Early in my dental career, I was the dental advisor for elder care facilities in Honolulu. The most challenging tasks were demonstrations on dental care. Some patients were extraordinarily combative!
The combative patient’s teeth are typically not clean — minimal toothbrushing is done. It can be a struggle! Occasionally, though, you may be able to use a proxy-brush (a small Christmas tree-shaped brush) to clean between their teeth. Sometimes, using a thin, wet cloth or gauze around your finger works well in place of a toothbrush.
Teeth that are very loose should be removed. They may choke and/or aspirate them.
If the person can still go to the dentist and has cavities, the amount of difficulty and risk while conducting the restorative treatment must be weighed against the amount of discomfort the patient is in. A product we call “Silver Diamond” (silver diamine fluoride) is easy to use and works well in arresting decay. It does turn the decayed area black and may require more than one application.
If the person you are caring for is cooperative, then do whatever you can to remove the plaque and debris. I admire all of you who are caregivers. You all have hearts of gold.