Adjunctive Therapies to Improve Oral Health in Patients with Dementia
Caries incidence increases in older adults and root caries are a particular problem due to gingival recession, xerostomia, and poor plaque removal.91,123 These problems are particularly pronounced in patients with dementia who are unable to care for their teeth themselves, may be taking multiple medications that cause xerostomia, and may not be able to receive treatment for caries in an outpatient dental office. 123,124 Silver diamine fluoride (SDF) is an alkaline topical solution containing fluoride and silver that has been approved by the FDA for both caries arrest and root desensitization.125,126 SDF is effective in caries arrest through remineralization and inhibition of collagenases and cysteine cathepsins.127 Yearly SDF application on exposed radicular surfaces has been shown to be effective in reducing caries progression when compared to fluoride varnish and placebo with rare complaints about the dark staining that is seen with SDF.128 Given the low cost of SDF, the infrequency of application, the relative non-invasiveness of treatment, and the simplicity of the therapy, SDF application should be considered as a preventive measure for oral health promotion in older adults with dementia.
Many patients with dementia require care for their activities of daily living, including oral hygiene.108 Coordination of care between oral healthcare providers, nursing staff, and family caregivers is critical to insure optimal oral health for those patients. Understanding the role oral bacteria and their byproducts may play in the development and progression of dementia allows for better care delivery to patients. Furthermore, utilization of mechanisms to reduce CRBs when oral hygiene is delivered, as well as coordination of preventative dental care within the residential nursing home environment, are integral components for maintenance of oral and overall health for patients.