Dementia and oral health

we need to ensure even more so that care staff feel capable and happy in doing what can be a stressful and demanding, as well as rewarding job, so that the residents with dementia are also well looked after and happy

With an ageing population the number of patients suffering with dementia will increase. In the UK one in 14 people over the age of 65 and 1 in 6 of those over the age of 80 are likely to be affected. Oral Health problems are common in older adults and older patients with dementia are at increased risk of oral health problems compared with those who have no cognitive impairment.

The aim of this review was to provide an up-to-date overview of studies about oral health in people with dementia.

Methods

Searches were conducted in the PubMed, CINAHL, and the Cochrane Library databases. Randomised controlled trials (RCTs) , cohort, case-control or cross-sectional studies in patients over the age of 60 diagnosed with dementia providing useable quantitative data concerning oral health and stomatognathic disease were considered.

Two reviewers independently selected the studies and assessed risk of bias. The Newcastle-Ottawa scale (NOS) was used to assess bias for cross-sectional, case-control, and cohort studies and the Delphi list for RCTs.  Diagnosis of dementia was considered adequate if recognised diagnostic criteria were used. The oral examination needed to have be carried out by a dentist. Data abstraction was undertaken by a single reviewer and crosschecked by 2 reviewers. A narrative summary of the findings was presented.

Results

  • 36 studies were included (14 cross-sectional, 10 case-controlled, 10 cohorts and 2 RCTs)
  • Older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care.
  • Candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia.

Conclusions

The authors concluded: –

The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow.

Comments

This review covers similar ground to a review by Foley et al we covered last year (Dental Elf – 6th Nov 2017).  This review included slightly more studies 36 compared to the 28 included in the Foley review. That review also reported on tooth status and caries while this review focuses on soft tissues are overall oral health.  The findings from both reviews are similar in finding that oral health status is poorer in older patients suffering from dementia. As oral health can have a significant impact on well-being the challenge is to ensure that patients with dementia can receive good oral care by close cooperative between dental professionals, the patient and their care team.

Links

Primary Paper

Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig. 2018 Jan;22(1):93-108. doi: 10.1007/s00784-017-2264-2. Epub 2017 Nov 15. Review. PubMed PMID: 29143189; PubMed Central PMCID: PMC5748411.

Other references

 Dental Elf – 6th Nov 2017

Dementia and oral health status

 

Dental Elf – 30h Jun 2017

Oral care in nursing homes

 

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