Oral bacterial biofilms are living entities that can transform into inhospitable environments given the right circumstances.84,93,94 Coaggregation of periodontal pathogens allows for innocuous local commensal bacteria to transform in the presence of more virulent pathogens.94 This overall increase in virulence of the bacterial biofilm allows for a shift in the balance in the local and systemic environments from homeostasis to dysbiosis, which can then impair the host immune surveillance and cause dysfunction in the inflammatory repair mechanisms.94 A recent review of the literature concludes that the oral health and hygiene of elderly individuals with dementia is inadequate and should be improved through oral health education of formal and informal caregivers.95,96 Given the importance to oral and overall health of maintaining optimal oral hygiene, it is critical for individuals with dementia to have effective oral hygiene measures performed by them or for them by caregivers.
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