What is dementia?
Dementia does not refer to just one single disease but is a collection of symptoms caused by disorders affecting the brain. It is affected enough to interfere with a person’s normal social or working life, affecting their thinking, behaviour and their ability to perform everyday tasks. (Alzheimer’s Australia, n.d.)
Dental problems in dementia patients
Dental health is important in providing and maintaining quality of life for patients living with dementia. However, due to their difficulty in performing everyday tasks and the challenge of communication, it is often hard to maintain good oral hygiene practices and to address pain or discomfort involving their oral health.
In dementia patients, the ability to care for their own teeth becomes a great challenge as patients may forget how to brush their teeth or no longer understand the importance of maintaining their oral health. This can become very problematic as improper oral hygiene can lead to gingivitis (gum disease), tooth or root decay and sensitivity. For this reason, it is important for carers to be persevering and help patients to take care of their teeth.
Dry mouth can also be a major issue with dementia patients and is where there is a significant reduction in saliva flow rate. It is often caused by certain medications taken for medical issues that become more common as we get older. Major concerns with dry mouth are tooth and root decay, which can eventually lead to tooth loss. To help with the symptoms of dry mouth, drinking more water or fluids will increase the moisture within the mouth. There are also varieties of dry mouth products available that may help; such as Biotene dry mouth gel, Fuji Drymouth ect. You will need to talk to your dentist for correct recommendation.
Keys to maintaining good oral health in dementia patients
- Carers to help with looking after teeth: reminding /assisting patients to brush their teeth twice daily for at least two minutes
- Use of a fluoride toothpaste and fluoride mouthrinse
- Maintaining regular dental visits
- Reducing sugar intake
Care of natural teeth
The use of an electric toothbrush over a manual toothbrush is preferable if the patient is able to tolerate it. Electric toothbrushes do feel hard on teeth and can possibly cause anxiety or fear especially if the patient has not used one before or is unable to tolerate the vibrations. If an electric toothbrush is unable to be used, always choose a brush with very soft bristles.
Use a fluoride toothpaste and don’t thoroughly rinse out as leaving small amounts of toothpaste resting on the teeth can be beneficial in reducing the risk of tooth and root decay.
Caring for the oral health of dementia patients
For carers, the use of short and simple instructions for patients will help making the process easier for them. These can include:
- “Hold your toothbrush.”
- “Put paste on the brush.”
- “Brush your teeth with the toothbrush.”
Alternatively, use a “watch me” or “hand-over-hand” technique. This involves holding a brush and showing the person how to brush his or her teeth, or putting your hand over the person’s hand and gently guiding the brush.
When assisting with brushing, stand in front of the patient or to the side. You may need to experiment to see which position best suits the situation.
Sometimes patients will clench their jaw or spasm their lips and cheeks. Bending the toothbrush 45 degrees backward and running the bent brush to the corner of the mouth will help break the seal. You can use your finger to help retract the cheeks to then be able to see the back of the teeth.
With dry mouth, food sometimes can pool at the sulcus of the cheeks (the curvature running from the cheeks to the jaw), It also a good idea before brushing to run the toothbrush up to these areas to remove the bulk of food particles. This will make cleaning of teeth much easier.
Care of dentures
Dentures should be removed and cleaned after meals with a denture brush and soapy water.
Dentures also need to be removed at night-time. They should be cleaned and placed in a container of water to soak over night.
When cleaning the denture, place a bowl of water in the sink under the tap so that breakage is less likely to happen if denture is accidentally dropped.
Denture cleansers such as Polident or Steradent are also useful but not necessary.
Partial dentures can be dangerous to patients with dementia as removal can be difficult once dexterity begins to diminish. This can cause damage to the surrounding soft tissue from clasps during insertion or removal. It may be necessary at the later stage of dementia to remove these dentures altogether.
Visiting the dentist
Discuss your dementia condition with your dentist at the early stage of dementia. Establish a routine, and discuss a preventative and uncomplicated dental treatment plan. Keep up with regular dental care for as long as possible.
Some patients may end up entering care at a nursing home. Prior to going to the nursing home it’s a good idea to advise your dentist regarding the move and discuss whether it is feasible for your dentist to do nursing home visits as you may find traveling more difficult as the disease progresses.
In the ACT there is s “Dental Van” provided by ACT Health which comes to nursing homes for about 4-6 weeks at a time. If you are eligible to receive Dental services by the government make sure you or your family are aware and place your name down for dental assessment and make sure you have a complete medical history with all your regular medications on file. It is good to have a family member or a carer to come to the dentist with you. For more information contact ACT Health or your local nursing home.
Alzheimer’s Australia. (n.d.). What is Dementia? Retrieved September 24, 2016, from Alzheimer’s Australia: https://www.fightdementia.org.au/about-dementia/what-is-dementia
Colgate-Palmolive Company. (n.d.). Oral Care Age 55+. Retrieved September 24, 2016, from Colgate: http://www.colgate.com.au/en/au/oc/oral-health/life-stages/oral-care-age-55-up