Dental care for someone with dementia: pain signs, consent, hygiene, dentures and general anaesthesia

Where should dental care for someone with dementia begin?

Dental care for someone with dementia should start with a check-up soon after diagnosis. The UK’s Alzheimer’s Society recommends this because the dentist can identify and treat problems before treatment becomes too difficult for the person to tolerate.

According to the World Health Organization (WHO), 57 million people worldwide were living with dementia in 2021, with nearly 10 million new cases each year. Alzheimer’s disease may account for 60 to 70% of cases. Dementia affects not only memory but also thinking, communication, mood and behaviour, changing the approach to dental treatment.

It helps to attend the first appointment with someone familiar. Alzheimer’s Society says that a family member or friend helps many people feel secure, and explaining each step before carrying it out may reduce anxiety. Bring a list of medicines and conditions; a separate article on dentistry for older people discusses medicines’ effects on the mouth.

How can you tell that someone with dementia has toothache?

Toothache in someone with dementia often shows through behaviour rather than words, especially later in the condition. Alzheimer’s Society stresses that changes in behaviour should not immediately be attributed to dementia, but considered possible signs of pain, and lists signals to watch for.

Note when symptoms began, how long they last and whether a painkiller helped, and show the notes to the dentist. The 2018 NICE NG97 guideline recommends considering a structured observational pain assessment tool for people with moderate to severe dementia and repeating pain assessments when behavioural changes may be pain-related.

According to the NHS, facial swelling with difficulty breathing, speaking or swallowing, swelling around the eye or difficulty opening the mouth require immediate attendance at a hospital emergency department (SOR in Poland) or a call to 112.

• Difficulty eating or refusing food, especially hard, very hot or cold foods.
• Frequently touching the face or mouth.
• Facial swelling.
• Taking dentures out and reluctance to wear them.
• A pained expression during toothbrushing.
• Bleeding, ulcers, broken teeth, cavities, dark discolouration, lumps or swelling in the mouth.

Why plan dental treatment early in dementia?

Early in dementia, people can usually participate in decisions and tolerate longer treatment, which becomes harder over time. Alzheimer’s Society explains that the dentist can plan future procedures at this stage, such as removing teeth likely to cause trouble, and the carer should be involved in these plans.

Goals change as dementia progresses. According to Alzheimer’s Society, later-stage dental care focuses much more often on a regular routine of toothbrushing and checking the mouth than on extensive procedures, while urgent treatment may require sedation or general anaesthesia.

In practice, ask for a written treatment plan showing the order of stages and discuss what to do first while the person can cooperate well. The table sets out priorities by stage of dementia.

Who consents to dental treatment for someone with dementia?

As a rule, a person with dementia consents to their own dental treatment if they have capacity to give informed consent and have not been declared fully incapacitated by a court; the diagnosis alone does not remove this right. Alzheimer’s Society stresses that dementia does not mean someone cannot make decisions about their dental care. If a court has declared the person fully incapacitated, the statutory representative consents, and an examination also requires the patient’s own consent if they can express an informed opinion about it.

In Poland, the rules are set out in art. 17 i 18 of the Act on Patients’ Rights and the Patient Rights Ombudsman (Rzecznik Praw Pacjenta) and art. 32 do 34 of the Act on the Professions of Physician and Dentist (legal status as of 24 October 2026). The key rules follow.

An unusual legal situation is best discussed with the healthcare provider before the procedure day. The article on dentistry for people with disabilities also explains who signs consent in cases of disability.

• If the patient cannot give informed consent, their statutory representative consents, if one has been appointed.
• A de facto carer, someone who provides ongoing care without a statutory duty, may consent only to examination if there is no statutory representative.
• Further treatment of a person unable to consent who has no statutory representative requires permission from the guardianship court with jurisdiction over the place of treatment.
• For surgery or treatment involving increased risk, consent must be written; consent given through Internetowe Konto Pacjenta, Poland’s online patient account, must be in documentary form.
• A patient who retains sufficient understanding despite their condition may object to treatment even if the statutory representative or de facto carer consents; guardianship court permission is then required.
• In an emergency, examination and treatment without consent are permitted if the patient needs immediate medical care, cannot consent because of their health or age, and neither the statutory representative nor the de facto carer can be reached. Surgery or an increased-risk method may be carried out without the consent of the representative or the court only if the delay would put the patient at risk of death, serious bodily injury or serious damage to health. Where possible, the decision is discussed with another doctor and recorded in the notes, and after an increased-risk procedure the doctor notifies the representative, the de facto carer or the guardianship court.

How do you brush the teeth of someone with dementia?

Brush twice a day with fluoride toothpaste, including just before bed, preferably at regular times. This is recommended by Alzheimer’s Society and the 2016 NICE NG48 guideline on oral care in care homes, which also covers daily denture cleaning and overnight removal.

If the person refuses, respect this and try later. Alzheimer’s Society reminds carers that everyone has the right to refuse, and that mouthwash helps remove food debris but does not replace brushing. The dentist may prescribe higher-fluoride toothpaste or rinse, or apply fluoride varnish every 3 to 4 months.

A separate article on brushing a bedbound person’s teeth gives step-by-step guidance, while the article on dentistry for older people discusses dry mouth and root decay.

• Let the person brush independently for as long as possible and help only when they stop; first offer a calm prompt.
• For hand-over-hand assistance, stand beside the person and help move the hand holding the toothbrush.
• Use small circular movements, spending around a minute on the upper teeth and a minute on the lower teeth.
• Use a pea-sized amount of toothpaste and have the person spit it out afterwards without rinsing with water.
• If swallowing is difficult or the person chokes, choose a non-foaming toothpaste.
• Early in dementia, an alarm or a note somewhere visible can provide a reminder.

Dentures and dementia: labelling, cleaning and fit

Consider marking dentures with the person’s full name, as loss or breakage is common and replacements take many weeks and several visits. Alzheimer’s Society recommends labelling especially if the person lives in a care home or may go into hospital; NICE NG48 recommends laboratory marking when dentures are made.

Remove and clean dentures every evening, store them in a labelled container and put them back in the morning. Keep cleaning tablets out of the person’s reach. An alarm or bedside note can remind them to remove dentures; later in dementia, help is often needed.

Poorly fitting or broken dentures can cause gum pain and swelling, and adjusting to a new set can be difficult. According to Alzheimer’s Society, some people never adjust and stop wearing them. In DentalBlue’s price list, “Naprawa protezy” (denture repair) costs 500 zł and “Podścielenie protezy” (denture reline) 450 zł. The final scope and cost are agreed at consultation, and prices may change.

When is dental general anaesthesia considered for someone with dementia?

General anaesthesia is considered when necessary dental treatment cannot be carried out safely in the chair. Alzheimer’s Society says the dentist may recommend sedation or general anaesthesia if it makes treatment safer and simpler, but in later dementia this carries risks and requires discussion with the person, family and carers.

The dentist and anaesthesiologist decide after assessment, using the medical history, medication list and test results. Adults are entitled to NFZ-funded dental general anaesthesia (NFZ is Poland’s National Health Fund) if they have an official certificate of moderate or severe disability and medical indications (§ 4 ust. 2 of the regulation on guaranteed dental services, t.j. Dz.U. 2025 poz. 615, legal status as of 24 October 2026). A dementia diagnosis alone does not meet this criterion.

The article on dental treatment under general anaesthesia for adults explains assessment, the procedure day and returning home. Consent to general anaesthesia follows the same rules as other treatment.

Dental care for someone with dementia at DentalBlue

At DentalBlue in Białystok, the first step can be a “Wizyta bez bólu” (visit without pain, 300 zł): panoramic X-ray, consultation, examination and a written treatment plan. For symptoms, a “Wizyta z bólem” (visit with pain, 340 zł) also includes pain relief. When treatment in the chair is not possible, the clinic’s own anaesthesiology department (2 anaesthesiologists and anaesthetic nurses) provides treatment under general anaesthesia, including for patients with disabilities.

The procedure is preceded by a joint dental and anaesthesiology consultation with a panoramic X-ray, medical history, medication list and test results. NFZ entitlement is confirmed during assessment. Carers can phone Monika Gosiewska (preoperative and postoperative care, 606 983 347).