Dementia and Dental Care: Nurse Offers New Oral Hygiene Strategies

Amanda Chan, MyHealthNewsDaily Staff Writer   |   May 03, 2011 12:03pm ET

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When someone has dementia, normal daily activities become difficult. Something as simple as brushing your teeth can become a challenge. And for those caring for people with dementia, helping them brush their teeth can be challenging, too, because dementia increases threat perception and decreases ability to understand things in context, health experts say.
But it's important to care for the teeth of this aging population, especially as more of them are able to retain their natural teeth because of good preventive dental care (regular checkups) and fluoridated water, said Rita Jablonski, an assistant professor of nursing at Pennsylvania State University. A dirty mouth provides a breeding ground for dangerous bacteria, such as Streptococcus pneumoniae that causes pneumonia.
During dementia, there are changes to a region of the brain called the amygdala, Jablonski said. The amygdala holds and moderates memories of fear, which is a good thing for example, getting stung by a bee teaches a person to avoid bees, she said.

"It's important for the organism to have a recall of adverse events and avoid these things," Jablonski told MyHealthNewsDaily.
But for people with dementia, other parts of the brain are unable to communicate with the amygdala, leaving neurological plaques and tangles that literally obscure pathways in the brain, she said. For a person with dementia, everything is a threat including a nurse who is trying to clean teeth or scrub dentures.
But throughout Jablonski's career as a nurse and then a nurse practitioner, she has used trial and error to compile several tips to help both nurses and family caregivers deal with people suffering from dementia.
"I started accidentally finding ways to interact with people with dementia , whether it was looking into their mouths or listening to their lungs or undressing them," she said. "I was finding things that worked."
Here are a couple of the techniques included in the Managing Oral Hygiene Using Threat Reduction (MOUTh) oral hygiene approach, developed by Jablonski and her colleagues, that are important not only for oral care , but for overall care of a person with dementia:
No 'elderspeak'
When a lot of people talk to older adults, they engage in a type of speech called "elderspeak," Jablonski said.
"Elderspeak is characterized by high-pitch, sing-song voice, use of plural pronouns, and it sounds comical," she said. "It's how I talk to my cat."
A person with dementia may forget the day of the week, the year or even the names of his or her children or spouse. But a person with dementia never forgets that he or she is an adult, Jablonski said.
So when a person uses elderspeak with an older person -- whether he or she has dementia or not -- it's a direct assault on their personhood, and that person better duck, she said.
"If you do baby talk to an 85-year-old, they're not going to like it," Jablonski said.
This falls in line with a study published in 2008 in the American Journal of Alzheimer's Disease and Other Dementias, which showed that elderly patients exposed to elderspeak were more likely to be aggressive and uncooperative than patients who were spoken to like adults.
Promote independence
Another thing that people do that generates a negative response from an older person is doing things for the person, Jablonski said.
"It's faster, it's easier, so if I grab a toothbrush and I do it because I have to leave in 10 minutes, I'm rushing the older adult," she said. "I may be rough and I may not realize it. I may be hurting them and not realize it."
Therefore, allowing someone with dementia to do take care of his or her own hygiene -- within reason -- helps to promote their independence, she said.
One strategy is to use the "hand-over-hand" technique, which allows the person to hold the toothbrush. Then, the caregiver puts a hand over the dementia patient's hand, so that he or she is still technically brushing the teeth, Jablonski said.
Another good strategy is to gesture and pantomime, especially because words can get jumbled up and confusing for people with dementia , she said.
"Sometimes with dementia, the ability to process verbal directions is compromised," Jablonski said. "So if I say to you, 'Brush your teeth,' you may hear 'Brush your teeth' but have no idea what I'm talking about. But if I open my mouth and gesture like I'm brushing my own teeth, then you understand."
Pass it on: Don't use elderspeak and help retain independence for people with dementia, especially when it comes to their oral care.

Otzi the Iceman needed to see a dentist

Ötzi the Iceman Needed a Dentist

Tia Ghose, LiveScience Staff Writer   |   April 11, 2013 11:41am ET

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Otzi the iceman, an astonishingly preserved Neolithic mummy found in the Alps in 1991, shows evidence of severe gum disease and cavities (shown in red). Credit: UZH View full size image

Ötzi the Iceman could have used a dentist. The amazingly preserved Neolithic mummy found in the Italian Alps had tooth decay, gum disease and dental trauma, new research suggests.
The new findings, published Tuesday (April 9) in the European Journal of Oral Sciences, suggest that the Iceman mummy's grain-heavy diet took a toll on his dental health.
"It's surprising how bad condition he is in," said study co-author Frank Ruhli, a paleopathologist at the University of Zurich in Switzerland. "We have the whole range of disease pathologies you can imagine." [Album: What Otzi the Iceman Looked Like]

Ötzi is probably the most-studied Neolithic man in history. More than 5,000 years ago, the ancient iceman was hit by an arrow and bled to death on a glacier in the Alps between modern-day Austria and Italy. The glacier preserved his body until it was discovered by hikers in 1991.
Since his discovery in the Ötzal Alps by the hikers, scientists have reconstructed Ötzi's face, analyzed his clothing, scrutinized his body and sequenced his genome.
These extensive studies revealed that Ötzi was a middle-age, well-to-do agriculturalist who lived not far from where he died. He also suffered from heart disease and joint pain, and probably had Lyme disease.
But somehow, scientists had never analyzed his teeth before. So Ruhli and his colleagues used a CT scanner to analyze the condition of Ötzi's teeth. They found that the ancient farmer had several cavities, likely caused by his carbohydrate-rich diet.
Ötzi also showed severe wear of his tooth enamel and severe gum disease. Hard minerals in milled grains abraded the surface of his teeth and gums, exposing the bone below and making the roots loose. Similar wear-and-tear is found in the teeth of Egyptian mummies who ate milled grains, Ruhli said.
"This is like a sandpaper acting on your teeth," Ruhli told LiveScience. "In another five to 10 years, he certainly would have lost some of his teeth."
As a result of his poor dental health, Ötzi would have felt pain when eating hot or tough foods, Ruhli said.
Ötzi also showed evidence of trauma to his front right incisor from being struck, either in a fight or an accident.
Ötzi's dental problems show the results of switching from a strict hunter-gatherer diet to an agricultural one, Ruhli said.
"Hunter-gatherers were depending on meat and berries, whereas [Ötzi] had processed food," Ruhli said. "The processing added a bigger variety of food but also impacted the quality of the teeth."