ORAL HEALTH AND DEMENTIA
Live webinar held Friday, the 29th of August, 2014, 1:00 pm EasternBACKGROUND
Appropriate dental care and the maintenance of oral health are very important for the older adult population, particularly persons affected by dementia. Poor oral health can detrimentally affect nutritional status, behavior and overall quality of life. A decline in oral health is often observed among older adults after admission to long-term care. Persons with dementia experience a higher risk for oral disease because they forget to and become unable to perform oral hygiene. In addition, they have a decreased ability to report pain or discomfort and may attempt to resist assistance from caregivers, which can sometimes indicate the presence of a dental issue.
Medications taken by older adults and medical conditions afflicting this population, particularly Alzheimer’s disease, can cause a reduction in the production of saliva leading to dry mouth, which can lead to the development of gum diseases and dental caries. Antipsychotic drugs can cause repetitive tongue and jaw movements that make wearing dentures difficult. In addition, dentures can become loose and ill fitting after many years, causing damage such as oral lesions. These common oral issues and many others can be avoided by implementing an appropriate oral hygiene care plan and insuring professional dental treatment is received. So, what should we do if we care for individuals with dementia and such dental issues? The webinar will address this question and more, allowing us to learn about the what, the why and the how in order to manage good oral health for the individuals in our care.
Intended Audience
The series addresses professional service providers which include medical doctors, registered nurses, social workers, geriatric care managers, gerontologists, gerontology students, counselors, ombudsman/patient advocates, and family caregivers.
Learning Objectives
At the end of this presentation participants will be able to: 1. Describe the importance of maintaining good oral/dental health in older adults. 2. Communicate a basic understanding of characteristics of oral-systemic interactions as associated with aging and common among older adults. 3. Describe oral-pharmacological interactions often experienced by older adults, with a focus on those with Alzheimer’s Disease. 4. Translate the bi-directional relationship between periodontal/gum disease and Alzheimer’s Disease. 5. Discuss proper brushing and flossing techniques and how to perform them on individuals with Alzheimer’s Disease.
Test Your Knowledge
RECORDING
SLIDES
AlzPossible Oral Health and Dementia AUG 2015 Webinar ReportDownload the slides here.
REMAINING QUESTIONS POSED DURING THE EVENT
AlzPossible very much appreciates Dr. Bonwell’s time and effort to respond to these additional questions.
Q: Do older adults need to visit the dentist more often than every six months?
PB: The need to see an oral health care professional more frequently will vary from patient to patient and what they present with regards to their oral health status/condition. Those with periodontal issues and/or present with more plaque and/or calculus would benefit from seeing an oral health care professional more frequently. Your oral health care provider will be able to establish the proper recall for dental care.
Q: Is it better to use a manual toothbrush or electric?
PB: Research findings support the use of electric toothbrushes, especially for individuals with poor dexterity, for whatever reason/condition, or with other special needs. However, if the brushing technique is performed properly, manual tooth brushing is very effective.
Comment: The new Virginia Commonwealth Coordinated Care Program under two of the providers, DOES cover Dental Benefits. Anthem HealthKeepers covers exams, cleanings and X rays and Humana covers annual evaluations and cleanings.
PB: One of the potential benefits of The Virginia Commonwealth Coordinated Care Program (CCC) is coverage of additional benefits beyond the typical Medicare and Medicaid covered services. Retrieved from Anthem Health Keepers offers dental benefits, including exams, cleanings and X-rays, Humana offers annual dental evaluation and cleaning. An individual can only apply for one of these new programs that provide dental benefits if they are dual eligible, meaning they are eligible for both Medicare and Medicaid.
Outside of these two new options, coverage, for routine dental care, is only for folks under 21. Medically necessary oral surgery and the services used to determine the medical problem such as X-rays and surgical extractions for individuals 21 and older. See: https://coverva.org/mat/H_PE_Covered_Services.pdf
Comment: There is a local clinic for those within the Central Virginia Area called the RCSC located at Central VA Training Center in which individuals (some who are dx: ID/Dementia /Alzheimer’s who are being discharged into the community can utilize in comparison to community based care.
PB: Thanks for sharing this info.
Q: What sort of modifications should be made for an individual who cannot/does not expectorate? How about someone who is on thickened liquids and cannot/does not expectorate?
PB: Gauze can be used to dry the mouth and remove excess saliva while brushing. You can also incorporate the use of a suction brush. For more info on some of these brushes see (but, of course, there are others available): https://www.alimed.com/res-q-vac-suction-toothbrush.html
Q: Is there any particular benefit to mouthwash with alcohol compared to alcohol free mouthwash.
PB: Mouthwashes containing alcohol act as great bacteria killers/controllers when used appropriately. The use of alcohol mouthwashes can serve as supportive adjuncts when combating periodontal diseases. However, if a person suffers from dry mouth possibly from medications taken, the use of a mouthwash containing alcohol is not recommended as the alcohol will act more like an irritant to the gingival tissues.
Comment: Not a question, just the method we are using with residents with impaired swallowing, is using a suction toothbrush. Very effective.
PB: Great tool!
Q: Can dentures or partials be flossed?
PB: No, dentures and partials cannot be flossed as they are made as one unit without spaces between the fabricated teeth. If you are referring to implants, they can be flossed around or if you are referring to permanent bridges, they can be flossed under.
Q: my mother-in-law has upper & lower dentures, she uses Seabond wafer (2-3/day) for uppers b/c they fall out – she doesn’t have much bone to hold them in – any recommendation – she eats well – thank you.
PB: If she is eating well wearing the dentures and is able to communicate well, with no signs of gingival tissue irritation or other gingival conditions or oral lesions, then continuing to use the Seabond wafers will work. However, she may benefit from having her dentures relined to provide a more secure fit and possibly eliminate the use of wafers. It would not hurt to have her evaluated by an oral health care professional.
Presenter
Patricia Brown Bonwell, RDH, BSDH, MSG, PhD, serves as the Dental Clinic Coordinator for Lucy Corr Village, a Continuing Care Retirement Community (CCRC). She is also an Assistant Professor for the VCU School of Dentistry’s Dental Hygiene Program where she serves as the Director of the Program’s Public Health Courses and as a Clinic Instructor. She also teaches an elective course offered to fourth year VCU Medical students focusing on an interdisciplinary approach to oral and overall health in the geriatric population.
Dr. Bonwell is a Registered Dental Hygienist and a Gerontologist. She focuses on improving and maintaining the oral health of members of the geriatric population. From the Medical College of Virginia/Virginia Commonwealth University, she received a Bachelor of Science Degree in Dental Hygiene, Cum Laude, a Master of Science Degree in Gerontology, and a Doctorate of Philosophy in Health Related Sciences with a focus in Gerontology. She was awarded, by the Department of Gerontology, the A.D. Williams Award, which recognizes outstanding academic and professional performance. Dr. Bonwell was also recognized as one of the forty (40) Outstanding MCV/VCU Dental Hygiene Alumni.
Dr. Bonwell is a member of the Gerontological Society of America and is a member of Sigma Phi Omega, the National Gerontology Academic Honor and Professional Society. She is also an active member of the American Dental Hygienists’ Association at both the state and local levels. Dr. Bonwell has received grant funding from various resources and has conducted research and authored and co-authored successful peer reviewed publications. She also has an educational module published in the American Association of Medical Colleges’ MedEdPortal. Dr. Bonwell also serves as a member of the Virginia Oral Health Coalition’s Board of Directors.
Moderators
E. Ayn Welleford, PhD, received her BA in Management/Psychology from Averett College, M.S. in Gerontology and PhD in Developmental Psychology from Virginia Commonwealth University. She has taught extensively in the areas of Lifespan Development, and Adult Development and Aging, Geropsychology, and Aging & Human Values. As an educator, researcher, and previously as a practitioner she has worked with a broad spectrum of individuals across the caregiving and long term care continuum. As Associate Professor and Chair of VCU’s Department of Gerontology, she currently works to “Improve Elder Care through Education” through her Teaching, Scholarship, and Community Engagement. Outside of the classroom, Dr. Welleford provides community education and serves on several boards and committees. Dr. Welleford is former Chair of the Governor’s Commonwealth of Virginia Alzheimer’s and Related Disorders Commission, as well as a recipient of the AGHE Distinguished Teacher Award. In 2011, Dr. Welleford was honored by the Alzheimer’s Association at their annual Recognition Reception for her statewide advocacy. Dr. Welleford is the author of numerous publications and presentations given at national, state and local conferences, community engagement and continuing education forums. In 2012, Dr. Welleford was appointed to the Advisory Board for VCU’s West Grace Village project. She is also the recipient of the 2012 Mary Creath Payne Leadership Award from Senior Connections, the Capital Area Agency on Aging.
John (Jay) T. White has a Masters in Gerontology from the Virginia Commonwealth University and is the Department of Gerontology’s Director of Professional and Community Development. His background includes marketing, public relations, fundraising and organizational development within statewide non-profit, education and tourism-related organizations.
Jay earned his BA in American History from Washington and Lee University and completed coursework for an MA in American Studies from the College of William and Mary. Current volunteer involvement includes Family Lifeline’s ElderFriends Task Force and a Grace Place Adult Day Center. Jay is a member of the Richmond Senior Network, the RVa Better Aging Forum, the Gerontological Society of America and the American Society on Aging.
Jay has co-authored articles and given presentations on a variety of topics including: LGBT and Aging, Aging in Place, Nutritional Needs of Older Adults, Evaluating Depression and Dementia and Person-Centered Care and Culture Change.