Dementia REFERENCES
1:
www.gerodontology.com 2. Factsheet 448,
www.alzheimers.org.uk Dental Care and Dementia
3. See this link for factsheet 438 about ARBD (other key word “Wernicke-Korsakoff”) from the Alzheimer’s Society
http://www.alzheimers.org.uk/factsheet/438
4. Dementia UK Consensus prevalence rates of dementia from Alzheimer’s Society (2007). A report to the Alzheimer’s Society on the prevalence and economic cost of dementia in the UK produced by King’s College London and London School of Economics.
5. DSDC, 2009, from
www.dementiashop.co.uk Continued »
Dental Action Plan target. It has a section on dementia and special care. People with demen- tia in care homes don’t always have their oral health needs met. In the early stages of demen- tia a person will still be able to clean their own teeth. They might need to be reminded or given some supervision. When advising family or carers on how to encourage oral care, remind them that the person may imitate actions. So giving them their brush with toothpaste on it and then standing in front of them brushing your own teeth and encouraging them to do the same is a good way of helping them to keep up their own dental hygiene.
Although electric tooth- brushes and adapted handles can help when older people have problems with dexterity, the person with dementia might become confused or alarmed, so don’t leave it too late to introduce these new things. If a stage is reached where the carers need to take over this task, they need guidance and support on how to do it, but remember that they are the experts on the individual quirks of that person with dementia. The dentist can show them
techniques like standing behind the person and cradling their head, but they need to introduce this carefully to avoid distress. Everyone with dementia is different, and their level of tolerance will differ as well. There is a national initiative to reduce the use of antipsychotics,
56 Scottish Dental magazine
and encouragement in the use of non-pharmacological methods in dealing with disturbing behaviour. However, many medications are still given to older people, and often in syrup form. Don’t hesitate to ask if the medication has been recently reviewed to see if it is still necessary. Many carers will not have been warned about dry mouth side effects. People with dementia have
significant communication problems and staff who care for them are sometimes not trained to understand non-verbal com- munication. The commonest cause of disturbing behaviour is said to be undiagnosed pain. It is important to have regular mouth checks, whether the person has teeth, dentures or nothing at all. The Caring for Smiles education pack reminds care workers that the person may only demonstrate oral problems by going off their food, or rejecting their dentures, moaning and shouting, and by aggressive behaviour. It is particularly cruel if the person is sedated as a result, making their condition worse and not dealing with the cause at all. People with dementia can
have good days and bad days: dental care is better postponed to a good day, if possible, or scheduled to a person’s best time of day. Make sure you and your staff have read guidance such as Ten Helpful Hints for Carers; practical solutions for carers liv- ing with people with dementia,5 which offers non-pharmacolgi- cal solutions to the commonest disturbing behaviours.
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