses by accident, we usually recommend using a cotton gauze soaked in the mouthrinse to apply over the teeth surfaces, after toothbrushing, to prevent accidental swallowing.

4. Question by Lisa

Hi Prof Yang,

My 92-year-old mom refuses to use the automatic toothbrush and insists on brushing her own teeth herself. She's obviously not doing it well cos the x-rays show some teeth are dead.

Particularly the front tooth. She refuses to have it taken out, guess for vanity reasons. The dentist mentioned some dark shadow at the tooth.

Is it ok to wait for the dead tooth to drop on its own? Any suggestions on how to take over the teeth brushing?

Thank you for your advice.

Answer by Clin Asst Prof Yang

If the person living with dementia (PLWD) refuses to extract the infected tooth, it is important to watch out for signs of infection if the tooth is left in the mouth.

These will include pain, which may manifest as refusal to brush her teeth, refusal to open mouth, reduced appetite or disturbance in her sleep, or a visible swelling, with or without pus, seen in the mouth.

In cases of active infection, it will be highly recommended to have the causative tooth extracted.

Wirh regards to your mom's rejection of oral care, this is common amongst persons living with dementia.

This can stem from fear of being touched, or a change in caregiver, or the manifestation of oral diseases, such as gum infections and toothache.

It is also important to engage the PLWD on oral care when she is relaxed and able to focus on the task. 

Choosing the correct place to perform the oral care is also important.

The bathroom may not be the best place for oral care because perceptions may change in those with dementia. The mirror may be confusing for some as they may not recognize themselves. It may be difficult for person with dementia to distinguish if the basin is surrounded by white tiles.

In addition, the toilet may give rise to echo, which makes it hard for the PLWD to hear the instructions. Consider other places such as the kitchen table, where you can prepare a basin or a plastic cup of different colour for the patient to spit into and cloths/tissues to provide the oral care.

You can start by giving her cues to brush his own teeth by describing and showing her the toothbrush. Ask if she is left or right handed and give her the toothbrush to hold. You can sit opposite him and brush your own teeth, for her to mimic you.

If the PLWD does not initiate brushing, gently bring the person’s hand holding onto the toothbrush to her mouth and describe what she needs to do, while encouraging her to do it herself.

Alternatively, you may place your hand over the individual’s hand and start brushing together with her.

This gives your mom some control while you guide her to ensure she cleans effectively.

If that fails, distraction can be considered, for example, you can give the individual an item to hold or play his favourite music.

Ref: F26