SACRAMENTO, CA (PRWEB) NOVEMBER 30, 2015 | In honor of National Alzheimer’s Disease Awareness Month, CDHA has collaborated with The Alzheimer's Association to discuss the oral hygiene needs of these patients. CDHA would like to emphasize the importance of the RDH and RDHAP as primary care providers for this population. “Registered Dental Hygienists in Alternative Practice (RDHAP)” can travel to and treat patients in nursing homes, residential care homes, and private homes of homebound people. They can come to you” states Heidi Coggan RDHAP. Some RDHAPs even have their own walk-in practices in dental shortage areas. RDHAPs are specifically trained in caring for those suffering from Alzheimer's, and can treat the patient in their place of residence.

Good oral hygiene is important for overall health and well-being. Because Alzheimer’s and dementiaare conditions that grow progressively worse over time, it is important to establish a dental care program soon after the diagnosis. The program should help to improve oral health and reduce the risk of developing poor dental health. “It is important that the person with dementia is given the opportunity to make, or take part in, decisions about dental treatment. The dentist or hygienist should explain to the person in simple terms what is being done and why. Short sentences that are phrased in a way where the person can answer 'yes' or 'no' can be effective,” states CDHA President Lygia Jolley, RDH, BA. “Oral hygiene may often be overlooked,” continues Jolley, “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 dentures clean.

Early stages of Dementia/Alzheimer’s 

In the early stages of dementia, oral care can be accomplished individually, with supervision from a caregiver as needed. It is very important to establish a daily care routine in the early stages of dementia. To aid in this daily care, an electric toothbrush or a toothbrush with an adapted handle to improve grip, may be beneficial.

The RDH or RDHAP may be able to advise the person and/or caregiver on the best methods for preventing tooth decay and gum disease. This may include a prescription, high-concentration fluoride toothpaste used daily, and/or regular application of fluoride varnish. Fluoride can be applied by the RDH/RDHAP every three to four months.

Middle Stages of Dementia/Alzheimer’s 

During this stage, the person may be relatively physically healthy, but cognitive abilities are greatly reduced. The focus of oral treatment at this stage is the prevention of further dental disease: gum disease and tooth decay that can progress to a condition that requires root canal therapy or extractions. These dental conditions can leave the patient with even more severely compromised dental, mental, and physical health.

With regards to treatment, some patients at this stage may require some form of sedation for their dental treatment. The decision will be based on the individual's dental treatment needs, general health, social support, and ability to co-operate. It is during this stage that issues regarding consent to treatment may arise.

Later Stages 

As dementia and/or Alzheimer’s progresses, the person may lose the ability to clean their teeth, or lose interest in doing so. Caregivers may need to assume this task, and a hygienist can provide guidance and support on how to assist in cleaning another person's teeth. The technique will vary depending on the individual concerned. Generally, the easiest way is for the patient with dementia to sit on a straight-backed chair with the caregiver standing behind. The caregiver supports the person against their body, cradling the patient’s head with one arm. They can then brush the patient's teeth using a dry toothbrush and a pea-sized amount of toothpaste. If the patient doesn’t get agitated, using an electric toothbrush can be more effective and easier.

During the middle and late stages of Alzheimer's, oral hygiene care may become even more challenging. The person may forget what to do with toothpaste, how to rinse, or may be resistant to assistance from others. CDHA offers the following tips, provide short, simple instructions, use the "watch me" technique and hold a toothbrush to show the patient how to brush his or her teeth. Keep the patient’s teeth and mouth clean by brushing twice daily, use different types of toothbrushes, but always soft bristled, and floss daily using a “proxabrush” when necessary.

Be Aware of Dental Pain or Conditions 

The time may come when the Alzheimer’s patient is unable to communicate that they are experiencing pain or discomfort in their mouth or teeth. They will need to rely on others to notice and interpret their behavior and to arrange a visit to the dentist if necessary. There are several behavioral changes that may indicate that someone with dementia is experiencing dental problems. These may include: 

•     refusal to eat (particularly hard or cold foods) or strained facial expressions while eating

•     frequent pulling at the face or mouth

•     leaving previously worn dentures out of their mouth

•     increased restlessness, moaning or shouting

•     disturbed sleep

•     refusal to take part in daily activities

•     aggressive behavior

If there is no explanation for the change in behavior, arrangements should be made to identify the cause, and should include a dental assessment as part of the process. If the person's dementia reaches a point where their dentist can no longer manage their treatment needs, they might be referred to an RDHAP or to a geriatric dentistry specialist with experience caring for Alzheimer’s patients. These services act as a safety net for people who are unable to receive care from a general dental practitioner or have limited ability to travel. The RDHAP’s are trained to provide dental care for people with disabilities and complex medical conditions in the comfort of their own home or long term care facility. Kari Walker, Director of Education for the Alzheimer's Association Orange County Chapter adds, "We appreciate the attention that is being brought to the importance of dental health for persons with dementia. Because Alzheimer's disease often prevents a person from being able to communicate basic oral discomfort in the early stages, many people develop more severe dental complications which could have been prevented.” Working out a long term oral health care plan with an RDH or RDHAP at the time of diagnosis is imperative to maintain the oral health of those suffering from dementia and Alzheimer’s.

The California Dental Hygienists’ Association recommends visiting its website for more information and to find an RDHAP near you:https://www.cdha.org