Understanding Alzheimer’s disease and oral health

Challenges for oral health

According to a report commissioned by the Alzheimer’s Society, around 900,000 people are living with dementia in the UK,[iii] with approximately 520,000 living with dementia caused by Alzheimer’s disease.[iv]Thought to be caused by the ‘abnormal build-up of two proteins, amyloid and tau’, symptoms can vary depending on what part of the brain has been damaged.[v] The NHS reports that while the causes of the condition are not wholly understood at present, risks can increase with age, if there’s a family history of the disease, if one has untreated depression and due to certain lifestyle factors.[vi] It’s more common in those over 65, estimated to affect around 1 in 14 people, increasing to around 1 in every 6 people over 80.^v

As the condition progresses, cognitive function and motor skills start to decline. This can impact a person’s ability to maintain a thorough oral hygiene routine. Alzheimer’s patients are often prescribed medication, including antidepressants and, potentially, antipsychotics and sedatives.[vii] As such, they may suffer from xerostomia, accentuating the risks associated with poor oral hygiene, like gingival bleeding, periodontitis and attachment loss.[viii] Tooth loss is another worrying ramification of Alzheimer’s disease, which in turn can cause masticatory issues and malnutrition.^vii

Treating Alzheimer’s patients can be challenging, as they may present with behavioural issues and struggle to co-operate with the dental team. Similarly, a declining memory and comprehension ability may raise concerns over informed consent and communication.[ix] Family members and/or caretakers play a vital role in establishing good oral hygiene behaviours, and should be closely included with the patient in any oral hygiene advice and guidance.

Protecting and maintaining oral health

The dental team will need to tailor their approach to care depending on the severity of the condition. Patients in the early stages of Alzheimer’s disease may still be able to care for their own oral health, but may struggle with conventional methods of brushing and interdental cleaning. As such, dental professionals can discuss with them and/or their caregiver the best methods to keep their oral cavity healthy. This might include electric toothbrushes, interdental brushes or water flossers as opposed to conventional brushes and dental floss. Regular fluoride varnish application may also be indicated for patients who have retained their natural teeth.[x] For patients with advanced Alzheimer’s disease, the caregiver/s may need to be more hands-on, offering physical support.

The Waterpik^® Water Flosser is backed extensively by research, and is clinically proven to provide significant oral health benefits. Needed for only one minute a day, the Waterpik^® Water Flosser is able to remove up to 99.9% of plaque,[xi] and is significantly more effective for improving gingival health versus interdental brushes.[xii] Dental teams can recommend the Waterpik^® Water Flosser to their patients with confidence, as it has been accredited by the Oral Health Foundation and is an ideal tool to protect patient’s oral health from diseases.

Good news on the horizon

The news about the drug that slowed cognitive decline in Alzheimer’s patients, albeit still in its fundamental stages and not yet ready to be delivered to patients, offers hope that the devastating impact of the condition may be soon better managed. Currently, patients with Alzheimer’s disease require comprehensive support from healthcare professionals to ensure a good quality of life. Dental professionals play a monumental role in ensuring Alzheimer’s patients, and their caregivers, are able to protect and maintain their oral health for as long as possible.

For more information on Waterpik^® Water Flosser products visit www.waterpik.co.uk. Waterpik^® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.

Join the 3,000+ dental teams who have already benefitted from a professional Waterpik^® Lunch & Learn. Book your free session for 1 hour of verifiable CPD and a free Waterpik^®Water Flosser – available either face to face or as a webinar – at https://www.waterpik.com/oral-health/pro/lunch-learn/signup/

Gillian MacQueen

Qualified from Glasgow Dental Hospital in 1987 some would call me an ‘oldie’ however I would describe myself as a Dental Hygienist steeped in vast knowledge and experience. Passionate about delivering the very best treatment to all of my patients I have taken many courses to keep me abreast of new technology. Hypnosis, whitening, digital scanning and GBT are but a few that I use within practice. Finding the best home products for my patients to use are so important. I find Waterpik waterflossers to be so beneficial for my patients as an adjunct to brushing. My patients love it and I see the results in clinic!

[i] van Dyck, C.H., Swanson, C.J., Aisen, P., Bateman, R.J., Chen, C., Gee, M., Kanekiyo, M., Li, D., Reyderman, L., Cohen, S., Froelich, L., Katayama, S. and et al. (2022). Lecanemab in Early Alzheimer’s Disease. The New England Journal of Medicine. [online] Available at: https://www.nejm.org/doi/suppl/10.1056/NEJMoa2212948/suppl_file/nejmoa2212948_data-sharing.pdf [Accessed 2 Dec. 2022].

[ii] www.who.int. (n.d.). Dementia. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/dementia#:~:text=Alzheimer[Accessed 5 Dec. 2022].

[iii] Alzheimer’s Society (2019). How many people have dementia and what is the cost of dementia care? [online] Alzheimer’s Society. Available at: https://www.alzheimers.org.uk/about-us/policy-and-influencing/dementia-scale-impact-numbers [Accessed 2 Dec. 2022].

[iv] Alzheimer’s Society (2018). Alzheimer’s disease. [online] Alzheimer’s Society. Available at: https://www.alzheimers.org.uk/about-dementia/types-dementia/alzheimers-disease [Accessed 2 Dec. 2022].

[v] NHS (2019a). Dementia guide. [online] NHS. Available at: https://www.nhs.uk/conditions/dementia/causes/ [Accessed 2 Dec. 2022].

[vi] NHS (2021). Alzheimer’s Disease. [online] NHS. Available at: https://www.nhs.uk/conditions/alzheimers-disease/ [Accessed 2 Dec. 2022].

[vii] www.alzheimers.org.uk. (n.d.). Drugs and dental problems | Alzheimer’s Society. [online] Available at: https://www.alzheimers.org.uk/get-support/daily-living/drugs-and-dental-problems#content-start [Accessed 2 Dec. 2022].

[viii] Gao, S.S., Chu, C.H. and Young, F.Y.F. (2020). Oral Health and Care for Elderly People with Alzheimer’s Disease. International Journal of Environmental Research and Public Health, [online] 17(16), p.5713. Available at: https://www.mdpi.com/1660-4601/17/16/5713 [Accessed 2 Dec. 2022].

[ix] Alsaleh, A., Kapila, A., Shahriar, I. and Kapila, Y.L. (2021). Dental informed consent challenges and considerations for cognitively impaired patients. Periodontology 2000, [online] 87(1), pp.43–49. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456831/[Accessed 2 Dec. 2022].

[x] www.alzheimers.org.uk. (n.d.). Daily care of teeth | Alzheimer’s Society. [online] Available at: https://www.alzheimers.org.uk/get-support/daily-living/daily-care-teeth#content-start [Accessed 2 Dec. 2022].

[xi] Biofilm Removal with a Dental Water Jet – Gorur A, Lyle DM, Schaudinn C, Costerton JW. Compend Contin Ed Dent 2009; 30 (Suppl 1):1 – 6.

^[xii] Water Flosser compared to Interdental Brush on Bleeding Scores and Gingival Abrasion – Slot DE, Lyle DM, Van der Sluijs E, Hennequin-Hoenderdos N, Van der Weijden F. J Dent Res 2018; 97(Special Iss. B): Abstract #0622 (www.iadr.org). Conducted at Academic Center for Dentistry Amsterdam (ACTA), Netherlands.