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Dental hygiene for people with dementia

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As with any debilitating disease, Alzheimer’s and other dementias pose limitations to what a patient can and can’t do. Good dental hygiene is one of the self-care daily habits that, unfortunately, often fall by the wayside in cognitively impaired individuals.

In the beginning stages of Alzheimer’s, a daily reminder might be all it takes to ensure that a person with dementia continues with their dental hygiene routine. As the disease progresses, the individual might need a more hands-on approach.

Why is dental care for dementia patients important?

It doesn’t matter whether you have dementia or are in tip top shape, dental care is a primary factor in overall health. Maintaining your dental health is much more than having a beautiful smile. Tooth decay and gum disease can affect your heart, your lungs, and your brain.

Periodontal disease has been linked to diabetes, heart disease, and Alzheimer’s disease.

According to the U.S. Centers for Disease Control and Prevention, one out of every two American adults over the age of 30 has some form of gum disease. Oral bacteria can migrate to distant sites in the body. Elderly and immuno-compromised patients, such as those suffering from cancer, diabetes or rheumatoid arthritis, may be especially vulnerable to systemic oral pathogens.

Periodontal disease is also associated with weight loss and wasting, which might contribute to cognitive decline. Gum disease often results in tooth loss, which often leads to problems with chewing, swallowing and food selection. And individuals don’t absorb nutrients from food efficiently if it is not chewed well. Evidence from several studies indicates deterioration in nutritional status in individuals missing teeth.

Certain medications can cause dry mouth

Decongestants, antihistamines, painkillers, diuretics and antidepressants are known to reduce saliva flow. Saliva neutralizes acids produced by bacteria in the mouth and helps protect you from microbes that can multiply and lead to infection and disease. The problem is, salivary glands are less productive as we age. Individuals with dementia also forget to drink when they’re thirsty. It’s important to be alert to cracked lips and dry mouth in your care partner in order to know when an individual is dehydrated.

8 Tips for preventing dry mouth

  • Sip water throughout the day—carry a water bottle.
  • Suck on hard, sour candies.
  • Chew sugarless gum.
  • Avoid or reducing the medications listed above.
  • Use Biotene, Plax, or ACT mouthwash which contain no alcohol.
  • Eat fibrous foods like apples, carrots and celery. They’re mildly abrasive and sweep bacteria and plaque off the teeth.
  • Use a humidifier to keep the membranes moist.
  • Get regular dental check-ups and alert the dentist about dry mouth. The teeth can sometimes be coated with protective substances that protect the teeth from bacteria and plaque.

12 Ways to assist dementia patients with oral hygiene

  • Talk your patient through the steps of brushing, if necessary. Put your hand over their hand that is holding the brush to guide them.
  • We typically brush our teeth in the bathroom. However, if it’s more comfortable for someone to brush while sitting down on a chair or in bed, by all means provide a plastic tub and glass of water for the patient.
  • As dementia progresses, it becomes more difficult for patients to visit their dentist for regular cleanings. It also becomes more difficult for caregivers to help with daily brushing, which is why caregivers must be more diligent in trying other techniques.
  • If a regular toothbrush is hard to hold and manipulate, try an electric toothbrush. Or, provide a toothbrush with a large handle. Some caregivers get creative and put the handle through a tennis ball to give the patient something heftier to hold onto.
  • Don’t use fluoride toothpaste if the patient is inclined to swallow it. If the patient doesn’t like toothpaste, try using baking soda and water, or just plain water.
  • Flossing is very important. See “Does gum disease really cause Alzheimer’s disease?” https://barbracohn.com/?s=flossing&submit=Search. Flexi-Floss, Stim-u-dent-or a tiny brush makes the job a bit easier.
  • If you can trust the patient not to swallow mouthwash, try an anti-plaque mouthwash when brushing is not feasible.
  • Ask your dentist about using a super soft toothbrush or one with a sponge head instead of a bristle head. Foam oral swabs are available at medical supply companies.
  • If your patient wears dentures, make sure to take them out and clean them daily. Use a soft brush to clean the patient’s gums and roof of their mouth when the dentures are removed.
  • Be alert to dental pain which may be exhibited by rubbing of the jaw or cheek, flinching while being shaved or having their face washed, refusing to put dentures back in, moaning, flinching, etc.
  • As mentioned in the above section, eating fibrous foods like apples and celery, and drinking plenty of water can help prevent plaque build-up.
  • It’s important to find a dentist who is patient and knowledgeable about dementia in order to make your patient’s dental visits as pleasant as possible. Let the staff know ahead of time about any concerns. If your patient gets agitated, ask his/her physician for an anti-anxiety medication beforehand. Or, use a homeopathic remedy such as calcarea carbonica or aconite, or an essential oil such as lavender oil to reduce anxiety. For a list of herbal remedies that reduce anxiety see “20 Natural Remedies for Depressed Caregivers (and everyone else).” https://barbracohn.com/category/aromatherapy/

References

  1. Hee Lee, K, Wu, B, and Plassman, B. Cognitive function and oral health—related quality of life in older adults. JAGS. 2013: 61: 1602-1607.

2. Elsig, F, Schimmel, M, Duvernay, E, Giannelli, SV, Graf, CE, Carlier, S, Herrmann, FR, Michel, JP, Gold, G, Zekry, D and Muller, F. Tooth loss, chewing efficiency and cognitive impairment in geriatric patients. Gerodontology. 2013: 1-8.

3. Chalmers, JM, Carter, KD, and Spencer, AJ. Oral diseases and conditions in community-living older adults with and without dementia. Spec Care Dentist. 2003: 23: 7-17.

4. Fabiano, JA. Oral health management in the patient with dementia. Medscape. May 24, 2011.

Does gum disease really cause Alzheimer’s disease?

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Doctor holding blue crystal ball with gum disease sign on medical background.A study published January 23, 2019 in Science Advances caused a lot of people to freak out. It implied that the bacteria called Prophyromonas gingivalis that cause gum disease—gingivitis– might be the culprit in Alzheimer’s disease. It sounded too good to be true. But can you reduce your risk by getting regular dental check-ups, and brushing and flossing every day?

I posted a link to the study on my Facebook page and got some heated responses such as “I don’t believe that. My mom and husband always went to the dentist??????” Another person called the study “BS.” 

So, what is the bottom line? And what is the response of scientists who were not involved in the research paid for and conducted in part by employees of Cortexyme, Inc., a San Francisco–based biotech company? 

Here’s the gist of the Cortexyme study: the researchers found that enzymes made by P. gingivalis, called gingipains, interact with amyloid-beta and tau (the proteins implicated in Alzheimer’s disease) in test tube experiments and in the brains of mice. According to the study, gingipains cause A-beta to accumulate and tau to behave abnormally. These are the primary signposts of Alzheimer’s disease in the brains of humans.  The Cortexyme group also found genetic material from P. gingivalis in the cerebral cortex – an area involved in conceptual thinking – in the three Alzheimer’s brains they examined. Cortexyme, Inc. is developing compounds that block gingipains, which their scientists claim reduce the amount of A-beta in the infected mice.

In a previous study, Sim Singhrao at the University of Central Lancashire, UK, found that P. gingivalis can migrate from the mouth to the brain in mice with gum infections. Her group of researchers concluded that periodontal disease is a polymicrobial inflammatory disease that leads to chronic systemic inflammation and direct infiltration of bacteria/bacterial components, which may contribute to the development of Alzheimer’s disease.

A cautious response

Rudolph Tanzi,PhD, an Alzheimer’s researcher at Massachusetts General Hospital in Boston says that the Science Advances study is inconclusive.  An interview in Science News (January 31, 2019) conducted by Laura Sanders reported Tanzi’s responses to the following questions:

Do we now know what causes Alzheimer’s disease?

No. “It would be a complete fantasy to say that now we’ve solved Alzheimer’s based on this,” Tanzi says.  “People need to know that this was a small study…. It’s way too early to say that this result is valid.  We need to see many more samples. We need much more replication.”

Headlines that claim gum bacteria causes Alzheimer’s disease stretch the science way too far, he says. “It got out of hand. People should not be freaking out just because they didn’t floss enough. It doesn’t mean you’re going to get Alzheimer’s.”

But did it make sense to look at whether gum bacteria play a role in Alzheimer’s?

Yes. Tanzi and his colleagues suspect that Alzheimer’s is kicked off by brain inflammation, perhaps prodded along by bacteria, viruses or fungi. His team has been looking at large swaths of genetic material found in brains to figure out exactly which infectious entities might be in the brains of people with Alzheimer’s.

“We went in expecting to see periodontal bacteria in the brain. That was a leading hypothesis. One of the biggest pools of bacteria in your body lives in your gums if your gums are not clean. We expected to find them, but we didn’t.” (Those negative results, from dozens of brains, are unpublished.)

What you need to know

Periodontitis is the most common infectious inflammatory disease of humans. A recent survey in the USA concluded that 47.2% of adults aged 30 years and older had periodontitis. The disease is characterized by the loss of periodontal ligament, connective tissue, and alveolar bone, and is a major cause of tooth loss. 

Now we know that virulent strains of P. gingivalis can affect the central nervous system, which can result in Alzheimer’s and dementia. Although the research is still in its early stages, it’s a good idea to amp up your dental care and get thee to a dentist at least once a year for an exam and cleaning. It is certainly worth the bucks if it will help reduce your risk of Alzheimer’s disease. Don’t you think?

For more information about periodontal disease and why it’s important to floss please take a look at my previously published blog Do you still need to floss“

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    Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at Amazon, Barnes & Noble, Boulder Book Store, Tattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.