Unique to You

Dementia is a general term that describes the slow and steady decline of various cognitive functions. This decline ultimately impacts a person's ability to perform activities of daily living. While there are many types of dementia, the most common is Alzheimer's disease, which accounts for 60-80% of all cases of dementia.¹ Alzheimer's affects nearly six million Americans. It is one of the top five leading causes of death in adults over the age of 65.²

Some types of dementia are related to microscopic bleeding in the brain or blockages in the brain's blood vessels. Alzheimer's disease is different. It has been more closely associated with high levels of specific proteins and generalized plaque build-up inside and outside brain cells. This build-up makes it more difficult for these cells to properly transmit and receive signals with one another.³

The effects of these devastating conditions include memory loss and a diminished ability to speak, solve problems, or care for oneself. Given these effects, oral health can be compromised as well. This article primarily provides tips for caregivers, so they can help loved ones who suffer from these conditions to maintain their oral health properly. It also aims to educate you about how poor oral health may play a role in the onset or progression of dementia and specifically Alzheimer's, so you are motivated to take action for yourself and those you love.

Alzheimer's and your oral health

While there is still much to learn about what causes Alzheimer's and contributes to the speed of its progression, research suggests that age, family history, diet, physical activity, and other lifestyle habits like long-term alcohol and tobacco use may all play a role.⁴

Poor oral health is another possible risk factor that is getting increasing attention.⁵ Research shows that individuals with dementia have higher rates of tooth decay, periodontal disease, dry mouth, and facial pain than those without dementia. Researchers hypothesize that the bacteria that cause oral disease may travel through the bloodstream and ultimately breach the blood-brain barrier. When it does, it is believed that this may increase inflammation and prevent beta-amyloid, a key contributor to Alzheimer's, from being naturally removed from the brain.⁶

There is also evidence suggesting that people with missing teeth may be more likely to develop cognitive impairment, dementia, or Alzheimer's than those without missing teeth. This risk appears to increase as the number of missing teeth increases. While tooth loss may be the result of people with these conditions ignoring their oral health⁷, researchers also observed that people who replaced missing teeth in a timely fashion showed a reduction in the progression of these conditions.⁸

While research about these connections is still emerging, there is enough evidence to suggest that oral health may contribute to the development and progression of Alzheimer's Disease. So make your oral health a priority.

If you are caring for someone who has been diagnosed with dementia or Alzheimer's, it is important to consider that they may be challenged in their ability to maintain the same oral hygiene practices that they did prior to the onset of their condition. Here are some tips that you can use to help ensure they maintain their oral health routine.

At home⁹

• In the early stages of the disease, encourage your loved one to continue brushing at least twice a day and flossing and using a fluoride mouthwash daily to remove bacteria and plaque. This can help avoid more frequent and extensive dental treatment in the future, when it may be more challenging for your loved one to tolerate the appointment.
• As dementia progresses, use short, simple instructions to explain how important dental care is and how to practice good oral hygiene. If necessary, talk through the process in a step-by-step fashion. When dementia or Alzheimer's disease advances, it may be necessary to help your loved one brush and floss their teeth.
• Try different options until you are confident that your loved one is brushing properly and regularly. Electric toothbrushes may be confusing. A soft-bristled children's toothbrush or a long-handled toothbrush may work better.
• If your loved one has bridges, dentures, or missing teeth, take special notice of their eating habits. Poor-fitting appliances, missing teeth, or mouth pain can lead individuals to eat different foods that may not provide adequate nutrition.
• Always ensure that dentures are rinsed with clean water after every meal and soaked in mouthwash or denture cleaner every night. Once dentures are removed, use a soft toothbrush or damp gauze pad to clean the gums, tongue, and other soft tissues.
• Help your loved one make and keep dental appointments. The frequency of the appointments should be at the recommendation of their dentist and may vary based on the treatment they need.

At the dentist¹⁰

• Help your loved one find the right dentist. Some dentists specialize in working with people with older adults with dementia or Alzheimer's. Your local dental society or the Special Care Dentistry Association (www.scda.org) may be able to provide helpful resources and guidance.
• Inform the dentist about your loved one's condition, as well as any other medical conditions they may have. If you have noticed certain behaviors, such as resistance or aggressiveness, it's important to alert the dentist and staff before the appointment.
• When you arrive at the appointment, tell the dentist or hygienist about any medications and their dosages that your loved one is taking. Write them down in advance if necessary. Certain medications can lead to complications or delays in treatment.
• If you are asked to complete and sign any paperwork on behalf of your loved one, such as informed consent forms, be certain you understand what you are signing. Don't hesitate to ask questions if you are unclear.
• Be sure to provide the dentist and any physician treating your loved one with each other's contact information. This is important if they need to discuss your loved one's disease, oral health status, and medications.
• Take the time to understand all of the treatment recommendations and options that the dentist or hygienist describes. If you are unclear, ask questions and take notes. Consider seeking a second opinion before deciding on a course of treatment.
• Ask your dentist about fluoride varnish to prevent new cavities and decay around existing dental work like crowns and fillings. If you feel this may be inconvenient, prescription fluoride products are available that can significantly reduce the chance of developing tooth decay and the expense of restoring decayed teeth.

Malnutrition: Oral conditions can affect what your loved one eats, and poor nutrition can result. This can impact someone's ability to fight disease. For example, dementia and Alzheimer's can reduce sensitivity to pain, and your loved one's memory loss or confusion can make it more challenging for them to explain the situation to others.¹¹ As a result, people with these conditions may avoid nutritious foods that are fibrous, hard, or crunchy such as proteins, fruits, and vegetables. If you notice this occurring, talk to their physician or dentist, or seek the counsel of a registered dietitian. They may be able to help devise strategies to get the nutrition they need.¹²

Other medical conditions: People with dementia or Alzheimer's often have other underlying medical conditions, such as cardiovascular disease, diabetes, cancer, osteoporosis, or kidney disease. Oral health has implications for all of these conditions. In addition, the medications taken for these conditions can contribute to oral health conditions such as dry mouth, periodontal disease, and tooth decay. This is why it's important to inform the dentist about all medical conditions and medications and to be sure that the dentist collaborates with your loved one's physicians. If a medication is causing oral issues, there may be alternatives that can alleviate the symptoms.