Moffitt Restorative Dentistry

Alzheimer’s disease.

Jun 26 2016

Alzheimer’s disease (AD) is a “brain degenerative disorder that gradually destroys the ability to remember, reason, learn, and imagine.” The neural dysfunction and synaptic loss experienced by patients with AD include poor attention span, impaired learning processes, and limited ability to perform self-care. It also is the most common cause of dementia.
As AD progresses, so does the severity of cognitive and functioning skill impairment. This decline increases patients’ susceptibility to oral diseases due to their inhibited ability to perform adequate oral hygiene. Challenges often faced by patients with AD and/or dementia include amassing of food fragments, ill-fitted and unclean prostheses, tooth loss, and increased risk for caries and periodontal diseases. To improve oral health in this patient population, health promotion efforts must be innovative, collaborative, and interdisciplinary. Maintaining a patient-centered approach is an important component of improving the oral health in patients with AD and/or dementia. Individuals with AD who depend heavily on caregivers with low oral health literacy are at greatest risk, so caregivers need to be included in all patient education efforts.
Xerostomia is a common side effect in patients taking medications for AD. Oral health professionals can recommend over-the-counter (OTC) products to ease the symptoms of xerostomia such as salivary substitutes, oral lubricants, and sugarless gum with xylitol. Table 1 provides additional strategies for managing xerostomia.
THE ROLE OF ORAL HEALTH PROFESSIONALS
Due to reduced cognitive abilities and difficulties with self-care, patients with AD may present with numerous oral health challenges and diseases. Maintaining comprehensive medical histories, consulting with patients’ primary health care providers, and educating caregivers about oral health ensure a patient-centered approach to care.
Treatment planning is influenced by the patient’s stage of AD. Oral health professionals need to determine the patient’s independence level and cognitive, mental, and physical status before providing care. Assessing these factors will determine if a patient is able to provide informed consent for dental treatment. If a patient cannot provide informed consent, it must be obtained from a responsible party before treatment can begin. A care­giver may also need to be present during dental ap­pointments.
The abilities of caregivers to encourage, and, if necessary, to provide oral hygiene for patients with AD and to help them receive professional dental care significantly affects the oral health of this population. Dental hygienists can help caregivers understand the importance of maintaining oral health and provide instructions on how to provide effective oral hygiene care. More qualitative research is needed to examine strategies for ensuring caregiver compliance with oral hygiene regimens.
Increasing age is a significant risk factor for developing AD or other diseases that lead to dementia. Individuals with such cognitive problems will need support to maintain both their overall and oral health. As dementia progress, caregivers may need to assume full responsibility for a patient’s oral self-care as well as ensure patients receive timely and adequate professional care.

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