Cognitive Impairment and Oral Health

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1 Geriatric Lectures Series: Cognitive Impairment and Oral Health Dr. Leo Marchini, DDS, MSD, PhD Department of Preventive and Community Dentistry University of Iowa College of Dentistry and Dental Clinics 1

2 Cognitive Impairment Pixabay/Geralt Poor oral hygiene Xerostomia Plaque accumulation Bleeding gums Calculus Rampant caries Tooth loss Orofacial pain Oral Health Dietary changes due to tooth loss Atherogenesis Chronic inflammatory response Inflammatory markers Polymicrobial / chronic infection Frequent bacteremia 2

3 Contents Cognitive Impairment Oral Health How does it happens? Why bother? How to improve oral health for them? Oral Health Cognitive Impairment Current theories and studies 3

4 How does cognitive impairment affect oral health? To answer this question in a proper way, we should understand the etiology of oral diseases, and how cognitive impairment impacts oral diseases progression. By doing so, we will be able to figure out why epidemiology of oral diseases among cognitively impaired patients is so concerning 4

5 How does cognitive impairment affect oral health? Etiology of oral diseases The two most common oral diseases among the elderly are Caries and Periodontal Disease 5

6 How does cognitive impairment affect oral health? Etiology of caries BACTERIA PATIENT CI Plaque Pathogenicity Specificity Removable prosthesis Fixed prosthesis Frequent plaque removal Antibacterial agents CI CI CI CI DIET Sugar quantity Sugar frequency Sugar substitutes Consistency Sticky food CI CI Tooth morphology Tooth resistance (Fluoride) Tooth fillings CI Saliva CI Oral Hygiene Ability to hold a toothbrush CI Compliance CI Need for help Combative behavior CI 6

7 How does cognitive impairment affect oral health? Etiology of periodontal disease BACTERIA PATIENT CI Plaque Pathogenicity Specificity Removable prosthesis Fixed prosthesis Frequent plaque removal Antibacterial agents CI Host response CI Habits Systemic diseases CI Saliva CI Oral Hygiene Ability to hold a toothbrush CI Compliance CI Need for help Combative behavior CI 7

8 Pixabay/Geralt How does cognitive impairment affect oral health? Impact of cognitive impairment Cognitive Impairment Memory impairment Aphasia Apraxia Agnosia Behavioral problems Medications Dependence Financial restraints Poor oral hygiene Xerostomia Plaque accumulation 8

9 How does cognitive impairment affect oral health? Epidemiology of oral diseases among cognitively impaired patients 9

10 10

11 11

12 12

13 13

14 Giuseppe Arcimboldo 14

15 Why worrying about cognitively impaired patients oral health? Research conducted during the last decades ( ) presented poor oral hygiene and increased dental caries experience and more dental problems in older adults with dementia Ettinger, 2015 But, why bother? 15

16 Caries Tooth loss Pain Fever Discomfort Behavior / Delirium Dentures Edentulism Social interactions Eating ability Diet type Nutrition Aspiration pneumonia Reduced quality of life Orofacial pain 16

17 Gingivitis Periodontal disease Orofacial pain / Tooth loss Aspiration pneumonia Atherosclerosis Diabetes control Pain Fever Discomfort Behavior/Delirium Dentures Edentulism Social interactions Eating ability Diet type Nutrition Reduced quality of life 17

18 Other important oral health problems Xerostomia Among older populations, xerostomia prevalence ranges from 12% to 39% (weighted average of 21%) The role of medications Important impact on QoL 18

19 Other important oral health problems Common oral mucosal lesions among the elderly 19

20 Other important oral health problems Oral cancer 20

21 21

22 How to improve oral health for my cognitively impaired patients? Provide systematic oral health to improve quality of life Promote oral hygiene at least twice a day to minimize risk of remote infections Provide regular dental appointments for checkups Provide dental appointments when a resident: shows or seems to show (nonverbal) signs of oral pain; complains about oral dryness; complains about or shows (non-) denture-related oral soft tissue lesions Modified from De Visschere et al.,

23 Provide systematic oral health to improve quality of life Oral care is important, like feeding and bathing, and must be promoted as an activity central to caring for older adults. Coleman, 2002 Daily oral hygiene routines Periodic dental appointments Emergency dental appointments 23

24 Promote oral hygiene at least twice a day to minimize risk of remote infections Different patients, different oral hygiene procedures 24

25 Tooth plaque removal Electric toothbrush Manual toothbrush handles Manual tooth brush adaptations Interproximal brush Floss handles 25

26 Electric toothbrush 26

27 Manual toothbrush handles Drummond et al 27

28 Manual tooth brush adaptations 28

29 Interproximal brush 29

30 Floss handles 30

31 Specific products for caries prevention Generic 31

32 Specific dietary interventions for caries prevention 32

33 Specific products for periodontal disease prevention Chlorhexidine 0.12%, 15mL, seconds Active against G+ and G-, facultative anaerobes, aerobes and yeasts Lasts longer than other mouthwashes Cause stains (teeth, tongue, gingiva and resin restorations) Prolonged use can reduce bitter and salt taste sensations Both plaque index and gingival inflammation are reduced significantly 33 33

34 Brushing the teeth is the cheapest and more effective way of keeping good oral health conditions for dentate patients!! 34

35 However, sometimes it is not that easy Coleman,

36 Zwetchkenbaum,

37 Denture plaque removal 37

38 Denture plaque removal 38

39 Edentulous mouth cleaning 39

40 Provide regular dental appointments for checkups 40

41 Provide regular dental appointments for checkups 41

42 Provide dental appointments when a resident shows or seems to show (non-verbal) signs of oral pain Neglecting to eat Being disinterested of food Chewing of the lip, tongue or hands Pulling at the face or mouth Not wearing dentures Grinding of teeth or dentures Aggression Alteration in activity level Chalmers & Pearson,

43 Provide dental appointments when a resident complains about mouth dryness ebay.com 43

44 Xerostomia management Symptoms relief Managing problems with dentures Preventing dental caries and soft tissue involvement Monitoring the use of medication 44

45 Provide dental appointments when a resident complains about or shows (non-) denture-related oral soft tissue lesions 45

46 Current theories and studies on how oral health may be a cognitive impairment risk factor Epidemiological data Correlation analysis No causal relationship 46

47 47

48 48

49 49

50 Thank you for your attention! 50

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