Just the Facts and More: Dental Care
The person with Alzheimer's disease may have special problems maintaining good oral hygiene. For example, (s)he may have difficulty brushing because (s)he forgets what to do with the toothpaste or how to rinse. As the disease progresses, the person may forget that dental care is important and neglect caring for his/her teeth and gums.
You, the caregiver, may need to assume increasing responsibility for your family member's dental care. Your efforts early in the course of the disease may help the person to avoid extensive dental procedures later, when (s)he may have trouble tolerating them. In addition, good oral hygiene can help to maintain the person's integrity, appearance and comfort despite the progression of Alzheimer's disease.
Take preventive measures.
- Recognize the relationship between diet and good dental health. You may want to eliminate or limit sugary foods such as candy, cookies, cakes and soft drinks. If the impaired person has a "sweet tooth," you should hide sugary foods in a cupboard, refrigerator or freezer. You may also want to consider foods with artificial sweeteners.
- Be aware of the dangers of some between-meal snacks. Try to encourage the person to eat fruits and raw vegetables rather than sugary snacks. But if you must give him/her sugary foods, make them a part of regular meals. After the meal, encourage the person to brush his/her teeth or at least rinse his/her mouth with water.
- To protect tooth surfaces from decay, encourage the patient to use a fluoride rinse or gel as well as a fluoride toothpaste. Fluoride rinses can be purchased over the counter, but you need a prescription to purchase a stannous fluoride gel. If the person has difficulty spitting, you may have to wipe the gel from his/her mouth or allow him/her to swallow it. Consult your dentist about using stannous fluoride gel.
- Help the person brush his/her teeth at least twice a day for two minutes, if possible, with the last brushing after the evening meal and night time liquid medication. Allow plenty of time and find a comfortable position if you must do the brushing yourself. Gently place the toothbrush in the person's mouth at a 45-degree angle so you massage gum tissue as you clean the teeth. Also, you may want to use a spoon or another brush to pull the cheek sideways so you can see the area being brushed.
- Try to use dental floss. Most dentists recommend dental floss, although you and the person with Alzheimer's may find it frustrating to use. As an alternative, some caregivers use a "proxabrush" to clean between the teeth.
Find a dentist you can trust.
- Seek dental care for the person shortly after (s)he is diagnosed with Alzheimer's disease. Try to work with the dentist throughout the progression of the disease.
- Contact your local dental society to find the names of professionals who are qualified to work with elderly patients. Some general dentists are familiar with the illnesses and conditions of older people and have often spent extensive time working in nursing homes.
- Emphasize prevention. Instead of having the patient visit the dentist twice a year, you may want to schedule visits more frequently for regular cleanings. It is important to prevent tooth decay and gum problems in order to prevent pain and infection.
- Stress maintenance. By working with a dentist to treat the person's dental problems early in the disease, you can help to avoid having to do extensive dental work as the disease progresses.
- Be sure to provide the dentist with a complete listing of all health care providers who have served this family member, his/her complete medical history, and the names of all medications (s)he has received. You may ask the dentist to arrange for the transfer of records from other offices to his/her office.
- Be aware of potential medication problems. Among the medications you should discuss with your dentist are Haldol, which may cause "dry mouth." Other medications you should discuss include blood thinner, antidepressants, anti-anxiety agents, antihistamines, diuretics, and hypertensives.
- Be aware of the special problems of dry mouth. Saliva tends to act as a buffer against tooth decay. Some medications reduce the production of saliva, leading to an increase in tooth decay and gum problems. If the person complains of dry mouth, offer him/her water periodically throughout the day, or buy artificial saliva (available at your pharmacy). Since alcohol can contribute to a dry mouth, some experts suggest using mouth rinses that are low in alcohol, or diluting mouth rinses containing alcohol.
Use patience and common sense.
- Explain dental care to your family member. Don't expect the person to remember how to brush and floss. Instead, encourage him/her to brush by saying, "Show me how you brush your teeth." You may need to guide the person through each step of the process by placing your hand over his/hers, or demonstrate by brushing your own teeth at the same time. If the person seems agitated or uncooperative, you may want to postpone brushing until later in the day, or brush fewer times a day.
- Experiment with different types of toothbrushes or dental devices. Many caregivers believe that a soft-bristled children's toothbrush works better than a hard-bristled adult's brush. Other caregivers prefer a long-handled or angled brush. Be aware that electric appliances may confuse, disturb or be a safety concern for the person with Alzheimer's.
- Make it easy to use dental devices. Many caregivers find that it is easier for the person to grasp a toothbrush if a ball or bicycle handlebar grip is attached to the end of the handle. Another idea -- wrap aluminum foil around the toothbrush handle or attach a Velcro strap around the person's hand.
- Be aware that, as the disease progresses, the person with Alzheimer's may refuse to clean his/her teeth or may become uncooperative in the dental office. At this point, you may need to assume complete responsibility for the patient's dental hygiene.
Take special care of dentures.
- If the person wears dentures, ask your dentist to verify that they fit properly. Poorly fitting dentures make it difficult for him/her to eat and digest food, and may contribute to a poor appetite or lack of interest in certain foods.
- Rinse partial and full dentures with plain water after meal times to remove food particles. Use a hard-bristle brush, such as a manicure or fingernail brush to clean the dentures. Be sure you remove the dentures and soak in a cleanser or mouthwash overnight and then help the person reinsert the dentures in the morning.
- If the person is in a group or nursing home environment, you may want to ask your dentist to have the dentures labeled with his/her name.
- Keep in mind that in the later stages of this disease, the person may not be able to wear full or partial dentures. Speak regularly with the dentist about the patient's changing needs.
One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.
The primary resource for this fact sheet were Barry W. Ceridan, DDS, PSC, a general dentist in private practice in Louisville, Kentucky and President, American Society for Geriatric Dentistry; and Marilyn R. Carlson, DMD, MD, President, Ohio Chapter, American Society for Geriatric Dentistrys.
Special thanks to the following Chapters of the Alzheimer's Association: Cape Cod and the Islands, Massachusetts; Eastern Massachusetts; Honolulu, Hawaii; Louisville, Kentucky; Northern Virginia; St. Louis, Missouri; and Western Massachusetts.
Recognition is also extended to the American Society for Geriatric Dentistry.
For more information on how to find a dental professional who treats special care patients, contact your local or state dental society.
Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.