Maintaining Oral Health in Dementia Care

While much attention is focused on the cognitive decline and memory loss associated with dementia, oral health is often overlooked. 

Many caregivers and healthcare professionals may not realize that oral hygiene is not just about keeping teeth clean. Poor oral health, particularly gum disease, can exacerbate cognitive decline, increase inflammation, and even contribute to other health complications in individuals with dementia.

For caregivers, home care companies, care homes, and healthcare professionals, understanding the strong link between oral health and dementia is essential for providing comprehensive care. By prioritizing dental hygiene, the quality of life for individuals with dementia can be improved, and health complications reduced.

The Impact of Poor Oral Health in Dementia

Poor oral health, particularly gum disease (periodontitis), is linked to increased inflammation and bacteria in the mouth, which can enter the bloodstream and potentially affect the brain. Studies such as the one published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, found that individuals with poor oral hygiene were at a higher risk of developing cognitive impairment, including dementia. 

The study noted that the bacteria responsible for gum disease, particularly Porphyromonas gingivalis, can trigger inflammation in the mouth. When left untreated, gum disease causes the gums to recede and pockets to form, allowing these harmful bacteria to enter the bloodstream. Once in the bloodstream, the bacteria can travel to various parts of the body, including the brain. This inflammation could contribute to the build-up of amyloid plaques in the brain. 

Amyloid plaques are abnormal clumps of protein that accumulate between nerve cells in the brains of individuals with Alzheimer’s disease. These plaques disrupt the communication between brain cells and are a hallmark of Alzheimer’s pathology. 

Additionally, the immune system’s response to these bacteria can accelerate brain tissue damage. 

The body’s inflammatory response, intended to fight infection, may inadvertently cause harm to the brain over time. This cycle of inflammation and bacterial infection appears to create a feedback loop: the more inflammation in the mouth, the more it contributes to brain inflammation, accelerating the development of Alzheimer’s disease and other forms of dementia.

In essence, poor oral health is not just a matter of hygiene but can act as a silent contributor to the brain’s deterioration. By neglecting oral health, caregivers may unknowingly be allowing bacteria to exacerbate the cognitive decline that is characteristic of dementia.

Challenges of Oral Care in Dementia

Dementia patients often face significant challenges when it comes to oral hygiene. 

As cognitive function deteriorates, so too does the ability to perform simple daily tasks, including brushing teeth. This can result in a build-up of plaque and food particles, increasing the risk of tooth decay and gum disease. 

Additionally, many individuals with dementia may experience difficulties with communication, making it hard for caregivers to recognise signs of oral pain or discomfort.

Behavioural changes are another concern. 

Individuals with dementia may become resistant to daily oral care routines, especially if they are not familiar with the process. Some may have a fear of dental procedures or feel disoriented during tooth brushing, making it more difficult for caregivers to help.

The Role of Caregivers and Care Homes in Maintaining Oral Health

Given the impact of oral hygiene on well-being, it is therefore essential for caregivers to make daily oral hygiene a priority and find strategies that work best for each individual. Below are some practical tips for caregivers to improve oral health in dementia patients:

Establish a Routine: People with dementia often respond well to structured routines. Try to make oral care part of a daily routine, at the same time each day, to build familiarity.

Patient and Gentle Approach: As life becomes busier, it’s easy to overlook oral hygiene, especially for individuals who are unable to communicate their needs. However, it’s crucial to approach oral care with patience and consistency. Rushing or skipping routines can lead to serious health issues, so it’s important to make time for thorough and gentle oral hygiene every day. Use a soft-bristled toothbrush, and apply a fluoride toothpaste to help prevent cavities. If the person resists, try distraction techniques such as playing soothing music or using a familiar object.

Regular Oral Check-ups: Caregivers should make it a habit to visually inspect the mouth and teeth regularly for signs of issues like chipped teeth, sores, or inflammation. A foul smell could indicate infection or untreated gum disease, while a noticeable lack of interest in food or difficulty chewing might be linked to dental pain. If any concerns are noticed, it’s important to seek professional dental care promptly to ensure the individual’s comfort and well-being.

Dental Tools and Modifications: Use adaptive dental tools that are easier for individuals with dementia to hold and use. There are electric toothbrushes with large handles, as well as specialised cups that can help with rinsing.

Encourage Hydration: Dry mouth, a common issue for individuals with dementia, can complicate dental problems. Encourage the person to drink water frequently, as this helps in washing away food particles and bacteria.

Diet and Nutrition: A well-balanced diet rich in fruits and vegetables can promote good oral health. Minimise sugary snacks and drinks, as they can contribute to tooth decay.

Caring for someone with dementia requires more than just compassion. It demands a commitment to learning, observing, and being patient. By educating ourselves on the crucial role of oral health and paying close attention to subtle signs, caregivers can better detect and address potential issues before they become serious problems. While the journey can be challenging, maintaining a consistent, gentle approach to oral care can significantly improve comfort, reduce unnecessary health complications, and help individuals with dementia retain a sense of dignity.

At Dementia Solutions, we’ve made it our mission to demystify dementia behaviour and continue to explore person-centred, creative, non-pharmacological solutions to manage dementia-related behaviours. We believe that awareness creation and skill-building through education is the most effective and powerful tool we have to promote and maintain the well-being of both the person with dementia and their caregiver.