Oral hygiene is a fundamental aspect of care for individuals with dementia. Neglecting this routine can lead to oral pain, which is often difficult for the patient to communicate, resulting in behavioral changes like refusal to eat or increased agitation. Poor oral health creates a breeding ground for bacteria, raising the risk of systemic infections such as aspiration pneumonia. It can also contribute to malnutrition and dehydration when chewing becomes painful or difficult. The progressive nature of dementia makes this task a challenge, requiring specialized techniques to ensure the individual’s comfort and safety.
Preparing the Environment and Patient
The process of denture removal should begin by minimizing anxiety and creating a calm setting. Select a time when the person is generally most relaxed and cooperative, often shortly after a meal or during their established evening routine. A calm environment with reduced sensory stimuli is helpful; turn off the television and avoid loud background noise.
Ensure the patient is comfortably seated in a well-lit area, allowing you to clearly see inside their mouth. Gather all necessary supplies—disposable gloves, a soft cloth or gauze, and a denture container filled with water—before you begin to prevent interruptions.
Approach the individual from the front, maintaining eye contact and speaking in a calm, clear, and low-pitched voice. Always explain the action using short, simple sentences, such as, “It is time to take out your teeth now.” Non-verbal cues, like a gentle touch on the shoulder or arm, convey a sense of safety. Donning disposable gloves is a necessary hygiene step that protects both the caregiver and the patient from potential infection.
Step-by-Step Guide to Denture Removal
Before attempting removal, encourage the patient to rinse their mouth with lukewarm water, which helps loosen the suction seal, especially if adhesive was used.
Removing the Lower Denture
The lower denture is typically easier to remove as it relies less on strong suction. Gently place your thumb and index finger on the middle part of the denture. Apply a slight back-and-forth rocking motion while simultaneously pulling gently upward and out.
Removing the Upper Denture
The upper denture is held in place by a vacuum seal against the palate, requiring you to break that seal. Position your index fingers at the back sides of the denture, near the cheeks. Pushing upwards and slightly outwards toward the nose will help dislodge the suction. Alternatively, place your thumb against the back of the front teeth and press upward and outward.
The removal should be slow, steady, and gentle, prioritizing comfort over speed. Continue to offer verbal reassurance, such as “You are doing great.” Avoid pulling directly on the front, as the vacuum seal is strongest there, and excessive force could cause injury to the gums. If the denture feels stuck, pause and have the patient gargle with more warm water to dissolve any lingering adhesive.
Managing Resistance and Agitation
If the patient becomes resistant, agitated, or clamps their jaw down, acknowledge that this behavior often signals fear, discomfort, or an unmet need. Immediately pause the procedure and step back slightly, allowing the individual a moment to calm down. Shouting or sudden movements can increase their perception of threat and worsen agitation.
Redirection is an effective de-escalation technique. Try shifting the patient’s focus by talking about a favorite object, a familiar person, or playing calming music. If the jaw remains clenched, gently massage the cheek and jaw area with a warm hand to promote muscle relaxation. A small amount of warm water or a gentle swipe with a moist, soft washcloth inside the mouth can also prompt the jaw to relax.
If resistance persists after two or three gentle attempts, or if the patient exhibits signs of distress like pulling away, abandon the attempt entirely and try again later. Forcing the issue risks injury and damages the trust necessary for future care. If persistent difficulty is observed, or if the patient shows non-verbal signs of oral pain (such as frequently touching their face), a dental professional should be consulted.
Essential Post-Removal Care
Once the dentures are successfully removed, immediate care for both the appliance and the patient’s mouth is necessary to maintain oral health.
Denture Cleaning and Storage
The dentures must be cleaned thoroughly. First, rinse them under cool water to remove loose food particles and saliva. Use a soft-bristled denture brush and a non-abrasive cleanser to gently brush all surfaces, including the grooves that fit against the gums, to remove plaque and residual adhesive. To prevent warping, store the dentures immediately in a labeled, clean container filled with clean water or a specialized soaking solution.
Oral Care and Inspection
While the dentures are soaking, turn your attention to the patient’s mouth, which may harbor bacteria and adhesive residue. Use a soft-bristled toothbrush or a moistened gauze pad to gently clean the gums, tongue, and the roof of the mouth. This stimulates circulation and helps remove remaining fixative or food debris. Inspect the patient’s gums and palate for any signs of redness, sores, or inflammation, which can indicate a poor fit or the beginning of an infection. Documenting the time of removal and noting any issues observed provides an accurate record for the care team and helps track potential oral health changes.