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Providing Dental Care for Patients with Dementia

April 25, 2014

Among a population of nearly 1.3 million nursing home residents struggling to receive dental care, patients with dementia are particularly at risk for untreated dental disease, and the severe health consequences that can result.

Nursing home facilities are required by law to provide residents with routine and emergency dental care, but delivering that care has been problematic. Now, dentists across the country are adopting nursing homes in their communities using the existing public health safety net in an effort to reach out to one of America’s most vulnerable populations.

Dr. Judith Jones is an ADA expert on eldercare, serving on the organization’s National Elder Care Advisory Committee (NECAC), and chair of the department of general dentistry at Boston University Henry M. Goldman School of Dental Medicine. For almost 20 years she served as a dentist for an interdisciplinary dementia study unit at Edith Nourse Rogers Memorial Veterans Hospital Home in Bedford, Mass. The team also consisted of neurologists, nurse practitioners, nurses, social workers, occupational and physical therapists, and a dental hygienist.

The study unit operated successfully because the members openly communicated about the treatment options and health concerns of patients suffering from dementia and their families, according to Dr. Jones.

“It wasn’t unusual at the VA hospital for the nurse practitioner or a therapist to ask about a patient who was having trouble with dentures, or who wasn’t eating,” she said. “They would ask if I could check to see if there were any dental problems.”

Patients with dementia often suffer from a variety of untreated diseases before they’re admitted to a long-term care facility, because early detection depends on communication, which is one of the greatest barriers health care providers face in providing treatment. Even when admitted to long-term care facilities, patients’ limited capacity to communicate can still be a major barrier to their receiving care, so it’s especially important that dentists develop a rapport with dementia patients, said Dr. Jones.

Patients with dementia can misinterpret your actions, so you have to establish a good relationship with your non-verbal communication,” she said. “Often it’s more important than your verbal communication with the patient.”

It is also important to ask patients with dementia to follow one instruction at a time.

“With most patients, you can ask them to sit down, lean back, and open their mouths,” said Dr. Jones. “Dementia patients cannot process all three commands quickly.”

On the dementia study unit, dental assessments were part of the pre-admission process for dementia patients. After the initial diagnosis, the dentist developed a treatment plan and the dental team cleans the patient’s teeth.

After the patient is admitted to the facility, the dental team will conduct a thorough examination, followed by routine recall examinations, as well as preventive and restorative care.

“We often took a full set of X-rays early in the process because we know that we might not be able to get them later on,” she said. “When treating patients with dementia, you want to get in and get out, providing care efficiently to prevent trouble with the experience. Prevention dental care from the time of diagnosis is the best care of all.”