Dental Care for Dementia Patients

We’re going to shed some light on the possible causes of dental problems in people with dementia and also to provide some tips and advice for maintaining dental health. People with dementia are often unable to verbally express their discomfort or pain, hence we need to focus on prevention.

People who have dementia have a high susceptibility to dental diseases, this is due to:

• Taking multiple medications which often results in a slowing or cessation of saliva flow. Saliva is of the upmost importance in clearing food debris off teeth and buffering the dangerous acid produced by the bacteria which lives in plaque.
• Eating patterns are often changed and involve sticky foods, snacking, sweet foods and treats
• Declining ability to take care of their own oral health with routine thorough brushing and flossing
• Medications are often suspended in a highly-sweetened syrup

People with dementia are often unable to communicate dental pain verbally, hence they pull faces when eating, exhibit behavioral issues or act out during eating. This is their way of trying to communicate the problem and we need to be consistently conscious of this.

Having the Right Dental Routine

Putting in place a stringent and consistent oral hygiene routine is essential. If the person is unable to effectively maintain their own oral hygiene, carers should create a twice daily routine which will take approximately 3 minutes each time, consisting of:

1. Two minutes of brushing, preferably with an electric toothbrush such as the Oral B Triumph. If you have ever had to brush some else’s teeth before you will know how awkward and unnatural it can be, so using an electric brush will allow you to effectively remove as much plaque as possible and those with timers are excellent to ensure you have spent enough time doing so. Avoid rinsing with water after brushing to retain as much fluoride in the saliva as possible.
2. Using a fluoride toothpaste, the level/concentration of which should be pre-determined by a local dentist. People with dementia are more often than not at high risk of decay, hence special high fluoride toothpastes are often essential such as Colgate Neutrafluor 5000. The additional fluoride fights to keep enamel healthy and strong, and at the same time repairing damage.
3. Supplementing with a high fluoride mouth-rinse which is non-alcohol based. People who had dementia often get dry mouth which makes alcohol based products uncomfortable.
4. Cleaning between teeth with interdental brushes such as Pixter brushes. There are many Youtube videos on how to use these brushes, in place of flossing, to remove plaque from surfaces between teeth. This is often an overlooked aspect of the oral hygiene routine.

**If the person can maintain their own oral hygiene then a dentist should regularly work to provide techniques and feedback to improve the routine.

Taking Care of Dentures

When dentures are placed into a mouth which is very dry and has plaque and food deposits, then we are asking for trouble. The most common areas I see decay developing in the mouths of those with dentures are at the junctions of the dentures and teeth. These surfaces often have food lodging and when it sits there for an extended period of time decay is inevitable. Denture hygiene is just as important as the maintenance of natural teeth and involves:

1. Rinsing dentures after every meal and brushing them with a soft toothbrush to remove food
2. Always remove dentures when sleeping
3. When visiting the local dentist he/she will professionally clean and polish the plaque and hard calculus from the denture as it houses bacteria and bugs which promote decay and bad breathe
4. Dentures should always have a mark of identification for those who have dementia
5. Taking Care of Dry Mouth

Dealing with dry mouth can be very difficult for carers and people with dementia alike. Often the discomfort of a dry mouth is difficult to comprehend for those of us that have never had dry mouth. For some perspective, having a dry mouth is a constant burden and impacts quality of life considerably. It can cause a burning or tingling sensation, often leaves the tongue and inner cheeks red and raw. It causes speech, chewing, swallowing and tasting problems.

Nearly everything in the oral cavity relies on saliva and any reduction can have drastic effects. Some tips to combat dry mouth:

• Regularly sipping water
• Visiting the GP and asking if medications which are known to cause dry mouth can be substituted for those that do not cause dry mouth
• Chewing sugar free gum: promotes saliva flow, and the xylitol in many gums is excellent for oral health
• Limit caffeine intake as it potentiates dry mouth
• Cease tobacco and smoking
• Avoid mouthwashes that contain alcohol
• Avoid antihistamines or decongestants
• Over the counter products and saliva substitutes: products containing carboxymethylcellulose or hydroxyethyl cellulose such as Biotene Oral Balance. Or products containing xylitol such as Mouth Kote or Oasis Moisturizing Mouth Spray.
• Mouth washes specifically for dry mouth such as Biotene Dry Mouth Oral Rinse

A summary of the keys to maintaining the oral hygiene of a person with dementia

1. An established and strict meal routine, minimizing snacking, sweets and sticky carbohydrates.
2. Ensuring that if the person cannot manage their own oral hygiene routine, that carer(s) have a stringent routine in place for 2 minutes of brushing to remove soft foods as well as the plaque buildup between teeth.
3. Having 3-6 monthly visits with your local dentist and hygienist who will work together to formulate a long term treatment plan considering all aspects of diet, saliva flow, fluoride requirements, brushing and cleaning tips and also professional regular cleaning.
4. Boosting Saliva flow