Dementia is a complex condition that affects over 733,000 people in Canada. It is caused by a decline in a person’s cognitive abilities and can severely impact their memory, behaviour, language and reasoning.
While many people recognize that dementia can affect the brain’s ability to function, what is not so commonly known is that it can also affect one’s oral health. Those who suffer from this affliction often fail to look after their teeth properly, which can end up causing them significant discomfort and inconvenience. Many dental professionals may have already noticed this correlation, but learning more information about this topic is beneficial for improved dental care.
In this post, we will examine the relationship between dementia and oral health. We will also discuss the challenges faced by dementia patients when it comes to caring for their teeth and outline some practical tips dental hygienists can provide to ensure that patients continue to brush, floss and use mouthwash regularly.
Impact of dementia on oral health
Dementia comprises a range of conditions, including Alzheimer’s disease, which is its most common form. Unfortunately, due to the nature of the affliction, dementia can lead to a variety of oral health problems.
One of the main reasons for this is forgetfulness. Individuals with dementia may simply forget to perform routine tasks, such as brushing their teeth or using dental floss. This can eventually trigger issues like gum disease, tooth decay, oral cancer, tooth loss or periodontal diseases. However, there are other factors at play too.
As dementia progresses, a person’s motor skills tend to decline, which in turn can make it difficult for them to perform the precise movements needed to brush and floss their teeth effectively. Congruently, some of the medications used to manage the symptoms of dementia can cause dry mouth, which increases the risk of suffering from dental decay and gum disease.
Dementia can also cause changes in behaviour, such as agitation or aggression, which may make oral care challenging for both the individual and their caregivers. It can even lead to difficulties with chewing and swallowing, particularly in the advanced stages of the condition, which can result in issues with malnutrition and weight loss.
Being aware of these issues ahead of a dental appointment can help you provide both optimal and empathetic care. Many dementia patients may come into your establishment feeling lost, confused, or scared, even when guided by a caregiver.
Putting them at ease is one of the most crucial initial steps to providing dental care. However, being aware of their unique needs and health concerns can also help you understand and address their dental issues more accurately. Discussing these issues ahead of time with their caregiver, if one is available, can also help you get a more accurate picture.
Challenges in administering oral health care to dementia patients
Caring for or administering oral health care to those living with dementia can be very tricky. It requires vast levels of patience and creativity, as well as highly specialized strategies. That is why having professional insight from a dental hygienist can help dementia patients and their caregivers alike to overcome these challenges.
Arguably the most common challenge is resistance to care. Many dementia patients may resist oral care simply due to fear, confusion or discomfort. This can make it very difficult for caregivers to effectively clean the patient’s teeth and gums. Additionally, as dementia can impair the sufferer’s ability to communicate, this can make it harder for caregivers to give instructions or understand the patient’s needs or preferences when it comes to oral care practices.
During an appointment with a dental patient, you can take the opportunity to advise their caregiver on the types of oral hygiene methods that can work at their home. By guiding them through this process, you can set your patients up for future success in dental health as they begin to use preventative dentistry regularly between appointments.
Tips for family members and carers
If you are unsure of what kind of advice to provide a dementia patient and their caregiver or family, it is best to start with the fundamentals. We have provided some key tips below to get you informed and ready to provide the most accurate advice possible.
Toothbrushing
People with dementia should continue to brush and floss their own teeth for as long as their ability to manually do so is not affected. However, if they start to lose their ability to control a toothbrush, family members or carers need to provide help to care for their teeth and gums. It is best to highlight this need several times during an appointment with a dementia patient so loved ones can understand how and when they should step up and provide support for oral care.
There are a range of techniques that can be embraced to brush the patient’s teeth. Generally speaking, these techniques are based on a cooperative approach that you can demonstrate during an appointment:
- Chaining: The carer starts brushing the teeth of the dementia before encouraging the latter to go on to complete it.
- Hand over hand: The carer places their hand over the hand of the dementia patient and helps them brush their teeth.
- Bridging: The dementia patient holds a toothbrush while the carer brushes their teeth with another brush. The purpose of this is to enhance the sensory connection.
- Yawning: The carer faces the dementia patient and yawns in the hope that they will follow suit, which will allow them to brush their teeth.
Emphasize that a caregiver should use an electric toothbrush if the patient will let them. This way, more thorough cleaning will be provided, even when facing difficulties getting the process underway. Otherwise, you can also indicate that a three-sided toothbrush should suffice.
Denture care
If the person living with dementia wears dentures, indicate to a caregiver that they need to make sure they are removed before teeth brushing. That is because dentures should be brushed separately using soft hand soap and a denture cleaning brush or a separate toothbrush.
Medication effects on the mouth
As previously mentioned, medications used to treat dementia can cause a decrease in the amount of saliva that is produced in the mouth, which could lead to dry mouth.
Saliva plays an important role in protecting teeth from tooth decay. Subsequently, having a dry mouth can significantly increase a person’s susceptibility to develop tooth decay. At the same time, a lack of saliva can also make the dentures more uncomfortable to wear or stay in place.
If you notice a patient is dealing with dry mouth, notify their caregiver of the issue. It may be best to find alternate medicines to prevent this issue. Otherwise, there is some generalized advice on how to limit the effects of dry mouth, but any specialized care is useful to raise as well.
Diet
For those dealing with severe dementia, they may need to stick to a soft or modified diet. If they consume processed foods high in refined carbohydrates or sugars, this can significantly increase their risk of suffering from tooth decay due to poor oral hygiene.
Some caregivers may not be aware of these issues, so it is best to educate them during an appointment about how diet can affect their patient’s oral health. Then, you can go on to indicate what foods should be consumed instead to ensure both a healthy and happy patient.
Likewise, throughout the day, encourage them to choose water over other drink options, especially soft drinks made with lots of sugar. That said, it would also be beneficial for them to regularly consume a dementia drink such as Souvenaid, which has been medically proven to slow down cognitive and memory decline by up to 60% in the early stages of Alzheimer’s disease.
Final thoughts
Dementia poses significant challenges for both patients and caregivers, not least when it comes to the matter of oral health care.
However, by understanding the unique needs of dementia patients and implementing specialized care strategies, dental hygienists can help patients practise good oral hygiene and improve their overall well-being. The strategies outlined above, along with regular dental check-ups and a supportive environment can help them achieve that.
Additionally, by prioritizing the patient’s oral health as part of their dementia care, it will go a long way towards improving their quality of life during their battle with this debilitating disease.
About the Author:
Chelsea Rogers is an aspiring journalist and marketing student based in Melbourne, Australia. She is passionate about growing her portfolio as a journalist and is particularly interested in social justice reporting. She is an avid music lover and regularly performs at local venues with her band.
