Geriatric Dental

Abstract

Geriatric dental care in the dementia patient is important to prevent various illnesses, as well as preventing side effects that are common among the diverse medications that these patients are taking. Dementia is a disease that causes damage to brain cells. It also causes patients to have memory loss of learning. Dementia starts out slow and becomes progressively worse over time, and eventually leads to Alzheimer’s disease. It is important to provide adequate oral healthcare to the dementia patient due to the risk of getting aspirating pneumonia. Dementia patients often have a caregiver or live in nursing homes. It is important to teach caregivers and certified nursing assistants the importance of providing daily oral hygiene to these patients. It is also important that dementia patients get regular dental cleanings and that dental hygienists are aware of how to properly treat patients with dementia. Properly treating these patients in the dental office include being empathetic and making the patient as comfortable as possible.

Dementia is a general term that is used to describe patients that have a decline in mental health that is severe enough to affect their daily lives. Dementia is a broad term that classifies diverse patients under one broad category. There are many diversified diseases that are classified under dementia including Alzheimer’s disease and Vascular dementia. “Alzheimers disease accounts for 60 to 80 percent of cases” (alz.org, 2017). Vascular dementia is another type of dementia that can be caused after a patient suffers from a stroke. “Vascular dementia is the second most common dementia type, but there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies” (alz.org,2017). Dementia is used to describe multiple patients’ behaviors if they appear confused, forget things easily, or seem to have a hard time focusing.

Dementia does not necessarily come with age. It can be caused from an array of things. Symptoms of dementia can influence activities in daily living such as forgetting one’s purse or wallet, and forgetting where one is going when traveling to or from somewhere as simple as the grocery store. However, these symptoms can also occur in patients who may not have dementia. There are “two core mental functions that must be significantly impaired to be considered dementia: memory loss, communication and language, ability to focus and pay attention, reasoning and judgment, visual perception” (alz.org,2017). Dementia is a disease that starts out slow, and then symptoms begin to get progressively worse over time.

It is important to be aware of the symptoms that are diagnosed with this disease. Sometimes a loved one may forget something small such as an event that was planned like a church gathering or family dinner, but that does not mean that this person has dementia. People are known to forget things time to time, but that does not mean that they have this disease. Dementia can be mistaken in some patients, especially elderly people. Dementia is a “widespread disease, but incorrect belief that serious mental decline is a normal part of aging” (alz.org,2017). Geriatric patients seem to interpret all of their health problems being linked to their age. However, most of the things that geriatric patients suffer from are things that are evolved due to their lifestyle rather than their age.

Dementia is similar to Alzheimer’s. In fact, it is one of the early symptoms of Alzheimer’s. Dementia is a condition that causes damage to brain cells. This type of damage interferes with how the brain cells communicate with each other to help one communicate properly and think clearly. When the brain cells become damaged communication, thinking process, and feelings become affected by this disease. Where the brain is such a large organ, and different lobes do different things there is potential for each lobe to be damaged and affect the patient in different ways. Depending on where the damaged cells are attacking, the patient will experience different symptoms of dementia. There is a region in the brain called the hippocampus that is the center for learning and memory, and this region is the one that is most often affected first by these damaging cells. Therefore,memory is one of the first things to go when being diagnosed with dementia and Alzheimer’s. Usually, when dementia is diagnosed, slow detection of the brain is common.Iif it is diagnosed in early stages, it is possible to regress the disease.

Treatment of dementia can be maintained to try and help the patient. However, if dementia has progressed into Alzheimer’s disease, there is no treatment and no cure currently available. Clinical trials are being done to try in finding a cure for this terrible disease. Some of the medications that are given to Alzheimer’s patients are current drugs that are used to treat symptoms associated with dementia. Recommendations to help reduce the risk of getting dementia include living a healthy lifestyle. Diet and exercise is a key factor in reducing this risk. Heart healthy diets, as well as Mediterranean diets are recommended to maintain healthy brain function. These are steps that have been reported by alz.org to have an impact on reducing the risk of being diagnosed with dementia in the future.

Geriatric patients that are more commonly expected to have oral disease include those that have had previous dental disease in their lifetime, as well as smokers, those that are not regular dental patients, patients that present with dementia, and patients that have swallowing problems and nutritional deficiencies. “The reason that dental hygiene is becoming more important among elderly patients is that most of them are keeping their natural teeth longer, and are decreasing the edentulism rate"(alz.org,2017). Therefore, less geriatric patients these days have full sets of dentures compared to the past.

Poor oral health can affect geriatric patients in more ways than one. “Geriatric patients that do not receive routine cleanings are at higher risk for respiratory illnesses, nutritional deficiencies, and overall declination in well-being”(alz.org,2017). The importance of oral hygiene care in geriatric patients is often misunderstood and neglected. Neglect and misunderstanding of dental pain is common among older adults that are institutionalized and that have been diagnosed with dementia. Most of the time a patient suffering from dementia that presents with dental pain often goes undiagnosed. However, “ behavioral problems in people with dementia can be caused by dental pain and problems; these behaviors include neglecting to eat and being disinterested in food, chewing of the lip, tongue or hands, ‘pulling’ at the face or mouth, not wearing dentures, grinding teeth or dentures, aggression (especially during activities of daily living) and alterations in activity (such as somnolence, weariness, screaming and restlessness” (Chalmers et al, 1997). Because aspiration pneumonia and bacteremia are common among dementia patients, it is important to provide thorough and frequent dental cleanings on a regular basis. As well as making sure that these patients have help in doing daily oral hygiene. Daily oral hygiene will help reduce the patients risk of getting aspiration pneumonia, and bacteremia. It is also important to “manage medication side-effects such as dry mouth (xerostomia or salivary gland hypo function), speech problems, swallowing problems, tardive dyskinesia and gingival overgrowth; maintain adequate nutrition and hydration; and manage consequences of common medical conditions such as Sjögren’s syndrome, arthritis, stroke, radiation, and chemotherapy” (Baker et al. 1991, Chamlers et al. 1997, Henry 1999, Russell et al. 1999).

There are many reasons why healthcare professionals should be taught to provide adequate oral hygiene in nursing homes and assisted living facilities. Oral hygiene is an important factor in one’s health and sometimes can be life or death to a geriatric patient. That is why it is important to teach caregivers and certified nursing assistants how to provide proper and adequate oral hygiene to a dementia patient, especially since these patients cannot provide proper treatment for themselves.

Learning how to treat a patient in the dental chair is something that all of the future hygienists will probably have to do at least once in their life. Even though dementia is more common among the elderly, that does not mean that when treating a dementia patient he or she will necessarily be of old age. However, it is important to be understanding and helpful when treating this type of patient. When treating a dementia patient in the dental chair, it is not just about removing biofilm and calculus. It will be about much more. When treating geriatric patients, it is important to consider the risk that can be associated if they do not have dental cleanings done on a regular basis. Geriatric patients can be at an increased risk for respiratory illnesses, such as pneumonia, due to the toxic pathogens that are being consumed on a daily basis. However, treating dementia patients can be easier said than done. It is important for the clinician to be understanding of the patient’s cognitive thoughts, and be able to provide communication even though these patients may be suffering from a declining learning curve.

Treating the patient with dementia is why it is important to have empathy in this profession. Dementia patients may present with fear as well as mistrust in the clinician. Therefore this can cause the clinician to have a harder time treating this patient unless the clinician makes a connection with the patient first. Connecting with the patient is important because it makes them more comfortable and less likely to be distrusting. Connecting with the patient can just be simply speaking with the patient about their interests, talking to them about their families, and even relating to them emotionally. “Connection might involve holding a precious family photo or applying lipstick to a female patient’s lips (especially one who wore it everyday for many decades), joining in singing a familiar song or hymn, or gently rubbing your hand across the patients face” (Slim,2017).

Not only is it important to build rapport with the patient, it is also important to be cognitive of the patient’s medical and personal history before the appointment. Aspiration is a medical condition that is common among patients that are in the later stages of dementia. The misdirection of gastric secretions in the lower respiratory tract can possibly lead to aspiration pneumonia, which is a predictor of mortality. That it why it is important for “patients with aspiration precautions to be advised to not use toothpaste: alcohol-free chlorohexidine is a great alternative and caregivers can dip the toothbrush into about 15ML rinse in a medicine cup (Tap off the excess and then brush) only use CHX for six weeks then switch to over the counter antimicrobial mouthrinse” (Slim,2017). It is also important to stress the importance of daily oral hygiene to the patients’ caregivers. If these patients live in a nursing home, it is especially important to teach the certified nursing assistants and registered nurses ways to provide daily oral hygiene to these patients. One daily oral hygiene tip involves dipping a toothbrush into a chlorohexidine or antimicrobial mouth rinse, and brushing the patients teeth t