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Dental care can fall by the way side in the midst of the ever-increasing demands of dementia care. It is vital to be aware of the importance of oral care and know how it can affect you or your loved ones dementia risks. There are multiple reasons you need to pay close attention to your oral health and some are not as obvious as preventing cavities and bad breath.

Effects of Dental Inflammation/Periodontal Disease on Dementia

Many studies have established a causal connection between inflammation (particularly periodontal disease) and Alzheimer’s disease. As severity increases and develops from gingivitis to periodontal disease, the risk of Alzheimer’s rises. Some studies suggest that those with Alzheimer’s Disease were four times more likely to have developed periodontal disease in middle age. Preventing gum disease begins with brushing and flossing daily. While it doesn’t prevent Alzheimer’s disease, it does reduce oral inflammation that is a major risk factor in Alzheimer’s Disease and related Dementia’s.

As dementia progresses there are common changes seen in habits around oral care;

Early on – patients will forget dental appointments and instructions

Later on – progressive neglect of oral hygiene

  • Forgetting the method

  • Forgetting the need for brushing and wearing dentures

  • Lost or broken dentures

  • Poor hygiene leading to dental problems and/or periodontal disease.

  • Halitosis and/or difficulty eating

Best Practices for Oral Health Care for Dementia

  1. Implement proper daily oral hygiene early (brushing, flossing with dental picks, gargling as long as they are not swallowing the mouthwash)

  2. Provide dental treatment during early stages to manage any outstanding dental needs.

  3. Obtain regular professional cleaning or teeth and dentures. (ensure dentures are labelled if living in a senior residence)

  4. Schedule regular dental checkups tailored to meet the patient’s needs to avoid pain and minimize chance of needing further interventions.

Because of the nature of the disease, dementia/AD (Alzheimer’s Disease) patients often cannot describe that they are experiencing pain. You have to be on the lookout for signs and symptoms that can indicate pain or developing discomfort.

Behaviour Changes for Dementia/AD that can suggest Oral Pain

  • § Constant pulling on the face

  • § Increased drooling

  • § Refusal to eat

  • § Changes to normally wearing dentures/refusal to wear

  • § Increased restlessness or agitation

  • § Moaning or shouting

  • § Disturbed sleep

  • § Refusal to cooperate with daily oral hygiene routine

  • § Self-injuring and/or aggressive towards caregivers

Finding a dentist who has the compassion and awareness can be a bit of a challenge but if they are aware of the special needs and complexities of someone with dementia it can mean the difference between safe prevention and unnecessary complications. A good Dentists should be asking questions when developing a treatment plan for a frail, elderly, confused (including those with dementia) and/or functionally dependent older adult. Educating yourself is the first step to ensuring good quality treatment when selecting a dentist’s suitability, as well as being sure you can advocate for yourself or your loved one.

Review this list of questions to ensure your dentist is a good fit.

  1. What will be the cost vs the benefit of effectiveness and least stressful treatment for this patient?

  2. What difference will denial of medical care make for this patient?

  3. Will the dental care result in perceptible benefits for this patient?

  4. How and why did this patient’s condition occur and can we do anything about it?

  5. Is the patient in pain?

  6. Can they predict the outcome of the planned treatment and will it benefit the quality of life for the patient?

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