Brushing Past Resistance: How Caregivers Can Help With Oral Health

“Because of diminished sensation in the teeth and the difficulty some people have in expressing pain, dental problems can progress to very advanced stages before anyone realizes. There is a silent epidemic of oral disease among seniors,” says Lyubov Slashcheva, a specialty care dentist in Fergus Falls, Minnesota, and president of the American Society for Geriatric Dentistry. “A lifetime of stability can change almost overnight when older Americans lose the ability to brush, develop dry mouth from medications or need help they aren’t getting.”

As we age, keeping teeth and gums healthy becomes increasingly challenging — and increasingly important. Tooth decay, gum disease and other oral health issues can develop more quickly, particularly for older adults managing chronic illnesses or cognitive decline.

“The condition of teeth and gums has a direct impact on overall health,” says Sandip Sachar, a New York City–based dentist who treats many older patients. “Neglected dental health can quickly escalate into pain, infections or even systemic medical complications — risks that are especially high for older adults and those living with chronic illnesses.”

These are some of the key oral health issues that older adults may face and that caregivers should be on the watch for, according to Sachar.​

• Cavities (caries). Older adults are prone to cavities due to dry mouth, receding gums, challenges with daily oral care and a softer diet with increased refined carbohydrates.
• Denture challenges. Some older adults may reject dentures. Gum and bone changes over time can cause loose dentures, ulceration or pain. Loose dentures should get refitted by a dentist to prevent sores and ulceration.
• Dry mouth (xerostomia). This is common due to medications, reducing saliva’s natural immune defense and gum lubrication mechanisms. Dry mouth complicates denture use, increases the risk for cavities and can make gum irritation more likely.
• Gum disease (periodontitis). Gums become thinner and more fragile, leading to recession and exposed roots. Chronic inflammation in the gums act like “open sores,” allowing bacteria into the bloodstream.
• Oral cancer. Risk rises with age due to cumulative exposure to tobacco and alcohol, age-related immune decline and reduced access to regular dental care, making early detection especially important.​
• Nutrition. Dental problems can make chewing difficult, leading many older adults to choose soft, low-nutrient foods. This often results in poor nutrition and greater frailty, while sugary, soft foods also raise the risk of tooth decay. Caregivers can help by offering easy-to-eat, nutrient-rich options like yogurt, cooked vegetables and smoothies.
• Tooth sensation. Older adults lose tooth sensation to detect pain, temperature and pressure — signals that normally alert someone to cavities, gum disease and infections.​

How caregivers can handle difficult dental care situations

​Beaulieu was not new to the challenges of dental care with her mom; she also cared for her grandmother, who had vascular dementia and passed away in 2015 from cancer. That experience taught her hard lessons about dental care and the gaps in the system, especially in nursing home environments.

“As caregivers, we constantly face decisions about which medical issues to prioritize — and dental care is often not at the top of the list,” says Beaulieu. “At facilities where residents won’t cooperate with daily hygiene, nursing home staff move on to the next patient, leaving oral health to deteriorate. Neglect like this can have serious consequences, yet it happens far too frequently.”

Her grandmother started chewing her medications instead of swallowing them, a habit that damaged her teeth. Even a simple tooth extraction became an ordeal. Her grandmother wouldn’t keep her mouth closed or press down on the gauze long enough for the bleeding to stop. Twice that day, panicked by the bleeding, she called an ambulance.

Even when health challenges mount, and your loved one becomes less interested in brushing and rinsing, small steps can help provide some oral health protection. Caregivers should aim to make and keep dental appointments at least once a year and offer to drive their loved ones to the dentist. Encourage them to continue brushing their teeth twice a day and flossing regularly.

“Caregivers can get creative to make oral care easier and more effective, keeping teeth and gums healthy while respecting the person’s comfort and independence,” says Slashcheva, who recommends these helpful tips:​

• Adaptive tools. Small-headed toothbrushes with modified handles, including toothbrushes for kids; electric versions are also a good option, with larger handles to grip. Even adding foam tape to a toothbrush’s handle can allow for better handling.
• Denture care. Remove dentures daily to allow gums to rest and recover, reducing gum irritation and pressure sores. Clean dentures gently with a soft brush and mild soap cleaner, and avoid toothpaste, which can be abrasive.
• Hydration. Encourage your loved one to drink 6 to 8 cups, or 1.5 to 2 liters, of water each day to support overall oral health and maintain saliva production, which can protect against bacteria and infection.
• Managing dry mouth. While water can help hydrate gum tissues of a dry mouth, it can also remove the small amount of saliva that is being produced to lubricate and soothe oral tissues. Salivary substitutes come in the form of gel, spray or mouth rinse to help lower risk for oral disease.
• Limiting sugar. Avoid sugary snacks and drinks that cause further cavities.​
• Iodine swabs. Apply iodine using a cotton swab, such as those used to clean ears, once or twice a month as a safe, supplemental way to reduce harmful oral bacteria for those who have difficulty brushing.
• Lozenges. Consider lozenges that contain xylitol, candy-like tablets or mints that have a natural sugar substitute. This will help reduce cavity-causing bacteria, particularly for those with dry mouth or difficulty brushing.​
• Mobile dentistry. Comprehensive dental care can be delivered at home, including cleanings, fillings, extractions, X-rays and fluoride treatments, without the pain or stress of being transported. Mobile dentists are not available everywhere, but check local listings and ask for recommendations. To find a mobile dentist in your area, browse this site.
• Silver diamine fluoride (SDF): This minimally invasive treatment hardens early-stage cavities without drilling or numbing, allowing decay to be stabilized quickly. It can be followed with a filling once hardened and helps manage multiple cavities efficiently, reducing stress and complexity for older patients. The staining caused by this product can be a downside, but sustained antimicrobial properties of SDF can also reduce gum inflammation.​
• Specialized dentists: Choose a geriatric dentist with experience working with older adults who have cognitive or physical limitations. The dentist should be able to coach patients through behavioral challenges, adapt techniques for mobility or memory issues and provide ongoing guidance for things like denture use, oral hygiene and individualized care, ensuring both comfort and effective treatment. Find a clinician focused on geriatric and special care dentistry through the Branchly Network’s clinician-finder or contact the Special Care Dentistry Association for access to its nationwide membership of clinicians.
• Time of day. Choose to perform oral hygiene activities during the time of day when the person is most cooperative. It doesn’t always have to be at the end of the day, but consider mid-morning or after lunch, when they are more engaged and alert. Getting effective oral hygiene at any time of day is better than not getting any oral care at all.​