Treatment Planning

Dysphagia often accompanies a diagnosis of AD. When providing care to a patient experiencing dysphagia, care should be delivered in a semi-supine (45° angle) position.88 The use of power scaling devices and air polishers are contraindicated. When using equipment or tools that produce a water spray, the aid of a dental assistant to evacuate water can be helpful.

Treatment planning for patients diagnosed with AD should take into consideration the severity of disease and anticipate declining oral health.68 Dental providers must keep in mind as AD progresses, the decline in patient cooperation and cognitive function may hinder the patient’s ability to visit the dental office. It is important to also recognize at some point the patient will be unable to practice oral self-care. Advanced restorative techniques, and aggressive measures to save teeth, should only be considered if a caregiver will be present to deliver oral care during the later stages of the disease.75,89 Because of the progressive nature of AD, it is important to complete dental treatment and stabilize the patient’s oral health as soon as possible.74,90,91 The goal is to prevent urgent dental emergencies from occurring during final stages of the disease.75 It may be difficult for a patient to adjust to new appliances, and removable appliances should be stable and easy to insert and remove. Dental providers should be mindful of the potential for aspiration and use caution when treatment planning small sized removable appliances.89 Finally, patients may forget to wear their prostheses.74

Patients diagnosed with AD have high or extremely high caries risk and periodontal disease risk. Preventive care is very important and should be scheduled every 3 months to minimize periodontal disease and decay.74 Dental providers should offer caries preventive measures such as fluoride varnish at every prophylaxis.82,83 The daily use of a prescription fluoridate toothpaste (5000 parts per million), chlorhexidine rinse, or both should be considered.68,92,93