Maintaining oral health care is crucial for elderly residents. Caregivers, even without dental training, can follow these evidence-based practices to support oral hygiene in aged care settings.

• The resident’s teeth should be brushed twice daily with a soft-bristled toothbrush and fluoride toothpaste. For those with dexterity or cognitive challenges, caregivers can assist by using an electric toothbrush or a modified handle for better grip.
• Remove dental plaque and debris once a day using floss, interdental brushes, or water flossers. Caregivers should select the right tool based on dexterity, using floss holders or wide-handled brushes if needed.
• Clean dentures daily with a denture-specific cleanser and soft brush. Remove them at night to allow the gum to rest. Proper storage in a dry or water-filled container based on dental advice is recommended.
• Encourage frequent sips of water and use saliva substitutes or moisturising gels to relieve discomfort from medication side effects.
• Caregivers should inspect the mouth daily for sores, swelling, or infections and report concerns. Residents should have annual or more frequent dental check-ups as needed.
• Caregivers can incorporate oral hygiene into morning and bedtime routines to maintain consistency with ongoing training and resources.

By adapting techniques to individual needs, caregivers can improve oral health and promote safe, effective hygiene practices in aged care.

Daily Brushing Techniques for Dependent Elderly

• Gather a soft-bristled toothbrush (manual or electric), fluoride toothpaste, a cup of water, a towel, and disposable gloves. Wash hands before starting.
• If possible, seat the resident upright with head support. For bedridden people, slightly elevate their head or turn it to the side to prevent choking.
• Use a toothbrush with a modified grip or an electric option to help those with limited dexterity clean their teeth more effectively.
• Apply a pea-sized amount of fluoride toothpaste. For sensitive teeth, choose a gentle formula. For dry mouth, select one with moisturising properties.
• Hold the brush at a 45-degree angle and use gentle circular motions to clean all tooth surfaces, including the gumline and tongue. Brush for two minutes.
• Encourage participation. If the resident resists, stay calm, explain each step, and try again later.
• Offer water for rinsing, or use a damp cloth to remove excess toothpaste. If spitting is difficult, use suction.
• Wipe the mouth with a soft cloth, apply lip balm if needed, and clean up materials. Dispose of gloves and wash hands.

Denture Care and Maintenance

• Clean dentures daily with a soft-bristled brush and denture-specific cleanser. Avoid regular toothpaste, which can scratch surfaces. Rinse after meals to remove food debris.
• Remove dentures before sleeping to let gums rest and reduce infection risk. Store them in a dry container or a cleaning solution as recommended. Avoid hot water to prevent warping.
• Watch for sore spots, chewing difficulty, or slipping dentures. If these occur, a dental professional should assess the fit.
• Maintain hygiene to prevent denture-related issues like stomatitis (gum inflammation) and cheilitis (cracked mouth corners), often caused by fungal infections. Regular cleaning and check-ups help.
• Even without dentures, caregivers should clean the gums, tongue, and mouth roof with a soft brush or damp cloth. Encourage rinsing with antibacterial mouthwash.

Managing Dry Mouth and Its Effects

Dry mouth (xerostomia) is common in older adults due to reduced saliva, which helps neutralise acids, aid digestion, and prevent oral infections. When saliva levels drop, it can cause discomfort, difficulty eating, and a higher risk of tooth decay, gum disease, and infections.

Common causes include medications for blood pressure, depression, and allergies, as well as conditions like diabetes, Parkinson’s disease, and Sjögren’s syndrome. Radiation therapy to the head and neck can also damage salivary glands. A dry mouth can make swallowing, speaking, and wearing dentures difficult.

To manage dry mouth:

• Encourage frequent sips of water and avoid caffeine, alcohol, and sugary drinks.
• Moisturising gels, sprays, or dry mouth mouthwashes can help relieve symptoms.
• Sugar-free gum or lozenges may promote natural saliva flow.
• A humidifier, especially at night, can reduce dryness.
• Soft, moist foods are easier to swallow. Avoid acidic or spicy foods.
• If dry mouth persists, a doctor or dentist can assess medications, recommend saliva stimulants, or check for underlying conditions.

Saliva helps dentures fit better and reduces fungal infections. Without it, dentures may loosen, cause sores, or increase infection risk. Proper cleaning, denture adhesives, and check-ups help prevent issues.

Proper Flossing and Interdental Cleaning

Interdental cleaning removes plaque and food debris, helping prevent gum disease and tooth decay. Traditional flossing can be difficult for older adults with dexterity or cognitive impairments, but alternative methods make it easier.

Floss holders provide a better grip, making them ideal for those with arthritis or limited hand strength. Floss, interdental brushes, and water flossers help clean between teeth and along the gum line, making oral care more accessible.

• Consider dexterity, cognition, and oral health when selecting a method. Choose floss holders, interdental brushes, or water flossers based on comfort and ease.
• If a resident cannot clean between teeth independently, use a patient approach. Insert floss or a brush gently without forcing it, keeping them comfortable.
• Ergonomic floss holders, soft-bristled interdental brushes, or adjustable water flossers can simplify cleaning for both the resident and the caregiver.
• Interdental cleaning should be done at least once a day. Caregivers can include it in morning or evening routines for consistency.