This one is written for the carer rather than the patient, because in practice the carer is the person who notices the problem, books the appointment and does the daily brushing.
Two things are worth knowing at the outset. Oral health declines faster with dementia than without it, and a great deal of that decline is preventable with fairly small adjustments.
Why the risk rises
The Australian Dental Association notes that “people with dementia can be at greater risk of poor oral health”, including people with Alzheimer’s disease, vascular dementia, Parkinson’s disease and Huntington’s disease.
The mechanism matters, because it points at what to do. Medications used in dementia can reduce the amount of saliva the mouth produces. Saliva protects teeth, so a dry mouth raises decay risk considerably. Modified soft diets add to it: the ADA notes these “can increase the risk of tooth decay developing especially if the person has poor oral hygiene and a dry mouth”.
So the common picture is not neglect. It is a person on necessary medication, eating a necessarily softer diet, whose mouth has quietly become a higher-risk environment than it used to be.
What the Australian evidence shows
The Australian Institute of Health and Welfare studied community-dwelling older adults in Adelaide with and without dementia. It found that “older adults with dementia had higher levels of dental disease and their oral health deteriorated faster over a one-year follow-up period” compared with those without.
The same report notes those individuals faced barriers to adequate dental care. That is the part worth acting on: the decline is measurable over a single year, so waiting for an obvious problem means waiting too long.
Two brushing techniques worth knowing
When someone resists having their teeth brushed, the instinct is to do it for them, which often makes the resistance worse. The ADA describes two approaches carers can use instead.
Hand over hand. You place your hand over theirs and guide the brushing, so the movement still belongs to them.
Bridging. The person holds a toothbrush themselves while you brush with a second one. Holding a brush occupies the hands and reinforces what is happening, which can reduce distress.
Dentures need cleaning daily as well, and it is worth checking that diet changes and new medications have not quietly altered the picture since the last visit.
Booking the appointment: timing is not a detail
This is the advice most often missed. The ADA suggests you “book an appointment that suits the person with dementias needs and routine. A morning may be best if the person experiences sundowning”.
Carers know sundowning well. Almost nobody connects it to appointment booking. If confusion and agitation reliably worsen in the late afternoon, a 4pm dental appointment is close to the worst possible time, and a 9am one may go entirely differently.
Two more things from the same guidance: tell the clinic about the diagnosis before you arrive, not at the chair, and keep seeing a dentist the person already knows where you can. Familiarity does a lot of work here.
When someone cannot manage treatment awake
Sometimes adjustments are not enough. Advanced dementia, some disabilities and some medical conditions make sustained treatment genuinely impossible, and that is not a failure of preparation.
Sedation is the usual path, and it is worth understanding how it is regulated. Only dentists whose registration is endorsed for conscious sedation may use the technique in Australia, so the first question to ask any practice is who would be administering it and under what endorsement. We cover what goes into a sedation quote separately, including the questions that make quotes comparable.
Treatment planning also changes with progression. Where someone’s condition is expected to advance, there is an argument for doing necessary work earlier, while they can still tolerate it reasonably, rather than deferring and facing the same work under harder circumstances later. That is a conversation to have with a dentist who knows the full medical history.
Frequently asked questions
Why does dementia affect teeth so much?
Several things compound. Medications commonly used in dementia can reduce saliva, and saliva protects teeth, so decay risk rises. Softer modified diets add further risk, particularly alongside a dry mouth and reduced oral hygiene. The AIHW found oral health in older adults with dementia deteriorated faster over one year than in those without dementia.
What if the person refuses to let me brush their teeth?
Try the hand over hand technique, where you guide their hand rather than replacing it, or bridging, where they hold a second toothbrush while you brush. Both keep the person participating rather than being done to, which often reduces resistance. Mention persistent refusal to the dentist, because it changes what prevention is realistic.
When is the best time of day for a dental appointment?
Often the morning. The ADA specifically suggests booking around the person’s routine and notes a morning may be best if they experience sundowning. If you know their agitation worsens later in the day, book against that pattern rather than around your own convenience.
Should I tell the dental practice about the diagnosis?
Yes, and before the appointment rather than on arrival. It lets the practice allow extra time, plan the approach and avoid surprises in the chair. It also lets them discuss sedation options in advance if ordinary treatment is unlikely to be manageable.
Support in Warrawong
King Street Dental provides sedation dentistry in-house at its Warrawong practice, alongside general dentistry and denture care. If you care for someone whose dental visits have become difficult, say so when you book so the appointment can be planned properly.
This article is general information for carers, not clinical advice about an individual. Discuss the person’s medical history, medications and treatment options with their dentist and doctor.