Dementia
Dental care and dementia
The role of dental professionals in helping to care for patients with dementia is vital to their health and wellbeing. Professor June Andrews explains
D
entists are really important for people with dementia. They can make a huge difference to the
comfort and happiness of people with dementia during the last years of their lives. Life is hard for people with dementia and their carers, and the dentist can reduce pain, and make eating and drinking a pleasure again. Not least, they can make it easier to be near the person by making sure their carers know about oral hygiene and how important it is. Dentists have told me they are
astonished at how relaxed care workers are about bodily fluids and excrement, while finding it impossi- ble to deal with someone’s mouth. We need to sort that. For specialist advice about care for older people, dentists can turn to the Journal of Gerodo- ntology1
and the work of Dr Janice
Fiske. She is the author in England of a fact sheet from Alzheimer’s Society.2 Dementia is a general term that is
used to describe a loss of intellectual function. The cause in over half of affected people is Alzheimer’s disease, when brain cells shrink. The next most common cause is vascular disease when the blood supply to brain cells has been cut off. There are other causes including alcohol related brain damage. All dementia is irreversible, though some people with alcohol related problems can get a bit better if they stop drinking and get treatment.3
It is worth the dentist
knowing what kind of dementia the person has as this may help predict
54 Scottish Dental magazine
some of their behaviours, and their prognosis. It has been estimated that there
were around 71,000 people with dementia in Scotland in 2010 and the number is set double in the next 25 years. More than half are female. The older a person is, the more likely they are to have dementia. However, around 2,300 people with dementia in Scotland are under 65.4 The changes that take place in a
person with dementia include: • a deterioration in the ability to carry on with basic every day activities like oral care • difficulty in working things out, like who you are, and what you are trying to get them to agree to • changes in social behaviour, like apathy and social withdrawal, which will make consultations potentially difficult • memory problems which may make compliance an issue • disturbing behaviour such as aggression, wandering, or other things that make a consultation more complicated. The person with dementia is often
aware that they have a problem, but may not seek help. Even those around them who can see the difficulties are often reluctant to raise the issue or approach the family doctor. The dementia can progress slowly over seven or 10 years. In the beginning the person may be very fit and active, and in the end they may need care for every function. Mild Cognitive Impairment (MCI) looks and feels like early dementia.
Many people with MCI never get dementia. However, everyone who gets dementia seems to go through a period of MCI. Also, an older person who has an infection or depression may show some cognitive impair- ment that looks like dementia for a time. If treated, the cognitive symp- toms go away. If they already had dementia, other illness or depression may make their existing cognitive impairment seem worse till the illness or depression is treated. In Scotland, as long as the person can understand what is proposed, their consent is needed, even if the person has a diagnosis of dementia. The Adults with Incapacity Act indicates that if a doctor believes the treatment will benefit the person, the doctor should sign a certificate of incapacity under Section 47. A dentist can sign a Section 47 form for dental treatment. If there is a welfare guardian or attorney, this person can make a decision on behalf of the person with dementia. You need to decide when assessing capacity
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