ORAL HEALTH AND DEMENTIA
Live webinar held Friday, the 29th of August, 2014, 1:00 pm Eastern
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.
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.
(documents will open in new tabs/browsers) Dental Care and Dementia Oral Health Assessment of Older Adults: The Kayser-Jones Brief Oral Health Status Examination (BOHSE)
Test Your Knowledge
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 http://www.virginiaccc.com/ : 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: http://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): http://www.alimed.com/res-q-vac-suction-toothbrush.html or http://www.vacubrushsuctiontoothbrush.com/
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.
This live webinar is made possible by AlzPossible and the VCU’s Department of Gerontology.