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Dental Health and Dementia: More than Forgetfulness

COURSE NUMBER: 566

Maggie A. Misch, BS; Maria L. Geisinger, DDS, MS

Credit Hours:

2 Hour(s)

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This course seeks to discuss the interrelationship between periodontal disease, dental caries, and dementia. It will also serve as an aid in the clinical decision-making process and discuss strategies for patients, dental healthcare provide...

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Overview

This course seeks to discuss the interrelationship between periodontal disease, dental caries, and dementia. It will also serve as an aid in the clinical decision-making process and discuss strategies for patients, dental healthcare providers, and caregivers to promote optimal oral health in patients with dementia.


In 2019, widely publicized findings indicated that enzymes (gingipains) secreted by a bacteria commonly thought to be one of the keystone pathogens for periodontitis, Porphrymonas gingivalis (P.g.), have been identified in the brain tissues of individuals with pathology and symptoms of Alzheimer’s Disease at higher levels than in the brains of individuals without such symptoms.1 This report has sparked interest in the potential role of periodontal diseases in development of Alzheimer’s and other dementias. It is, however, important to note that these data are based upon a cross-sectional analysis of tissues and that gingipains were found in 96% of all tissues assessed. This report also builds upon prior animal studies that have indicated that chronic oral application of P.g. or the gingipains it produces increase the production of amyloid beta, a component of the amyloid plaques whose accumulation contributes to Alzheimer’s Disease.2 While prospective trials are necessary to identify causation and/or common disease pathways, recent reports have speculated that periodontal health may be critical in this population.


Previous research has indicated that patients with periodontal disease are up to 70% more likely to present with Alzheimer’s Disease than those who are periodontally healthy.3,4 This association may be due to poorer oral hygiene over time due to deficits associated with dementia, dementia patients’ resistance to caregiver delivery of oral care resulting in a reduction of oral hygiene delivery, medication induced xerostomia, or other challendges associated with oral hygiene delivery for patients with dementia leading to larger dental plaque masses and/or more pathologic intraoral bacteria. It has also been hypothesized that this interaction may be mediated by inflammation, the periodontal microbiome, and the immune reactions to those pathogens.5,6 The elderly population (over 65 years old) in the United States is expected to nearly double from 43.1 million in 2014 to 83.7 million by the year 2050.7 Currently, over 5 million adults, approximately 13.9% of older adults, in the United States suffer with dementia.8 Additionally, the rate of total edentulism is dropping and is expected to reach as low as 2.6% by 2050, which, accounting for estimations of population growth and aging, represents a 30% decrease in overall edentulism.9 Furthermore, medications for dementia often increase symptoms of xerostomia and higher caries rates are seen in patients with dementia, in particular those with moderate to severe disease and/or those that reside in residential nursing care facilities.10,11 It follows, therefore, that a large number of older adults are dentate and suffering with dementia and will require dental care that is delivered or facilitated by primary care providers. There is a need for protocols that allow for effective oral home care for dementia patients while minimizing care resistant behaviors as well as nonsurgical interventions for patients with caries and/or periodontal diseases.12-14

  • Intended Audience:

    Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, Dental Assistant Students

  • Date Course Online:

    May 1, 2019

  • Last Revision Date:

    NA

  • Course Expiration Date:

    Nov 30, 2022

  • Cost:

    Free

  • Method:

    Self-instructional

  • AGD Subject Code(s):

    490, 730, 750

Learning Objectives

Upon completion of this course, the dental professional should be able to:


  • Understand the current scientific literature about the prevalence, etiology, and stages of dementia.
  • Recognize and discuss with patients the association of periodontal diseases and oral bacteria with dementia and Alzheimer’s Disease.
  • Develop and implement strategies for communication and delivery of oral hygiene and dental care to patients suffering with dementia.
  • Evaluate patients’ risk factors and oral hygiene to develop effective intervention and treatment modalities to reduce caries and periodontal disease rates.
  • Understand the utility of nonsurgical caries treatment (e.g., topical fluoride, silver diamine fluoride, etc.) in patients with moderate to advanced dementia.
  • Deliver instructions to primary care providers for patients with moderate to advanced dementia to increase compliance with oral home care and decrease care resistant behaviors.

Disclaimers

  • P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
  • Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.  Only sound evidence-based dentistry should be used in patient therapy.

Note:  Registration is required to take test.

Author(s)

Conflict of Interest Disclosure Statement

  • Dr. Geisinger has been or is currently a co-investigator and/or principal investigator on research funded entirely or in part by The Proctor & Gamble Company. All funds were used for research endeavors and not for personal gain. Dr. Geisinger has not accepted any payment from dentalcare.com for participation in this continuing education course.
  • Ms. Misch reports no conflicts of interest associated with this course.

Maggie A. Misch

BS

Maggie Misch is a fourth year dental student at the University of Alabama at Birmingham (UAB) School of Dentistry. She received her BS in Health Sciences from the University of Central Florida. Maggie Misch is a member of the American Studen...

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Maria L. Geisinger

Maria L. Geisinger

DDS, MS

Submission Information

Academy of General Dentistry (AGD) Submission For credit transfers to appear in your AGD account in real time, make sure to add your AGD membership number in the field provided on the “Share Your Test Score” page.


CE Broker For all states that use CE Broker for licensure, “proof of completions” are electronically reported the first of every month. If a course was taken in November, the “proof of completion” will be submitted the beginning of December.

Recognition

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ADA CERP Recognized Provider

The Procter & Gamble Company is an ADA CERP Recognized Provider.


ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.


Concerns or complaints about a dental CE provider may be directed to the provider or to ADA CERP at:


https://www.ada.org/en/ccepr/ada-cerp-recognition/complaints

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Approved PACE Program Provider

THE PROCTER & GAMBLE COMPANY


Nationally Approved PACE Program Provider for FAGD/MAGD credit.

Approval does not imply acceptance by any regulatory authority or AGD endorsement.


8/1/2021 to 7/31/2027

Provider ID# 211886

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AADH Approved Program Provider

Procter & Gamble is designated as an approved Provider by the American Academy of Dental Hygiene, Inc. #AADHPGC (January 1, 2022-December 31, 2023). Approval does not imply acceptance by a state or provincial Board of Dentistry. Licensee should maintain this document in the event of an audit.