Dental care is one of the most challenging aspects of Alzheimer’s and dementia caregiving. Proper oral care is necessary to prevent eating difficulties, digestive problems and infections. As a caregiver, you may have to assist with dental hygiene or take a more hands-on approach. Below are helpful tips from professionals at the Blende Dental Group, which is home of the House Call Dentists, serving patients with special needs, including people with dementia.
Dr. David Blende a graduate of the University of Southern California and has more than 30 years of experience. He is also chief of dentistry at both California Pacific Medical Center and Kaiser Permanente’s San Francisco Medical Center, and on staff at six additional Bay Area hospitals.
Michelle Bernardo has been a Registered Dental Hygienist since 1994 when she graduated from New York University School of Dentistry. She divides her time between the Blende Dental Group San Francisco office and visiting homebound and elderly patients throughout the Bay Area.
Dr. Blende, you were one of the first dentists to perform house calls for patients. How did the idea about House Call Dentists come about?
When I first began my practice in Beverly Hills, I saw virtually no Alzheimer’s patients. When I started doing work in hospitals, I was called out to see home-bound people or patients for whom transport to the dental office was overwhelmingly difficult.
This fit into my background quite well. My father was a physician in a rural town close to the Canadian border and I used to go on house calls with him. Up until 1940, 47% of all interactions between a physician and a patient occurred in the home. And now physicians and medical groups are coming back around to that model.
Why is dental health critical to the health of people with Alzheimer’s?
There’s a huge taboo about being in the mouth of someone past a certain age and certainly in the mouth of our parents or spouse. 95% of all disease in the mouth is preventable. When we see patients who’ve had 35 years of good dentistry, we want to make sure that they hold on to that right to the very end.
A healthy mouth is one of the great privileges of health. Enjoying a meal is a great privilege of health. But because of these taboos about getting into a husband or a wife’s mouth, things go undiscovered. And when a problem is undiscovered, it becomes akin to abandoned because the patient ceases to brush their teeth regularly.
An abandoned mouth ultimately becomes a true nest of infection. The bacteria in the mouth overgrow and seed out into the heart, lungs and kidneys. We know now that one of the major causes of aspiration pneumonia are the bacteria that are harbored in between the teeth in an infected mouth. We also know that a lot of patients with late stage kidney disease have oral bacteria down in the kidneys.
We recommend that caregivers take their partners or parents who have Alzheimer’s to their regular dentistas soon as symptoms appear. Insist that the dentist clean up their mouth so that it can last the 7 to 10 years that are still before them.
Michelle, what are some warning signs that caregivers should watch out for to recognize when there might be a problem?
When a caregiver is taking care of a patient, what they want to look for immediately is an increase of plaque accumulation on the gum line. This is either due to dexterity issues or the person forgets to brush. Ultimately, this plaque accumulation would lead to tooth decay or gum infection. Another sign to watch out for would be if the person stops eating comfortably or you start to notice an unfinished plate at the end of the meal.
Do you have any prevention tips for caregivers?
Sure, as a caretaker you want to make sure you’re brushing the person’s teeth after every meal, ideally, but at least two times a day. Have the person rinse their teeth after snacks or after drinking juices. If the person has lost their ability to rinse, make sure you wipe the inside of their mouth with either a piece of gauze or wet wash cloth to get sugar and food particles off the teeth and cheeks. And then you’ll always want to be pulling the cheeks away from the teeth to see if there is anything broken or if there are any sores.
Dr. Blende, what do you advise the caregivers that you meet in your practice?
When we make house calls, the first thing we do is we ask the caregiver to show us their mouth. We want to know how well caregivers take care of their own mouth. That then becomes another part of the education. If they’re taking good care of their mouth, then we’re advancing down the line.
A great reminder for caregivers is to make sure that the person you are caring for has a good routine. It’s also important for the patient to be on a dental routine with their dentist, so make sure to have their mouth checked every few months. When someone has a toothache, it’s pretty simple to diagnose or if their face is swollen, that’s pretty simple, as well. But probably 85% of the insidious disease and the real infection is very silent and it slowly but perniciously starts to destroy the mouth so you have to get someone to look at it.
Another problem is that as we age into 60’s, 70’s or 80’s, our saliva can diminish. When someone becomes distressed and they’re given anti-anxiety drugs or heart and pain medication, all of those have a side effect of drying out the mouth. And if the saliva dries, the mouth dries up. We like to tell people that saliva is like the tide at the beach. The tide comes up on the beach, picks up the kelp, makes it all wet, takes it into the ocean and puts it back on the beach. If someone, who’s been taking good care of their mouth for many years, begins taking one of the 400 drugs that causes dry mouth, you have a recipe for disaster.
What methods of treatment have you provided to individuals with dementia?
By the time we see an Alzheimer’s patient, they’ve been referred from their caregiver or from another dentist because they’ve fallen beyond the scope of that office’s ability to treat them. We gather the family together and individualize care. Some patients have had good care and some, unfortunately, are dealing with years of deferred maintenance and neglect. For these patients, we either offer palliative care, or if they want to restore the mouth so they can go back to enjoying food, we offer that option.
We treat patients either at our office with a physician anesthesiologist or in a hospital, depending on their health conditions. 70% of what we do is done under general anesthesia because by the time we see these patients, there’s a lot of catch-up treatment.
That’s the important point that I’d like to get across to families – if you can get their mouth stabilized before they go into the later stages of the disease, they’re way ahead of the curve. As the chief of a hospital division, before someone has to have radiation, they tell us to clean their mouth. Before chemotherapy, they ask us to clean up the mouth because they know what’s coming down the line. It should be the same way with Alzheimer’s. We know that there is a natural trajectory to the disease and what we want to do is make sure that oral disease is a non-issue in the late stages.
Helpful information related to this post:
FAQs
How do you clean your teeth with dementia? ›
Keep the teeth and mouth clean.
If the person wears dentures, rinse them with plain water after meals and brush them daily to remove food particles. Each night, remove them and soak in a cleanser or mouthwash. Then, use a soft toothbrush or moistened gauze pad to clean the gums, tongue and other soft mouth tissues.
Generally, the easiest way is for the person with dementia to sit on a straight-backed chair with the carer standing behind. The carer supports the person against their body, cradling their head with one arm. They can then brush the person's teeth using a dry toothbrush and a pea-sized amount of toothpaste.
What are three suggestions for caregivers of patients with Alzheimer's? ›- Schedule wisely. Establish a daily routine. ...
- Take your time. Anticipate that tasks may take longer than they used to and schedule more time for them. ...
- Involve the person. ...
- Provide choices. ...
- Provide simple instructions. ...
- Limit napping. ...
- Reduce distractions.
The results show that in patients with Alzheimer's, there is a greater loss of teeth and cases of edentulism than in subjects who do not have the disease.
Is baking soda toothpaste good for teeth? ›It is a good idea to use toothpaste regularly because baking soda alone does not have the ability to fight cavities. In addition, overuse of baking soda could damage the teeth. While conscious and careful use of baking soda can be beneficial, it is not a permanent replacement for a good toothpaste.
How do you brush a bedridden person's teeth? ›Oral Care For Older Adults - YouTube
Is there edible toothpaste? ›Now there is edible Japanese toothpaste called Neonisin. The active ingredient in this paste is a peptide found in soy bean curd, so it's completely safe to swallow. It's sort of like brushing your chompers with tofu, in a way. Don't worry.
Do teeth fall out with dementia? ›Alternatively, missing teeth might be an early sign of cognitive impairment: People with cognitive decline might be less likely to keep up with oral hygiene, leading to tooth loss.
How do you clean a patient's teeth? ›How Teeth Are Cleaned At The Dentist - YouTube
What are three signs of caregiver stress? ›- Feeling overwhelmed or constantly worried.
- Feeling tired often.
- Getting too much sleep or not enough sleep.
- Gaining or losing weight.
- Becoming easily irritated or angry.
- Losing interest in activities you used to enjoy.
- Feeling sad.
- Having frequent headaches, bodily pain or other physical problems.
What should you not say to a caregiver? ›
- “You Really Look Tired” ...
- “Your Loved One Used to Be Such a Wonderful Person to Be Around” ...
- “If I Were You, What I Would Do Is…” ...
- “You Should Just Put Your Loved One in a Home” ...
- “You Shouldn't Worry So Much”
- Give the person a hand massage with lotion.
- Brush his or her hair.
- Give the person a manicure.
- Take photos of the person and make a collage.
- Encourage the person to talk more about subjects they enjoy.
- Make a family tree posterboard.
A new study from 2019 in the journal Science Advances showed that P. gingivalis, the bacterium that's a major cause of gum disease, is also linked to Alzheimer's. The DNA of P. gingivalis is present in the brain tissue and spinal fluid of patients with Alzheimer's.
What bacteria causes memory loss and forgetfulness? ›Researchers recently published a new line of evidence supporting a hypothesis that Alzheimer's might be a result of an infection by oral bacteria P. gingivalis. The bacteria produces toxins called gingipains that are found to accumulate in the brain of Alzheimer's patients.
Why are people with dementia more susceptible to dental problems? ›People with dementia are susceptible to dental problems for a number of reasons, including: Reduced saliva - Taking medications that reduce the production of saliva by the salivary glands. Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions.
Can baking soda remove plaque? ›Brushing with baking soda can safely and effectively remove plaque. While still abrasive, baking soda toothpaste is not as hard as the enamel that makes up teeth and can remove plaque without damaging the enamel.
How do you remove brown stains from teeth naturally? ›Baking Soda & Water
If you're sure that the staining is caused by the foods or beverages you're consuming, there's a simple home remedy that can often help whiten them again. Mix baking soda and water, and brush your teeth with it every few days to supplement your typical oral care routine.
Baking powder is very abrasive to the tooth surface and acts by breaking and abrading down the outside layer of the tooth surface rather than actually brightening the tooth." While you might see some toothpastes containing baking soda, this isn't the same as putting the pure product on your teeth.
How do you maintain oral hygiene in bedridden patients? ›In the bedridden patient, electrical toothbrushes may be used, which eliminate extensive arm action and are efficient plaque removers. Suction toothbrush units are best for patients who have lost their ability to swallow as in severe Stevens Johnson syndrome, TEN and oral pemphigus patients.
How do you clean a bedridden mouth? ›Unconscious Oral Care - YouTube
How do you clean a bed ridden mouth? ›
Bring a toothbrush, toothpaste and a basin to the bed side so your loved one can brush their teeth. Keep mouthwash handy so they can wash their mouth in between meals. You will also have to make sure your loved one has clean clothes they can wear everyday so they don't feel uncomfortable throughout the day.
How do you make edible toothpaste? ›- Heat coconut oil over low heat until just barely melted. Takes about 30 seconds.
- Pour into container until almost 3/4 full.
- Add Baking Soda.
- Add Mint Leaves.
A toothpaste should be applied to the tooth and not ingested. If you swallow a small amount, it's generally safe. But if you've consumed too much, it may increase fluoride levels in your blood supply and result in an upset stomach, vomiting, and nausea.
Which tooth is connected to the brain? ›Wisdom teeth, on the other hand, connect to the central nervous system, heart, liver, and intestines.
What is Lewy body dementia symptoms? ›Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention. Other effects include Parkinson's disease signs and symptoms such as rigid muscles, slow movement, walking difficulty and tremors.
Does Alzheimer's affect oral health? ›Oral Health of Elderly People with Alzheimer's Disease
Specifically, they tend to have more prevalent periodontal problems, including gingival bleeding, periodontitis, and attachment loss. They may also suffer from xerostomia and oral lesions, such as stomatitis and Candidiasis.
Dental deep cleaning, also known as scaling and root planing, involves special techniques to get rid of plaque, tartar, and bacteria below the gum line down to your tooth roots. This prevents gum disease from advancing and causing tooth loss.
What home remedy can I use to clean my teeth? ›Using a paste made of baking soda and hydrogen peroxide is said to remove plaque buildup and bacteria to get rid of stains. Mix 1 tablespoon of baking soda with 2 tablespoons of hydrogen peroxide to make a paste. Rinse your mouth thoroughly with water after brushing with this paste.
What can you not do after teeth cleaning? ›- Don't eat anything while your mouth is still numb.
- Don't eat sharp, crunchy, grainy, or challenging foods on the first day.
- Don't drink hot beverages for about 48 hours.
- Don't rinse your mouth for about 48 hours.
Brush gently with small circular movements. Brush around each tooth and gently and carefully along the gum line. Brush the tongue lightly to help keep your loved one's mouth clean. Encourage them to spit the toothpaste out, but not to rinse, as this can lessen the benefit from the fluoride.
Can dementia patients go to the dentist? ›
The resulting cognitive impairment accompanied by psychological and behavioral symptoms usually prompts the need for long-term dental care. However, patients with dementia are often no longer able to adequately care for their personal health and hygiene, including dental health.
Does dementia affect your teeth? ›Alternatively, missing teeth might be an early sign of cognitive impairment: People with cognitive decline might be less likely to keep up with oral hygiene, leading to tooth loss.
How do elderly clean their mouth? ›Brush carefully and gently along your gum line. Lightly brush your tongue or use a tongue scraper to help keep your mouth clean. Clean between your teeth with dental floss, prethreaded flossers, a water flosser, or a similar product. This removes plaque and leftover food that a toothbrush can't reach.
How do you clean a bedridden tongue? ›Unconscious Oral Care - YouTube
How often should seniors have their teeth cleaned? ›Routine dental care is important—no matter the age or stage. So, if your loved one requires elderly dental care, they should be seen at least twice a year.
How do you brush a disabled person's teeth? ›Toothbrush Adaptors
Those in Orange County who need help gripping their toothbrush should consider a toothbrush adaptor. These are easily made at home and caregivers or patients can use a bicycle handle or a tennis ball to improve the grip on their toothbrush.
People with dementia are susceptible to dental problems for a number of reasons, including: Reduced saliva - Taking medications that reduce the production of saliva by the salivary glands. Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions.
Why is mouth care more of an issue for a person with dementia? ›However, people with dementia are more prone to tooth decay and gum disease. This may be because they find it difficult to follow an oral hygiene routine, or because they cannot express that they have a toothache, meaning problems go untreated.
What is xylitol in toothpaste? ›What is Xylitol Toothpaste? A sugar alcohol naturally sourced from plants and specific trees, xylitol adds a sweet flavor to toothpaste. However, unlike the type of sugar we all know and crave, xylitol does not contribute to cavities and decay.
What is the bacteria that causes Alzheimer's? ›Among those 65 years or older, both Alzheimer's diagnoses and deaths were associated with antibodies against the oral bacterium P. gingivalis, which can cluster with other bacteria such as Campylobacter rectus and Prevotella melaninogenica to further increase those risks.
Can rotting teeth affect your brain? ›
Tooth decay and gum disease can lead to serious health problems, including brain or heart infections.
Can rotten teeth cause dementia? ›The researchers found that adults with more tooth loss had a 1.48 times higher risk of developing cognitive impairment and 1.28 times higher risk of being diagnosed with dementia, even after controlling for other factors.
How do you clean your mouth when you have no teeth? ›- Brush your gums: You do not need to have teeth to use an extra-soft toothbrush on your gums. ...
- Brush your tongue: Bacteria and food particles will stick to your tongue and can lead to an unclean mouth. ...
- Use a mouth rinse: ...
- Take care of your dentures:
- Brush Your Teeth. May be it goes without saying, maybe it doesn't – but Brush Your Teeth! ...
- Swish With A Peroxide Or Alcohol Containing Mouthwash. ...
- Floss Between Your Teeth. ...
- Brush Your Tongue. ...
- Drink Water. ...
- Take A Probiotic. ...
- Eat Fibrous Food.
Guide for Carers Brushing someone else's teeth - YouTube