Patient Assessment Considerations

Individuals diagnosed with AD often experience difficulties accessing oral health care, especially during later stages of the disease. Patients may encounter the access to care barriers listed in Figure 6.75,83-86 It is important for dental providers to recognize and address these barriers.

Figure 6. Access to Care Barriers that Patients Diagnosed with AD many Experience.75,83-86
  • Lack of information regarding where and how to access services
  • Locating a provider knowledgeable about long-term treatment planning for individuals experiencing dementia
  • Caregiver unwilling to initiate treatment
  • Caregiver doubt regarding the dental provider’s ability to manage challenging behaviors
  • Attainment of informed consent
  • Cost

Dental providers need to thoroughly understand the patient’s medical history. The medical history should include detailed information about the patient’s medications, medical condition, disease prognosis, comorbidities, patient’s perception of their oral status, physical limitations, and cognitive status (level of cooperation and mental state).74,75 An interdisciplinary approach is critical for success, and dental providers should collaborate with the patient’s health care team (family, caregivers, physician, nurses, occupational therapists, psychiatrists, and other health professionals) to determine the overall management goals and prognosis, and confirm medical history findings. Communication with these individuals should be ongoing throughout each phase of dental treatment.75

It is critical for dental providers to understand the patient’s physical limitations and cognitive status so appropriate management modifications and accommodations can be made. Branson developed a patient assessment form, specific for dental providers, to aid in gathering this information (Figure 7). This guide considers mobility, positioning, approachability, verbal and visual interactions, ability to open mouth and turn head, and supportive equipment that is needed.87

Figure 7. Patient Assessment.87
Patient Assement

After the medical history is complete and the dental provider understands what accommodations are needed, the provider is ready to complete an oral health risk assessment and a comprehensive extra-/intra-oral assessment.75 Important items to consider include presence of drug-induced xerostomia, involuntary facial movements (tardive dyskinesia and bruxism), changes in periodontal or caries status, and dysphagia.74,81 Dysphagia can increase the risk of aspiration, choking, and pneumonia.74 Pneumonia is a frequently cited cause of death for patients with AD.1 The results of the risk assessment and intra-oral assessment should be reported to the patient’s health care team.