With all of the difficulties facing people with Alzheimer's disease -- not to mention their caregivers -- oral hygiene may seem like a trivial issue. Getting a person clean and dressed is hard enough. Who has time to worry about a few cavities or slipping dentures?
As it turns out, you do. Investing that time can be one of the most important things you do for your loved one.
Dental hygiene crucial to patients' comfort
Oral hygiene may often be overlooked, but it's a crucial part of keeping Alzheimer's patients as comfortable and healthy as possible. Older people in general tend to have dental problems that cause pain or make it hard to chew, swallow, and speak. Such problems become even more common when a person forgets how to use a toothbrush or how to keep her dentures clean.
And for Alzheimer's patients, dental trouble can actually be dangerous. A patient can easily choke if he can't chew properly. He may also have trouble getting enough nutritious food to eat, and a shortfall in nutrition has the potential to hasten the progress of the disease. He could also suffer excruciating pain from cavities -- pain that he might not be able to communicate.
If a person still has teeth, make brushing a part of her daily routine. If she has forgotten how to brush, you can jog her memory by brushing your own teeth in front of her. You may also need to guide her hand while she brushes. If she has trouble gripping the brush, find one with an extra-thick handle.
Brushing for two
As the disease progresses, your loved one may not be able to recognize his toothbrush, let alone use it properly. Now it's your job to put that foreign object into his mouth without upsetting him. Pick a time of the day when he's most cooperative and move slowly and calmly. If he puts up too much of a fuss, try again later. And if he refuses to unclench his teeth, clean the outsides; it's better than nothing at all. Flossing his teeth is also a good idea, if he doesn't mind. (Use the larger part of your hand to gently hold his mouth open, because if you have only a finger or two inside, you may get a painful bite if he closes his jaw unexpectedly.)
If the patient wears dentures, make sure they fit absolutely perfectly. Ill-fitting dentures can irritate the gums and interfere with chewing. And if dentures fit well, you may not have to fuss with adhesives. Dentures must be removed and cleaned every day. If you have never used dentures, talk to your loved one's dentist for advice and instructions.
Regular dental visits
And be sure your loved one sees the dentist regularly (ideally twice a year) to be checked for cavities. Morning appointments are best. Make sure the office understands the basics of caring for an Alzheimer's patient: The dentist should always introduce himself and tell the patient what he is about to do, and noise should be kept to a minimum. Dental journals note that direct eye contact, smiles and gentle touching help convey what is happening.
In addition, you will probably need to sit next to your loved one to help ease the stress of the visit, and hold his hand during the procedures if necessary. If these visits are difficult, ask for a referral to a geriatric dentistry specialist with experience caring for Alzheimer's patients. In the event that X-rays are needed, special examination techniques may be used; in addition, geriatric dentists are also more apt to pay attention to appropriate oral hygiene and to notice lesions that can cause pain and malnutrition.
Arthur H. Friedlander, DMD, Alzheimers disease: Psychopathology, medical management and dental implications J Am Dent Assoc, Vol 137, No 9, 1240-1251, 2006.
Michael Castleman et al. There's Still a Person in There: The Complete Guide to Treating and Coping with Alzheimer's. Putnam Publishers/
Howard Gruetzner, M.Ed. A Caregiver's Guide and Sourcebook. John Wiley & Sons
Nancy L. Mace, M.A., and Peter V. Rabins, M.D., M.P.H. The 36-Hour Day. Johns Hopkins University Press.