End
3-2-Behavioral Challenges in Providing Care
Section Completed! Most Common Challenging Behaviors End
Section Completed! Person is Agitated
- Assess the risk of self-injury or hurting others.
- Assess feasibility of performing oral care at the time.
- Use Rescuing and/or Distraction
- Reassure and help the person relax
Person is Asleep or Tired
- Assess if the person is sleepy or if another condition is causing the sleepiness
- Try a different time of day
Boredom
Person may be tired of doing the same thing every day
- Try new products, flavors, colors
- Try music or any favorite activity
- Make it fun and be creative
- Asking the person what could be done to reduce boredom
Forgetting Oral Care and Needing Supervision
Identify the best way to remind the person to perform oral care
- Set a timer
- Routine check-list
- Reminders such as sticky notes
- Verbal reminders after meals
Will Not Open Mouth
- Touch person’s lip with the toothbrush. Ask the person to say “Ah” and demonstrate (open your mouth) to prompt opening
- Massage cheek to relax muscles
- Use the end of the toothbrush handle, or another mouth prop, between the teeth while brushing with another brush
- Start slowly brushing the outer areas of front teeth
Cannot Remove or Replace Dentures –Lower
- Ask the person to remove/replace their dentures
- Use opening mouth techniques seen in: Will Not Open Mouth
- For the lower denture, pull up gently while applying a rocking motion
- Avoid placing your fingers between biting surfaces of teeth
- Insert denture at an angle
Cannot Remove or Replace Dentures – Upper
For the upper denture, removal may be more difficult due to the surface area and stronger suction.
- Place your thumb against the lower edge of the person’s front teeth. Press upward and outward toward the person’s nose, or slide your fingers or thumbs in between the upper portion of the dentures, where they meet the gums, until the adhesive seal is loosened and the denture comes out easily.
- Try to press down with even pressure, although applying slightly more pressure to one side at a time if necessary is important.
See this video for further instruction (opens in a new tab/window).
Biting Toothbrush or Caregiver
Utilize Mouth Opening Techniques
- Use a mouth prop
- Have several toothbrushes on hand and let the person chew on one toothbrush (unless you fear the person is biting too hard) while the caregiver brushes with another
- Consult medical and dental professionals concerning tardive dyskinesia or other movement disorders
Types of Challenging Responses
There are many types of challenging responses. Some include when the person:
- Refuses oral care
- Kicks, hits, bites, spits
- Cannot understand what is happening
- Cannot understand directions
Consider The Possible Cause for Challenging Responses
Examples of causes for challenging responses can be:
- Unfamiliar environment, or too many distractions, noise, etc.
- Pain in mouth
- Pain from other sources (positioning, wounds, back, etc.)
- Fear
Common Approaches to Challenging Responses
There are many approaches to challenging responses. Some include:
- Trying a different time
- Developing a routine
- Documenting successful strategies for future replication
For more techniques click here: Communication Techniques
Introduction
The following slides are the most common challenging responses.
For all, utilize the Common Approaches to Challenging Responses and Communication Techniques in the previous section.
Additional techniques are listed for each challenging response.
