The Hidden Link: How Dementia Impacts Oral Health and Access to Care

Imagine waking up one day and struggling to remember the simple routine of brushing your teeth. For millions of individuals living with Alzheimer’s and dementia, this isn’t just a moment — it’s a daily reality. Now, pair that with a healthcare system where accessing dental care is already a challenge for many. The intersection of dementia and oral health is one of the most overlooked aspects of elderly care and we need to talk about it!

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​Healthcare Access and Oral Health

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Access to oral health care is a well-documented issue in the U.S., and when dementia enters the picture, those challenges multiply. Many elderly individuals with cognitive decline face difficulties maintaining oral hygiene, recognizing dental pain, and communicating their discomfort. This leads to serious health complications, including infections, malnutrition, and increased risk of systemic diseases like cardiovascular disease (López et al., 2017).
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Why is this happening? Let’s break it down:
Cognitive Decline = Poor Oral Hygiene

• Dementia patients often forget to brush, floss, or even recognize the importance of oral care.
• Many lose the ability to follow multi-step tasks, making it difficult to properly clean their mouths (Chalmers & Pearson, 2005).

Caregivers and Lack of Training

• Many family caregivers and even long-term care staff do not receive adequate training in oral health.
• Signs of dental pain, such as facial grimacing or behavioral changes, are often misinterpreted as general dementia-related agitation (Nicol et al., 2020).

Physical Barriers and Accessibility Issues

• Many dementia patients rely on caregivers for transportation to dental visits, which may not always be available.
• In nursing homes, only 16% of residents receive routine dental care (Griffin et al., 2012).

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What’s Stopping Access?

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When we zoom out and look at the larger picture, we realize that accessing care is more than just remembering appointments. Accessing care is a complex issue, intertwined with financial constraints, healthcare gaps, and lack of awareness.

​Here’s what’s standing in the way:
Financial Constraints:

• Medicare does not cover routine dental care, leaving many seniors without affordable options.
• Low-income seniors often prioritize medical needs over dental care, even though oral health is directly tied to systemic health (Griffin et al., 2012).

Lack of Specialized Dental Care

• Many dentists are not trained to treat patients with cognitive impairments.
• Specialized geriatric dental clinics are rare and usually not within easy reach.
• Lack of training in alternative communication methods for non-verbal patients. ​ .

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How Do We Fix This?

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Luckily, researchers and policymakers have begun addressing these barriers. Here are some promising solutions:
Improved Caregiver Training

• Integrating oral health education into caregiver training programs can help improve early detection of dental issues.
• Simple techniques, such as using flavored toothpaste or playing music, can help dementia patients tolerate oral care (Jablonski et al., 2011).

Mobile and Teledentistry Services

• Expanding mobile dental units to reach homebound or nursing home patients can bridge accessibility gaps.
• Teledentistry consultations can provide caregivers with guidance on managing oral hygiene at home.

Policy Changes and Insurance Reform

• Expanding Medicare to cover routine dental care for dementia patients could significantly improve access.
• Advocating for state-level programs to fund dental services for seniors in long-term care facilities. ​  

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Caregiver Oral Hygiene Routine:
​Simple and Effective Steps

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Caring for someone with dementia means taking on many responsibilities and oral hygiene should be simple yet effective. Here’s an easy guide:

For Patients with Teeth:

• Use a soft-bristled toothbrush and fluoride toothpaste -electric brush if tolerable.
• Brush twice a day using gentle, circular motions.
• Offer a non-alcoholic mouth rinse to help with dry mouth. If aspiration is of concern, avoid mouthwash entirely.
• Use floss picks/proxybrush instead of traditional floss to make the process easier. Whatever flossing method is easy and effective - we don't want to add stress! 
• If the patient resists brushing, try playing calming music or establishing re-direction. Patients like to feel independence, if you try phrasing it like "I want to brush my teeth, could you teach me how?" - it allows the patient to gain a sense of independence while completing necessary home care. 

For Patients Without Teeth ​(Denture Care):

• Remove and rinse dentures after meals.
• Clean dentures daily with a denture brush and mild soap (avoid toothpaste, which can be abrasive).
• Soak dentures a denture-cleaning solution, antibacterial denture tablets (fizzle!)
• Brush the gums and tongue with a soft brush to remove bacteria.
• Keep the dentures moist to prevent cracking when not in use.

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​Link for Resources: 
​alzfdn.org/caregiving-resources/

Link for steps: 
​alzfdn.org/10-steps-for-healthy-aging/

References
Alzheimer’s Association. (2022). Alzheimer’s disease facts and figures. Retrieved from https://www.alz.org
Alzheimer’s Foundation of America. (n.d.). Caregiving resources. Alzheimer's Foundation of America. https://alzfdn.org/caregiving-resources/
Chalmers, J., & Pearson, A. (2005). Oral hygiene care for residents with dementia: A literature review. Journal of Advanced Nursing, 52(4), 410-419. https://doi.org/10.1111/j.1365-2648.2005.03605.x
Griffin, S. O., Jones, J. A., Brunson, D., Griffin, P. M., & Bailey, W. D. (2012). Burden of oral disease among older adults and implications for public health priorities. American Journal of Public Health, 102(3), 411-418. https://doi.org/10.2105/AJPH.2011.300362
Jablonski, R. A., Munro, C. L., Grap, M. J., Schubert, C. M., Ligon, M., & Spigelmyer, P. (2011). Mouth care in nursing homes: knowledge, beliefs, and practices of nursing assistants. Geriatric Nursing, 32(6), 473-480. https://doi.org/10.1016/j.gerinurse.2011.08.007
López, R., Baelum, V., & Holm-Pedersen, P. (2017). Oral health and general health in an ageing population: a summary of recent systematic reviews. Gerodontology, 34(1), 1-8. https://doi.org/10.1111/ger.12286
Nicol, R., Petrie, A., & Smith, A. (2020). The impact of dementia on oral health: A systematic review. Dental Update, 47(3), 234-240. https://doi.org/10.12968/denu.2020.47.3.234
Schulz, R., & Eden, J. (2016). Families caring for an aging America. National Academies Press. https://doi.org/10.17226/23606