Looking For A Dentist For An Elderly Individual With Alzheimers Or Dementia
We have extensive experience treating patients with Alzheimers Disease or Dementia. These patients are treated with kindness and patience. Their dignity is always maintained. Due to his extensive work with Alzheimers patients, Dr. Stu Rubin was appointed to the Board of Directors of Alzheimers New Jersey.
Finding The Right Dentist For Alzheimers Patients
A large number of Alzheimers patients have erratic or inconsistent oral self-care due to the nature of their disease. As a result, such individuals need specialized dental care.
Some of the common dental problems that dentists check for in dementia patients include cavities, broken teeth, tooth abscesses, dry mouth, and bad breath. These are all indicators of poor dental hygiene and can be painful for the patient. Moreover, they may require complex and expensive dental procedures if they are not caught and treated early. The aim should be to keep up with regular dental visits for as long as possible to prevent serious complications that may subsequently require complicated dental treatments.
In the advanced stages of Alzheimers disease, some dentists may schedule at-home visits or offer ambulatory care if going to a dental office is no longer possible for the patient.
Top Oral Care Products For Dementia Patients
Toothbrush OK. This may sound ridiculous to even recommend, but its true. I cannot tell you how many times I see a dementia patient, with teeth, use a sponge rather than a toothbrush. This is not appropriate for their mouth as a sponge cannot remove the food that gets impacted between the teeth and at the gumline. Please use the proper brush as follows:
- Adult Toothbrush: For patients with teeth. Be sure the bristles are extra soft and there is a tongue scraper on the other side of the head. This helps protect their teeth if they accidentally bite down on the toothbrush.
- Baby Toothbrush: Great to use for those hard-to-reach places, and potentially because a patients mouth may be too small for the adult size toothbrushes. More often, I recommend the adult toothbrush over a baby toothbrush.
- Sponge Lollipop: Typically given out at hospitals, this sponge is great only for those without teeth.
AllDay Dry Mouth Spray This product is wonderful for patients who have a hard time keeping their mouths wet. Dry mouth is typically caused by medications. The more saliva your patient has, the better. Saliva is a natural cleanser against bacteria.
Xylitol Gel Also made by AllDay , this gel is a toothpaste made of 44% xylitol, has a great taste, and is meant to be swallowed. This has the consistency of toothpaste and also picks up food particles. This is a great recommendation for those whose patients tend to swallow their toothpaste while brushing.
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Meet The Needs Of A Growing Population
The number of older adults in the U.S. has tripled over the past century and is projected to double again in the next 50 years.15,16 By 2030, nearly one in five Americans will be 65 or older.15 Research also shows that older adults are at greater risk of oral health problems than their younger counterparts.16 The necessary preparation to meet the needs of this growing population will require innovation and collaboration among dental and medical professionals.
Although the etiologies of AD and dementia are currently unknown, research is focusing on possible associations between oral health and cognitive decline. Preventive oral hygiene interventions are key to improving overall health, and may help delay or prevent cognitive decline.17 Insufficient evidence and methodological deficiencies in prior studies have not allowed researchers to conclusively show oral health status especially periodontal disease as a cause of cognitive decline.8 In addition, evidence supporting a causal relationship between oral health and dementia remains inconclusive. Additional research is needed to answer these questions.
Help Your Loved One With Dental Hygiene
How you help your loved one take care of their mouth and teeth depends mostly on how clearly theyâre able to think and if they can follow directions. In the early stages of Alzheimerâs disease, many people can brush their own teeth while you watch to be sure they do it right.
Later on, theyâll likely need help. They may be more likely to be scared and not want to cooperate. They may lash out. But you can do some things to make it easier to take care of them.
When you clean and check their mouth and teeth, start gently. Move and speak slowly, and make eye contact. You may want to talk with them for a while and then explain what you need to do. Let them know that youâll do your best not to cause any pain. Tell them to tell you if anything you do hurts, and that you will quickly stop.
You can put on latex or rubber gloves, or wrap your finger with gauze, then gently massage their gums, cheeks, and roof of their mouth. Have them spit. If this is hard for them, play some music or their favorite TV show to distract them.
If they wonât let you take care of their mouth, try to tell them in simple terms why itâs important. Get them involved in their own care by asking them if they want to try it themselves. It may help to make them more at ease if you give them a familiar item to hold while you get started. When they do let you care for their mouth, give them positive feedback.
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Moderate Stage Of Alzheimers Disease
Resistant behaviour is common during the moderate stage of Alzheimers disease . Managerial considerations may include mouth props for safety, treating in the supine position to reduce the risk of aspiration, and having short appointments . Apart from prevention, the aim of this stage of treatment is to maintain the dental status with simple treatments . Provisional treatments should be considered to avoid complicated treatments. The atraumatic restorative technique and sedation may also be considered for appropriate cases.
Daily Dental Care Tips For Seniors
While a dementia patients health is usually a caregivers main focus, quality of life is equally important. Although sugar is a notorious culprit when it comes to dental issues, if your loved one enjoys candy, cookies, cake, ice cream or other sweets, by all means, indulge them . After the snack is consumed, though, take the time to have them drink water or at least rinse out their mouth. This will help to flush out residual food particles and bacteria, preventing the buildup of tartar and plaque. Proper hydration also helps to keep their mouth moist and inhibit bacterial growth. Saliva is meant to serve this rinsing purpose, but many older adults suffer from dry mouth caused by a wide range of over-the-counter and prescription medications.
A fruit salad can be a surprisingly helpful tool in maintaining dental hygiene. Try to end every meal with a few orange slices and a few pieces of crisp, raw fruits and vegetables, such as apples, pears, celery or carrots. The acid in the oranges will break down the sugar and starch in their mouth, and the crunchy fruits or vegetables will help brush plaque from their teeth. Once again, the last step is using water to wash everything down. Check with their doctor and dentist before starting this type of program, especially if any chewing or swallowing issues are present.
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Complications Of Poor Oral Health In Patients With Alzheimers Disease
It is clear from the above paragraphs that oral health in Alzheimers patients is often less than adequate. It is essential to improve the oral hygiene status of such individuals to prevent serious complications which may require complex medical procedures in the future and result in a poorer quality of life or even death.
However, this can be challenging for multiple reasons. Elderly individuals with Alzheimers disease are frequently uncooperative with receiving the necessary dental services. Also, frailty, limited mobility, and compromised dexterity can limit the ability of these individuals to care for themselves. Medical comorbidities can limit their dental treatment options. Moreover, cognition and memory problems can make communication with dentists and caretakers difficult.
Nonetheless, despite these difficulties, a focus on oral care in Alzheimers patients is critical to reducing the occurrence of complications. Some of the potential problems that can arise in patients with dementia because of poor oral hygiene are described below.
How Do You Get Someone With Dementia To Brush Their Teeth
You need to use a technique called watch me if you are being proactive. Show the person how to brush his or her teeth by holding down a toothbrush. Alternatively, you could simply grab the brush and guide it gently over the persons head. Rather than brushing at an earlier date, delay brushing in case the person is agitated or is uncooperative.
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Dementia And Oral Health: How To Help Sufferers Care For Their Teeth
Dental care and oral health can be hard for dementia patients. These tips are designed to help caregivers deliver efficient and successful oral care.
Image by Vinoth Chandar on Flickr.
We are currently living through the most sophisticated and advanced medical age in existence. Our doctors and scientists have eradicated diseases and developed treatments which allow sick people to live for much longer than was ever thought possible. Yet, there is still much work to be done. Every year, millions of people die from cancer, AIDS, diabetes, coronary disease, and respiratory infection. And millions more are diagnosed with dementia.
This simple unassuming word continues to destroy families all across America and all across the world. At present, there are more than one hundred known varieties of dementia. The most common and widely discussed is Alzheimers disease, but there is also vascular dementia , fronto-temporal lobe dementia, Korsakoffs syndrome, DLB , and many more.
While some truly huge scientific breakthroughs have been made in recent years, we are yet to find a cure for dementia. It is a serious degenerative illness which affects the function of the brain and, particularly, the memory. It may start and progress slowly, but eventually, the condition begins to degrade identity and erase even the most basic motor skills. It is a quietly devastating disease and it puts a huge strain on family members and caregivers.
Use Of Fluoride Antimicrobial And Therapeutic Dental Products
- Fluoride toothpaste – Fluoride toothpaste should be used to brush natural teeth whenever possible, once or twice a day if possible. After brushing with toothpaste, do not rinse with a lot of water and try to leave some toothpaste behind around the teeth to prolong exposure to fluoride.
- Fluoride and antimicrobial rinses and gels – If tooth decay is evident, or the person appears to be at risk for developing decay, then the use of fluoride and antimicrobial products . These rises and gels, which are only available at the chemist, will be the most effective in helping to reduce dental decay and gum disease. They should be used weekly, and can be put in a small spray bottle or atomiser to spray onto the teeth. Note that fluorides and antimicrobials should not be used within 2 hours of each other. Perhaps try using one in the morning and one at night. Speak to your dental professional about the best options for use.
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What Challenges Does A Patient With Dementia Patient For Dental Practitioners
There are many health problems associated with an individual who has AD or dementia, including accumulating food fragments, ill fitting and unclean prostheses, and having lost teeth. Innovative, collaborative and interdisciplinary healthcare will be able to improve the oral health of this patient population if treatment is targeted effectively.
Oral Care Tips For Dementia Caregivers
With all the other concerns and responsibilities involved in taking care of a person with dementia, dental care can be easily overlooked. However, maintaining proper oral hygiene is a crucial factor that influences a seniors overall health and their quality of life.
Someone with Alzheimers disease or another form of dementia may not be able to communicate that they have a toothache or gum problems, especially in the later stages of the disease. An abscess in the mouth can lead to many serious complications, cause undue pain and suffering, and interfere with a seniors ability to get proper nutrition. Because dental problems can worsen quickly, every caregiver should make dentist appointments and daily dental care an important part of their loved ones care plan.
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Does Dementia Affect Your Teeth
People who suffer from Alzheimers disease may have difficulty in eating properly. It has been observed that their gums tend to age. It may be impossible to tell someone if you are in pain by not brushing your teeth or using your toothpaste. It may also take them ages to remember how to use the toothbrush and toothpaste.
Inflammation Oral Health And Cognitive Decline
Chronic inflammation is of growing interest in the etiology of cognitive decline and AD.8 One theory suggests that long-term systemic infection may prime cells to act atypically, resulting in brain disease.3 Neuroinflammatory responses may be triggered by pathogens both viral and bacterial.5 The oral microbiome can provide the source of chronic inflammation, especially in patients with periodontitis.8
Oral microflora may spur inflammation, most commonly in the form of gingivitis. Ulcerated crevicular epithelium typical of active periodontitis may serve as a conduit for bacteria and other microorganisms to enter the bloodstream and potentially circulate to other locations. Periodontal pathogens may directly affect the brain via the circulatory system and/or nervous system.3
Stewart et al8 investigated the relationship between periodontal disease and cognitive decline. Researchers hypothesized that poor oral health status was associated with cognitive decline and that high levels of inflammatory markers would partially account for the relationship. A large cohort of individuals age 70 to 79 participated in the five-year study. In the second year of the study, the participants received dental examinations. Results indicated that gingival inflammation was a significant predictor of cognitive decline. A bidirectional relationship in which cognitive impairment leads to poor oral health may also exist.8,9
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Dental Hygiene For People With Dementia
As with any debilitating disease, Alzheimers and other dementias pose limitations to what a patient can and cant do. Good dental hygiene is one of the self-care daily habits that, unfortunately, often fall by the wayside in cognitively impaired individuals.
In the beginning stages of Alzheimers, a daily reminder might be all it takes to ensure that a person with dementia continues with their dental hygiene routine. As the disease progresses, the individual might need a more hands-on approach.
Why is dental care for dementia patients important?
It doesnt matter whether you have dementia or are in tip top shape, dental care is a primary factor in overall health. Maintaining your dental health is much more than having a beautiful smile. Tooth decay and gum disease can affect your heart, your lungs, and your brain.
Periodontal disease has been linked to diabetes, heart disease, and Alzheimers disease.
According to the U.S. Centers for Disease Control and Prevention, one out of every two American adults over the age of 30 has some form of gum disease. Oral bacteria can migrate to distant sites in the body. Elderly and immuno-compromised patients, such as those suffering from cancer, diabetes or rheumatoid arthritis, may be especially vulnerable to systemic oral pathogens.
Certain medications can cause dry mouth
8 Tips for preventing dry mouth
12 Ways to assist dementia patients with oral hygiene
References
The Importance Of Physical Health
While dementia is in its early stages, it is possible for a spouse, child, or other relative to independently care for the sufferer. This usually involves moving in to the same house and remaining close by to help with everyday tasks. A range of different support options can be sought and most carers choose to alleviate the strain on their own lives by relying on nurses and domestic assistants.
As the condition progresses, the sufferer will find it increasingly difficult to not just physically perform everyday duties, but also to understand why they are necessary. At this point, it is very important for the caregiver to step in and provide sustained support. Without help, physical health deteriorates very quickly. The person with dementia will find it hard to remember basic tasks like eating, showering, dressing, and brushing their teeth.
They are likely to get confused if you ask them to perform these tasks, because they no longer relate them to their own health or physical wellbeing. Wherever possible, a caregiver must take steps to make sure that essential duties are carried out. This is particularly important when it comes to oral health, because dental problems can lead to serious illness if left untreated. It can be very tricky to persuade dementia sufferers to brush their teeth, but a suitable routine or method must be found.
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Effects Of Alzheimers Disease Pharmacotherapy
Medications can be effective in delaying cognitive impairment among patients with AD. The U.S. Food and Drug Administration has approved several prescription drugs to treat the diseases symptoms.10 Cholinesterase inhibitors, such as galantamine, rivastigmine and donepezil, are used to treat mild to moderate AD. The exact mechanisms of how cholinesterase inhibitors work are not fully understood, but they may inhibit the breakdown of acetylcholine, a chemical in the brain associated with memory and cognitive ability.10
Memantine, an N-methyl D-aspartate antagonist, is commonly used to treat moderate to severe AD.10 It works by regulating glutamate a key neurotransmitter and appears most useful in the later stages of AD. Tricyclic antidepressants, such as despiramine, notriptyline and amitriptyline, are also used to treat AD. Antipsychotic, anxiolytic and anticonvulsant medications may be prescribed to treat some of the behavioral symptoms.11
As patients with AD often take multiple medications to treat their disease and other health problems, dental professionals need to ensure that patients provide an updated, comprehensive medical history at each dental visit. This is imperative when administering anesthesia or prescribing antimicrobials and analgesics to patients with AD because these pharmacologics may interact with patients medication regimens.11