Ability To Implement Culture Change
If staffs are truly to be able to implement culture change, it is crucial that there be leadership support and organizational commitment to the new practice, and ongoing monitoring and feedback so that change is affected. Recognizing this need, Mouth Care Without a Battle provides training not only for direct care staff, but also for nurse supervisors, administrators, advocates, and others who care about quality mouth care for older adults. Training to secure leadership support and organizational commitment addresses the current limitations in mouth care and the grave consequences of poor oral hygiene provides an overview of the mouth care and behavioral skills taught to care providers and nurses and stresses the important role of the organizations leadership in enabling and promoting better care. A key step in this regard is making mouth care a priority and empowering the staff to change their practices accordingly. Further, it is this very consideration related to organizational buy-in that resulted in naming this program Mouth Care Without a Battle. That is, our previous programBathing Without a Battleon which this program is basedhas achieved national recognition as a culture change practice, and organizations are more likely to consider a new practice if it is similar to or consistent with a currently recognized and approved practice.
Dental Hygiene Appointment Modifications
Prior to beginning the appointment, determine if the patient is capable of providing consent. In the early stages of AD, the individual may have no issues providing consent. Those with mild AD may still be driving to the appointment alone. As the disease progresses, consent for treatment should be obtained from the legal guardian.
Medical history intake forms may not provide information about cognitive disorders and their presence may not be obvious. Dental providers may need to ask more questions after reviewing the forms completed by the patient to determine if a patient is capable of providing consent.
Appointment planning should consider the length of time needed for appointments, as shorter appointments may reduce stress experienced while at the dental office.
More appointment modifications will be needed as AD progresses. While still cooperative, individuals with mild AD should be seen for a comprehensive examination, radiographs, creation of a treatment plan, and dental hygiene services.19
In the mid-stage of AD, maintenance procedures should continue. If treatment was not rendered before the patient reached the mid-stage, extensive treatment may be necessary.19 Oral sedation may be helpful at this point. Minimally invasive restorative options, such as silver diamine fluoride, may be tolerated better because the treatment is completed quickly.19
Oral Health Care Resources For Caregivers
Organization: Canadian Dental AssociationProduct type/format:CDA Dental Patient with Special Health Care Needs Transition ProcessInformation about: This tool helps to guide patients, families, caregivers and oral health care providers seamlessly through the process of transition when an adolescent with special health care needs moves from pediatric to adult oral health care, or when an adult with special health care needs moves from one dental practice to another. The tool consists of 3 steps and can be used for and adapted to any SHCN patient group for assisting in transitioning individuals from one oral health care environment to another.
Organization: Canadian Dental AssociationProduct type/format: and Pre-visit questionnaireInformation about: Tips for parents and caregivers to make oral health care at home as easy as possible for persons with special health care needs.
Product type/format: Webpage, Section 7Information about: Finding a dentist
Product type/format: YouTube video, starts at 6:30sInformation about: Oral Care Best Practices for Residents with Responsive Behaviour: Approaches and strategies
Product type/format: Webpage, Section 2Information about: Learn how medications can affect the oral health of people with dementia.
Product type/format: Webpage, Section 3Information about: Dentures When are dentures required Wearing dentures Losing dentures Dentures marking
Product type/format: Brochure, Information about: Daily oral health care tips in French
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Mouth Care Without A Battle
Mouth Care Without a Battle is a system-level, evidence-based, tested approach to person-centered daily mouth care . It is appropriate for all individuals, but especially for persons with physical and cognitive impairment and who are at increased risk of pneumonia . Based on an extensive review of the literature and guidance from advisors expert in mouth care, dementia care, culture change, and nursing home regulation, an experienced interdisciplinary team developed an individualized, evidence-based intervention, evaluated it, and made it available through digital video disk and web-based training materials, to enable long-term care organizations and providers nationwide to improve their mouth care services. This section describes the program and issues related to implementation in reference to developing the evidence-base for culture change addressing care processes and outcomes benefiting all residents, ability to implement culture change, and costs of implementation . More specifically, each of these components needs to be explicated to provide an evidence base for culture change.
Tips For Parents And Caretakers
There are several things caregivers can do to help maintain good dental health for people with dementia.
For example:
- Help the patient brush his or her teeth after every meal. If this isnt reasonable, have them rinse their mouths out with water after eating or a few times each day. Or, consider wiping out their mouth with gauze or a wet cloth, especially after consuming sugary foods and beverages.
- If youre reminding someone how to brush, offer short, simple instructions. Go step-by-step and be as patient as possible.
- Demonstrate by brushing your teeth. Brushing together is a great way to help people with dementia remember what they should be doing. It also avoids embarrassment in the early and middle stages of the disease.
- Find a dentist who has experience working with dementia or other special needs patients. This makes those twice-yearly visits less stressful. Also, make sure the patients dentist has the contact information of other healthcare providers caring for the patient.
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Early Stage Of Alzheimers Disease
The aim of dental intervention should be prevention oriented, with long-lasting results and easy maintenance, as well as attending to the elderlys needs and circumstances . For example, controlling the disease may be best accomplished with relatively long-lasting and simple restorations that elderly people can easily maintain and that the dentist can easily remedy as the Alzheimers disease progresses . In addition, preventative programs should be instilled early on when elderly people are still astute and competent, as this is important for both preventing dental diseases and maintaining self-care . Fluoride therapy is an important strategy for caries prevention. Maintaining oral health is also possible with more frequent dental examinations and professional oral hygiene care, including scaling intervals . In terms of self-care, patient education must be tailored to address individual circumstances . Novelty devices may include an electric toothbrush, a water flosser, or a Collis Curve toothbrush . In addition, innovative strategies can be used to mark dentures, supervise the oral hygiene routine or use the 5S methodology to develop an oral hygiene routine . In addition, educating caretakers can help with maintaining oral hygiene .
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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Mouth Strategies Ease Dementia Patients Anxieties
Providing oral hygiene to dementia patients can be a tricky proposition at best, and can be especially difficult for clinicians whose dementia patients respond to oral care by attempting to bite or fight the clinician. A group of nurses at Penn State, however, have launched a pilot study to explore methods for improving oral care to persons who have dementia.
To my knowledge, we are the only nurses in the country who are looking at ways to improve the oral care of persons with dementia, notes Rita A. Jablonski, PhD, CRNP, assistant professor of nursing at Penn State. Poor oral health can trigger not only periodontal diseases, but also dangerous systemic conditions including pneumonia and cardiovascular disease. These conditions raise a particular health risk to persons with dementia who resist care when they feel threatened.
Jablonski and her team have woven together strategies that focus on raising the patients comfort level before and during care. The approach they tailored especially for dementia patients is called Managing Oral Hygiene Using Threat Reduction, or what they call MOUTh. The team developed 15 strategies that hinge on techniques to reduce threat perception. Some of the strategies include approaching patients at eye level, smiling during interaction, pantomiming, and guiding patients to perform their own care by placing a hand over the patients hand and leading.
Demographic Shift And Consequences For Dentistry
Due to demographic change, dentists will also have to focus on the dental care and treatment of the heterogeneous patient group of the old and very old in the future. Dentists can only successfully meet the challenges of this specific patient group with the help of a combination of dental as well as interdisciplinary knowledge . Furthermore, psycho-social skills such as patient management, communication concepts for dementia, etc. are also required for senior-friendly treatment . Dementia is one of the greatest societal challenges in view of the increasing number of people with the disease. By 2050, around 315400 people with dementia are expected, with an upward trend .
Prevention successes in dentistry result in a higher number of own teeth in the old and very old people. The increasing age of the population along with the occurrence of co-morbidities such as dementia urges us to work for good oral health to prevent pain and emergency treatments in people old and very old people with and without dementia.
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Finding A Mobile Dentist Experienced In Elderly Dental Care For Dementia Patients
The Team at In Motion Dentists is extremely experienced and comfortable working with local dementia patients. If your loved one is unable to leave home for routine dental cleanings or is just more comfortable at home, we can travel to you to provide regular cleanings as well as emergency dental care.
To learn more about In Motion Dentists dental care options for San Bernardino senior citizens with dementia, call 594-0374.
Dementia Resources And Training Links
On this page you will find links to resources and training available for dementia in the following areas:
Please Note: Health Education England is not responsible for the content or reliability of external websites. Links are provided for information and convenience only. We cannot accept responsibility for the sites linked to, or the information found there.
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Oral Diseases Common In Patients With Dementia
Xerostomia. Hyposalivation is frequently found among individuals with dementia it may increase biofilm accumulation as well as the risk for oral disease.2 Xerostomia is a common side effect of medications used to manage symptoms of mild to severe AD including donepezil, galantamine, and memantine.3,4 Medications used to treat the comorbidities of AD, such as antidepressants, antipsychotics, and sedatives, may also cause xerostomia.5
Xerostomia leads to a host of dental problems, including tenacious biofilm formation, dental caries, candidiasis, dysphagia, and difficulty retaining dentures.6
Biofilm Accumulation. Older adults with dementia often experience poor oral health, and biofilm accumulation is frequently the root cause.7 Research shows that individuals living with dementia have high levels of biofilm in the oral cavity.2 A 2018 systematic review discovered that those with dementia have higher plaque indices, more bleeding on probing, higher gingival bleeding indices, higher probing depths, and more clinical attachment loss than individuals without dementia.8
Coronal and root caries are more common among those with dementia compared to older adults without dementia.7 As dementia progresses, the risk for gingival disease and caries rises due to xerostomia, forgetting to brush teeth, forgetting how to brush teeth, or not wanting to brush teeth due to the sensation.2
Visits To The Dentist
- Regular check-ups are advised for all people with natural teeth and those with dentures
- A thorough dental assessment should be done in the early stages of dementia, with a long term, flexible and uncomplicated preventive dental treatment plan made
- Before a dental visit, discuss any environmental modifications such as reducing noise or the number of people around, transport issues, sedation or pre medication needs with the dentist and staff.
- Ensure a full medical history and a list of current medications is available for the dentist, preferably before a visit
- The presence of a family member or carer during a dental visit may also help
- If eligible for public-funded care, contact the dental hospital closest to you as many have staff who specialise in the treatment of people with dementia and other medical problems
- Inform dental professionals that they can contact Dementia Australia if they wish to discuss any issues or problems with a counsellor
The contents of this page are based on information provided by Associate Professor Jane Chalmers, a specialist in dementia dental health.
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Dementia And Dental Health Care Tips
Abbie Goudarzi, DDS, one of Delta Dentals of Washingtons consultants, has a parent with dementia and knows what a challenge it can be to help a loved one maintain good oral health. As a caregiver and dentist, she knows theres a lot you can do to ensure your loved ones smile stays healthy despite their dementia diagnosis.
Here are Dr. Goudarzis tips on caring for loved ones with dementia:
Use short instructions. Brush your teeth seems simple, but it may be too much. Walk through each step of the processhold the brush and put toothpaste on it. Breaking up instructions into mini-steps can make commands easier to understand. Be aware that a person with dementia may need a toothbrush with a different handle design that is easier to grip or one with softer bristles.
Do it together. Take the leadbrush together in the bathroom mirror. The demonstration will show the person firsthand how to brush.
As dementia progresses, you may find that you have to do the brushing and flossing for your loved one. The time and place are not important. Do it when you are both most relaxed and where it is most comfortable. It does not need to be done in the bathroom. It can be done with the person sitting in a chair with you positioned behind them. Flossing is also very important. It may be easiest to use a proxabrush or a floss holder.
When brushing and flossing is difficult, a wet gauze may be used to wipe out the mouth.
How Does Dementia Affect Oral Health
Dementia makes maintaining good oral health more challenging.
The best thing someone in the early stages of dementia and/or their caregivers can do is to focus on preventative dental care.
This means making a healthy mouth and dental hygiene a priority. It also means daily brushing and flossing and regular dental appointments.
Prioritizing the dental care of elderly patients makes it less likely there will be future problems that require extensive treatment and emergency dental care.
This is good advice for anyone, but its especially important for someone with dementia. Undergoing invasive dental treatments is stressful and difficult for people with dementia to understand.
During the mid- and later stages of dementia, caregivers will likely need to assist the patient with basic dental care. As challenging as routine dental care might be, keeping up with this is important.
As dementia progresses, it grows increasingly difficult for patients to communicate about pain. The more you can do to keep dental health stable and prevent problems, the less youll need to worry about a dementia patient experiencing pain or undergoing stressful treatments.
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Tips For Patients With Dementia
Brush and floss on a daily basis as youve done all your life. If you arent sure if youre doing it right, ask your dentist for a demonstration. If youre experiencing challenges at home, ask a loved one for assistance.
Visit the dental office for twice-yearly checkups.
There are special dental health tools available to help those who struggle with at-home dental health. A large-handle soft bristled toothbrush or electric toothbrush are a few options that make the experience easier.
If you are uncomfortable with anything about your usual at-home dental health routine, consider changing it. This includes brushing somewhere other than the bathroom or brushing at a different time of day.
Use a fluoride toothpaste under supervision if you tend to swallow when brushing. You can use baking soda and water or opt for a commercial fluoride-free toothpaste. But these alternatives wont have as much protection against tooth decay.
Utilization Of Dental Services
The utilization of dental services was found to be dependent on the degree of dementia. With the increase in dementia, there was a significant reduction in the demand on the services of the dentist and dental hygienist.
Despite the possibility for the uptake of dental services with the mobile dental clinic for subjects of this study living in long-term care facilities, the utilization of dental services by a dentist and especially by a dental hygienist decreased significantly with increasing dementia. It can therefore be assumed that the utilization of dental services by people with dementia depends more on the cognitive abilities, the need for care, the living situation and the oral functional capacity than on the possible access to dental services. The influence of these and other factors on the use of dental services by people living in long-term care facilities should be observed in further studies to adapt the concepts of mobile dental services offered.
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