The Connection Between Oral Health and Alzheimer’s Disease
Alzheimer’s disease (AD) is the most common type of dementia. This disease significantly affects one’s ability to conduct activities of daily living, including the ability to perform oral care. Oral health is an essential component of overall well-being and research demonstrates a relationship between an individual’s oral health and neurological degenerative conditions, such as AD. A healthy mouth can reduce the risk for the onset of dementia as well as reduce the severity and progression of AD (Hamza et al., 2021).
There are different stages of disease in the oral cavity. Healthy tissue is described as pink, firm, and moist. On the contrary, gingivitis, also known as gum disease, is characterized by red, swollen, and/or bleeding gums. Gingivitis is inflammation of the tissue in your mouth, and can be reversed through meticulous homecare, such as brushing and flossing. Periodontitis is a more severe form of oral disease and is characterized by virulent (or bad) bacteria, bone loss around the teeth, and inflammation. Porphyromonas gingivalis is the most common culprit of gum disease. This virulent bacterium can enter the bloodstream to the brain (Wilkins, 2013). A large study conducted by the CDC’s National Center for Health and Statistics (Beydoun et al., 2020) revealed P. gingivalis can release enzymes in the brain called gingipains that can destroy nerve cells. This destruction of nerve cells can lead to memory loss.
Dental Visit Considerations
In the early stages of Alzheimer’s, prevention is key. Caregivers play a vital role in oral health maintenance of people with AD. Seeing the dentist at least twice a year is critical. Brushing twice a day and flossing daily will reduce the virulent bacterial load in the mouth. This can prevent more invasive treatment in the future when the person with dementia is less likely to tolerate restorative procedures like fillings, crowns, and extractions (Lamphere & Nieto, 2021). When scheduling a dental visit, there are several things to consider:
- Schedule appointments at a time that is most ideal for the person with dementia.
- The person with dementia should be seen at least every six months, but the dental provider may encourage 3-month or 4-month preventive/periodontal visits, depending on the individual’s oral health status.
- Do not be afraid to ask your dental provider questions about how to best care for your loved one.
Homecare Education
During the middle and late stages of Alzheimer’s, completing homecare may become challenging. The person may forget the correct steps of brushing and may resist assistance from others. If the person seems agitated or uncooperative, postpone brushing to later in the day.
Below are homecare tips to consider:
- Provide short and simple instructions and break it down step-by-step. For example, “Hold the toothbrush. Put paste on the brush.” Then, “brush your teeth.”
- The mirroring or “watch me” technique is a strategy in which the caregiver demonstrates how to perform oral hygiene, while their loved one mirrors his or her actions at the same time. If this is not effective, place your hand over the person’s hand, gently guiding the brush.
As a caregiver, do not be afraid to experiment with homecare routines. Depending on the person with dementia’s physical abilities, a variety of tools are available to help improve homecare routines (Potts et al., 2023).
- Poor Grip Strength
When the problem is poor grip strength, there are options to increase the diameter of the toothbrush handle to make it easier for patients to grasp during brushing. Inexpensive options include a tennis ball, a hand towel secured with a rubber band, or silicone or rubber-based grips.
- Poor Dexterity
If dexterity and fine motor movements become difficult for the person to execute, an electric toothbrush many help. However, keep in mind, if your loved one is in the middle to late stages of dementia, the vibration from the electric toothbrush can be very agitating for the individual.
- Agitation while brushing
A three-sided toothbrush can be incorporated into the individual’s homecare regimen. This allows for all areas of the tooth to be brushed simultaneously (outside by the cheek, inside by the tongue, and on top of the chewing surfaces). This brush also reduces the amount of motion the individual or caretaker needs to execute for proper removal of bacteria in the oral cavity.
Quality of life is a chief concern. Oral diseases can lead to other health disparities, such as eating difficulties, digestive problems, malnutrition, and increased risk of infection. Contact your dental provider and care team immediately if your loved one has an unusual loss of appetite, as this is a cardinal sign of discomfort. As a caretaker, it is important to work closely with your loved one’s dental providers and care team to have the greatest opportunity to recognize oral disease in their earliest stages.
References:
Beydoun, S., Beydoun, H., Hossain, S., El-Hajj, Z., Weiss, J., & Zonderman, A. (2020). Journal of Alzheimer’s Disease, 75(1), 157-172. https://doi.org/10.3233/JAD-200064
Hamza, S., Asif, S., & Bokhari, S. (2021). Oral health of individuals with dementia and Alzheimer’s disease: A review. Journal of Indian Society of Periodontology. 25(2), 96-100. https://doi.org.10.4103/jisp.jislp_287_20
Lamphere, A. & Nieto, V. (2021). Caring for patients with Alzheimer disease. Dimensions of Dental Hygiene, 19(11), 40-43. Retrieved from https://dimensionsofdentalhygiene.com/article/caring-patients-alzheimer-disease/
Potts, E., Naderi, R., Hashmani, K., Catic, A., & Kiefer, L. (2023). Modifying oral hygiene techniques to improve oral health. Dimensions of Dental Hygiene, 21(8), 36-41. Retrieved from https://dimensionsofdentalhygiene.com/article/modifying-oral-hygiene-techniques-to-improve-oral-health/
Wilkins, E. (2013). Clinical practice of the dental hygienists (11th ed., pp. 652-653). Lippincott Williams & Wilkins.
Author:
Megan Reutter, DHSc, MSDH, RDH
