Dear Doctors: Our grandmother is 76 years old and has Alzheimer's disease. My siblings and I are helping our mom care for her. We'd like to know what to expect regarding dental care. Her dentist has other patients with Alzheimer’s and says it gets difficult to treat them as the disease advances. We want to be prepared.
Dear Reader: Oral care is a key component in maintaining overall good health and well-being. When you regularly brush, have cleanings and see a dentist, you protect more than just your teeth and gums. You also safeguard your general health.
The bacteria associated with gingivitis and gum disease cause chronic inflammation. It not only taxes the body, but it also opens the door to additional disease and illness. Research has revealed a clear link between poor gum health and an increased risk of heart disease, including coronary artery disease.
Individuals living with Alzheimer's disease gradually become unable to perform daily living activities. This includes dental care. Changes occurring in the brain also begin to interfere with the ability to swallow. The medical term for this difficulty is dysphagia. The result is that dementia patients often breathe in, or aspirate, the food or beverage they are trying to swallow. When gum disease is present, dysphagia increases the risk of bacterial lung infection, such as aspiration pneumonia. Dental problems can also make eating painful, and often play a role in malnutrition in these patients. This adds urgency to maintaining good oral health.
In the earliest stages of dementia, patients are typically able to care for their own teeth and participate in professional dental care. If repair or restoration is necessary, this is the optimal time for it to be carried out.
As cognitive abilities decrease, the focus shifts to preventive behaviors. Someone with Alzheimer's may not remember to brush their teeth, or why it is important to do so. It falls to caregivers to remind them, and often to demonstrate the practice alongside them. If someone wears dentures, caregivers will need to take over the task of cleaning and sanitizing them, and to help the individual clean their gums and tongue.
Routine and predictability are important in dementia care. Experts in the field advise caregivers to help the individual develop a dental care routine, and to carry it out the same way each day. This adds structure to the person's life and may extend their ability to participate in their own oral care.
As a patient's dementia advances, behavioral and psychological symptoms, such as depression and aggression, often arise. When coupled with the loss of cognitive abilities, this makes ongoing dental care difficult.
In advanced dementia, caregivers often actively help the person care for their teeth or do it for them. Professional dental care also becomes a challenge. If a dental procedure is required to safeguard someone's health, sedation may be required. Caregivers must then balance the need for the procedure with the patient's inability to give informed consent.
None of this is easy. The challenges of dental care in dementia are widely known. Your local dental society will be able to provide references to professionals with experience helping these patients.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
