Dementia is now one of the most common neurological disorders in the older generation. Here, Dental Hygienist, Jo Dickinson, explains why maintaining good oral health in dementia sufferers is so important and how this can be managed.
There is growing evidence that poor oral hygiene and periodontal (gum) disease is playing a role in the development of some forms of dementia. Although people with dementia’s needs are complex and ever changing, poor oral health can bring about a significant reduction in the quality of life of an individual. Painful or loose teeth can alter speech and affect eating which, in turn, can reduce nutrition. Dry mouth and ill-fitting dentures can have the same knock-on effect, it is therefore essential for all individuals with dementia to have regular dental check-ups.
“There is growing evidence that poor oral hygiene and periodontal (gum) disease is playing a role in the development of some forms of dementia.” Visiting the dentist; some practical tips
As dementia progresses, the need for moral and practical support may become obvious. If you are the person offering that support, you may find the following suggestions helpful:
Consider seeking dental care from a practice that is familiar to the individual as familiarity can reduce anxiety Contact the practice beforehand and share any relevant information Offer to accompany the individual to their appointments and sit in during treatment, this can be reassuring and can aid communication. It is also an additional safeguarding measure Write down questions before you go Ensure that the patient is comfortable with treatment continuing Have the person’s medical history and list of medication handy at each appointment and advise the team of any changes Ask for written /printed treatment plans so you can discuss later. Ask for advice on a preventive home care plan and discuss this with other members of the individual’s care team Speak to the dentist about possibly prescribing high fluoride toothpaste for the patient. This can reduce the chance of dental decay Encourage the individual to have regular dental checks to reduce the need for extensive or difficult treatments If dementia is advanced, it may be necessary for a relative to consent to treatment. If you have any documentation regarding Lasting Power of Attorney, take this with you too. Tips for cleaning teeth for a dementia sufferer:
If the patient wears dentures brushing is the most effective cleaning method, remove dentures and clean with a denture brush and liquid soap or denture cream. Brushing over a bowl of water reduces the chance of them breaking. Dentures should not be allowed to dry out so soaking clean dentures in water overnight is good. Denture disinfectant can be used once a week in addition to denture brushing. Do not use bleach.
When brushing someone else’s teeth, it is less confrontational for them if you stand behind or to the side of them (as a dentist would do at a check-up). Start at the back of the mouth and use gentle circular or a to and fro motion covering one or two teeth at a time. Using a small-headed toothbrush and non-foaming toothpaste can be advantageous. If the individual is only cooperative for a short period of time, then focus on different areas at each brushing session. It is often more successful if the same person offers the support each time. If possible, interdental cleaning can then be done with bottle brushes.
There is mounting concern that soon there may be a high number of individuals who have dental implants and find they are unable to clean them and will rely on care workers to clean them daily. Implants can fail rapidly without good oral hygiene. If the individual you care for has implants, discuss with their dental team what monitoring and care plan should be in place.
Care for individuals with dementia in care homes
Access to dental treatment in care homes is limited and varied. It is worth checking with the manager of the residence what level of care is available.
“Evidence shows that individuals who have their teeth cleaned regularly and thoroughly have significant improvements in their general health and wellbeing.” Personal oral hygiene for people with dementia often falls down when there seems to be a reluctance on behalf of care givers to help brush teeth and dentures. This seems to be a worldwide problem but countries such as Australia and America have started to address this and evidence shows that individuals who have their teeth cleaned regularly and thoroughly have significant improvements in their general health and wellbeing. Until similar programmes are run in the UK, the responsibility falls on the individual’s family to seek out care homes that do provide good oral care.
It can be a challenging task to support the oral care of an individual with dementia, but not something to be overlooked or avoided. The detrimental effects on the individual can be catastrophic. Overall, we all have a duty of care to ensure that these vulnerable members of society have clean, pain-free, healthy mouths, as far as is possible with each individual.