Dementia, a brain disorder, is the loss of cognitive functioning and behavioral abilities. This disease can affect a person’s daily activities. The most common form of dementia is Alzheimer’s disease. Alzheimer’s disease (AD) is a slow progressive and irreversible brain disease that destroys all memory, thinking, and reasoning skills. Which eventually overpowers their ability carry out simple daily tasks, at this point a caregiver is needed. Alzheimer’s contributes to the loss of connection between neurons and messages transmitted in the brain. The causation of AD is still unknown, but can be related to lifestyle, genetic, and environmental factors. At the age of sixty the risk of developing this disease increases, and increase as aging continues. 5.7 millions Americans are currently diagnosed with Alzheimer’s disease.
Dementia ranges from the mild stages, moderate, and progresses to the more serious stages. In the preclinical stages of the disease, a patient can present asymptomatic. Mild stages of AD usually show symptoms of memory loss and small changes in their personality may change. These patients may also forget some familiar people or things. When, working with a new patient with mild AD they may forget your name during the appointment. This can be very aggravating for the patient. This is why it is important to introduce yourself very clearly and make sure they understand. These patients will also lose their ability to plan and organize their schedule. If they have a caregiver it is important to let them know the dates for their next appointment. If not, write down when their next appointment is and give it to the patient, you should also call multiple times to remind the patient.
Moderate stages of AD show more obvious signs of confusion and memory loss. Following directions, and instructions become more difficult for these patients. AD patients begin to lack judgement and reasoning. These patients may decide that brushing at night isn’t important anymore or that mouthwash should be swallowed. These patients often experience trouble sleeping, personality changes, and may become aggressive. Severe AD is the last stage of Alzheimer’s and soon after resulting in death. These patients often need help with daily activities, walking, talking, and recognizing family members. These patients also have trouble eating and may refuse to eat. A caregiver is very important to make sure their tasks are still being completed in the most efficient and effective way.
A patient with AD has an increased chance to have periodontal disease. Periodontal disease is an inflammatory disease that involves several microorganisms that build up in the gingiva. This is evidence by the look of the gingiva, bleeding from the gums, movement of the teeth, and other decreases in oral health. The main bacteria involved in periodontal disease are Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Tannerella forsythensis, Eikenella corrodens, and Treponema denticola. There are two correlation mechanisms that can relate periodontitis to the progression of AD. The first mechanism involves the host response and the microorganisms in the oral cavity. This will increase the levels of proinflammatory cytokines. The increase will place stress on systemic and peripheral inflammation. Those molecules can enter cerebral regions of the brain and can result in neuron damage. The second mechanism states that the microorganisms found in periodontal disease can invade the brain via the bloodstream or nerves. This results in an inflammatory response, that similarly to the first mechanism, can result in eventual neuron damage. Two types of microorganism found in a periodontitis have also been found in brain tissue, P. gingivalis and T. denticola. This was found to be an association not causation of the disease.
In dental hygiene, the progression of the disease becomes important when working with the patient. A patient with mild progression will not need as much instruction and care compared to a patient that’s disease has worsened and progressed to more serious conditions. When cleaning your patients teeth you notice they are becoming irritable or frustrated, it would be a good idea to sit them up and give them a break, let them use the bathroom and walk around. Depending on the different stage of Alzheimer’s your patient has developed you as a hygienist must adjust accordingly. It is important to be very patient, listen, and empathize with these patients. Communication can be tough, discussing OHI and OHI-S are important for not only the patient but also the caregiver. In severe AD cases and patients with dexterity problems, the caregivers will be performing the tasks related to maintaining their oral health, the dental hygienist will also be instructing the caregiver on home care compared to the patient.