Tuesday, December 4, 2012

Breast Cancer and Oral Health

Most people realize the major risk factors of cancer.


These include smoking, alcohol use and others. The surprising fact is how your oral health has a connection to breast cancer. You may be 11 times more likely to develop breast cancer if you have poor oral health or gum disease. Journal of Breast Cancer Research and Treatment conducted a survey of 3,273 people and found that individuals with chronic periodontal disease (gum disease) had a higher occurrence of breast cancer.

Another study was reported by the World Health Organization (WHO) and was conducted between 1985 to 2001. This study also concluded that gum disease increases the risk of breast cancer.

Gum disease has been linked to several general health chronic illnesses, including pneumonia, prostate cancer, stroke, heart disease, problem pregnancy, diabetes and breast cancer.

·         Pneumonia: Bacteria in the oral cavity can be aspirated into the lungs and cause respiratory diseases including pneumonia.

·         Prostate cancer: In 1986, over 48,000 men were involved in a study conducted by Dr. Dominique Michaud, Imperial College of London. The study concluded gum disease increases the risk of prostate cancer by 14 percent.

·         Diabetes: According to the American Academy of Periodontology, diabetic patients are more likely to develop gum disease, which in turn can increase the risk of infection.

·         Heart disease: Researchers have found that people with gum disease are almost twice as likely to suffer with coronary artery disease as those without it. As oral bacteria enters the blood stream, it attaches to fatty plaques in the heart blood vessels and contributes to clot formation. These blood clots can then obstruct normal blood flow, which can lead to heart attack.

·         Pregnancy problems: Pregnant women who have gum disease may be more likely to have babies that are born too early and too small.

Connecting the Dots
In general, gum disease causes inflammation. Inflammation has been found to be the precursor of heart disease, stroke, pregnancy problems and over all fatigue. In other words, it is a marker for generalized ill-health. This has been confirmed through blood work and C-reactive protein. C-reactive protein is a inflammation marker which decreases when gum infection is brought under control, and increase with advanced gum disease.

Inflammation: The Warning Sign Not to be Ignored
The first sign of gum disease is inflammation. You’ll know when this is present as your gums appear slightly red, tender, and may even bleed when you brush or floss. The main cause of inflammation is bacteria that form a film called plaque, and stick to the gum and teeth surfaces. If this plaque is not removed at least once per day, the problem can advance to severe gum disease. As inflammation advances, the disease effects destruction of the gums and eventually bone. The teeth develop tooth decay, become loose and may have to be extracted. This is why dental visits are very important at least every three months to monitor the health and condition of your teeth and gums, especially with the presence of cancer.

The bacteria that causes gum disease forms a thin biofilm called plaque and accumulates on the gums and teeth. This same bacteria is found in hardened plaque in arteries that lead to arteriosclerosis. A study by the Karolinska Institute reported the bacteria in gum disease can result in the Epstein-Barr virus and cytomegatocirus. These viruses may result in the suppression of the body’s immune system, which can contribute to the incidence of breast cancer.

There are other connections between breast cancer and oral health. Chemotherapy and radiation may be used to kill or slow breast cancer cells by interfering with growth and multiplication of cells. If chemotherapy or radiation is prescribed as part of treatment for breast cancer, side effects can be severe and include:

·         Mucositis, a severe form of inflammation of the mouth.

·         Increase risk of infection in the mouth. If the drug suppresses white cells, which normally protect against infection, deep cleanings and other invasive procedures such as tooth extraction can result in infection.

·         Difficulty in swallowing.

·         Taste alterations ranging from unpleasant to tasteless.

·         Due to dry mouth, difficulty with speech and eating.

·         Oral yeast infection from the fungus candida.

·         Poor nutrition due to difficulties in eating, dry mouth or loss of taste.

·         Deep aching and burning pain that mimics toothache.

Most patients are treated with chemotherapy or radiation. However, some patients may be treated with bisphosphonates, such as Fosamax, Boniva, and others. Recent studies from University of Southern California suggest long-term use of such bisphosphonates may develop into destruction of the jaw bone. The risk is low but increases with chemotherapy.

How to Minimize Side Effects
Most people are aware of hair loss with chemotherapy. But most don’t realize that more than one-third of people being treated for breast cancer can develop complications that affect the mouth. These complications can affect your quality of life. Preexisting or untreated oral disease can even complicate cancer treatment. This is one reason to make sure you visit your dentist at least one month before beginning cancer treatment.

The mouth is made of cells that renew themselves daily. Since chemotherapy and radiation target certain types of cells that regenerate quickly even under normal circumstances, your mouth will be susceptible to damage. If you minimize bacterial plaque buildup by practicing good hygiene, you can decrease the side effects of treatment for breast cancer. The following recommendations are important to follow:

1.    Brush with a soft toothbrush or sponge brush to clean your teeth and gums.

2.    Floss gently.

3.    Only use alcohol-free mouthwash, preferably one free of saccharin, but one containing xylitol.

4.    When white blood cells counts are reported by your physician to be low, avoid dental treatment.

5.    Avoid dental treatment for about a week after chemotherapy.

6.    Inflammation starts with red gums that may bleed. Even slight bleeding should not be ignored.

7.    Use toothpaste and chewing gum with xylitol.

8.    Regular dental visits to identify problems before they develop.

9.    If you wear dentures, make sure you keep them clean and that they fit well. Make sure to take them out at night.

Thursday, November 15, 2012

Supplements That Make You Smile

Vitamins and minerals are essential for your body, which of course, includes your teeth and gums. Oral health disease may be prevented when vital nutrients are not deficient in your body. That being said, it’s not unusual to find consumers who misuse supplements, believing that just by taking a supplement or herb, they can cure tooth decay or even systemic disease. However, there are benefits to taking supplements for oral health.

Calcium—Setting the Foundation
Calcium supplements are important for prevention of osteoporosis, which has also been associated with tooth loss. Calcium is needed for healthy bones, teeth, and muscle contraction. It stands to reason that calcium would help not only osteoporosis but also preventing tooth loss through gum disease.

Pre and post-menopausal women are among those that are at high risk for osteoporosis and gum disease. Other situations that bring about gum disease and could lead to tooth loss include smoking or chewing tobacco, certain chronic illness such as diabetes, stress, poor oral hygiene, and heredity. Evidently, calcium is a good solution to help prevent gum disease, even if you were born with not the best dental genes.

You can get calcium from food or in supplement form. Calcium rich foods include milk, yogurt, and dark green vegetables. Women at risk of osteoporosis should take a minimum of 1200 mg of calcium per day.

What Type Of Calcium Should You Take?
There are several types of calcium that are sold in supplement form. The type you take is important since some dissolve and can be used by the body, while others require extra stomach acid for absorption, or may not be absorbed at all. The different types of calcium include citrate, carbonate, dolomite, coral, gluconate and lactate.

Calcium citrate is the best and easiest to absorb. You can take it anytime including on an empty stomach since it doesn't require high amounts of stomach acid to dissolve. However, you may need more of it to get enough “elemental calcium.”

Some prefer the natural form through dolomite. However, you should know that this type can be hazardous. A study published from University of Alberta found it is insoluble in stomach acid and is eliminated before it can be absorbed and used by the body. Also, dolomite may contain toxic elements including lead. Coral calcium should be avoided. Many health claims have been made about it, but not established as fact.

Antioxidants for Oral Health
Antioxidants have specific actions and act to help neutralize harmful free radicals. In 2005, researchers at Texas A&M University Baylor College of Dentistry determined that antioxidants were able to minimize the harmful effects of free radicals released from smoking, alcohol and hydrogen peroxide.

Vitamins A, D, and E are the antioxidants that are available and most commonly taken in supplement form. Vitamin C is particularly important if you have bleeding gums. It helps with collagen building, which is a component of tissues. Ubiquinol or Coenzyme Q10 is another powerful antioxidant that has promise in preliminary studies towards heart health and healthy gums.

Vitamin C (ascorbic acid) and A are found in fresh fruits and vegetables. Vitamin E is available in vegetable oils. Coenzyme Q10 is made in our bodies, however, supplementation has been found to be important for especially heart health.

An Ounce a Day…
To prevent tooth loss, brush with toothpaste that contains xylitol and baking soda to help neutralize acids in the mouth and take calcium supplements, preferably the citrate form. Eat a balanced diet rich in calcium and you’ll keep smiling with happy teeth. If you are not able to eat nutritiously rich food, then consider supplements.

Monday, October 15, 2012

Sports, energy drinks are causing irreversible damage to teeth


An "alarming increase" in the consumption of sports and energy drinks is causing irreversible damage to teeth, according to researchers in a new study.

Adolescents are being affected by the damage more than any other age group, they say. The high acidity levels in the drinks erode the tooth enamel, the glossy outer layer of the tooth. Damage to tooth enamel is irreversible, and without the protection of enamel, teeth become overly sensitive, prone to cavities and more likely to decay.

The study is published in the May/June 2012 issue of General Dentistry, the peer-reviewed clinical journal of the Academy of General Dentistry.

"Young adults consume these drinks assuming that they will improve their sports performance and energy levels and that they are ‘better' for them than soda," said Dr. Poonam Jain, lead author. "Most of these patients are shocked to learn that these drinks are essentially bathing their teeth with acid."

Researchers examined the acidity levels in 13 sports drinks and nine energy drinks. They found that the acidity levels can vary between brands of beverages and flavors of the same brand. To test the effect of the acidity levels, they immersed samples of human tooth enamel in each beverage for 15 minutes, followed by immersion in artificial saliva for two hours. The cycle was repeated four times a day for five days, and the samples were stored in fresh artificial saliva at all other times.

"This type of testing simulates the same exposure that a large proportion of American teens and young adults are subjecting their teeth to on a regular basis when they drink one of these beverages every few hours," said Dr. Jain. What they found is that damage to enamel was evident after only five days of exposure to sports or energy drinks, although energy drinks showed a significantly greater potential to damage teeth than sports drinks. In fact, the authors found that energy drinks caused twice as much damage to teeth as sports drinks.

It's important to educate parents and young adults about the downside of these drinks. AGD reports that 30 to 50 percent of U.S. teens consume energy drinks, and as many as 62 percent consume at least one sports drink per day. "Teens regularly come into my office with these types of symptoms, but they don't know why," said Dr. Jennifer Bone, an AGD spokesperson. "We review their diet and snacking habits and then we discuss their consumption of these beverages. They don't realize that something as seemingly harmless as a sports or energy drink can do a lot of damage to their teeth."

Dr. Bone recommends that her patients minimize their intake of sports and energy drinks. She also advises them to chew sugar-free gum or rinse their mouths with water following consumption of the drinks. "Both tactics increase saliva flow, which naturally helps to return the acidity levels in the mouth to normal," she said.

Also, patients should wait at least an hour to brush their teeth after consuming sports and energy drinks. Otherwise, said Dr. Bone, they will be spreading acid onto the tooth surfaces, increasing the erosive action.

Thursday, August 23, 2012

Mouth Sores

Mouth Sores

Mouth sores come in several different varieties and can have any number of causes, including:
·         Infections from bacteria, viruses or fungus
·         Irritation from a loose orthodontic wire, a denture that doesn’t fit, or a sharp edge from a broken tooth or filling
·         The symptom of a disease or disorder.
Your dentist should examine any mouth sore that lasts a week or longer. Among the most common mouth sores are:
·         Canker sores. Small ulcers with a white or gray base and a red border, canker sores appear inside the mouth. They are not contagious, but can return frequently and may be only one canker sore or several. Their exact cause is uncertain but some experts believe that immune system problems, bacteria or viruses may be involved. Canker sores usually heal on their own after a week or two. Over-the-counter topical anesthetics and antimicrobial mouthwashes may provide temporary relief. Stay away from hot, spicy or acidic foods that can irritate the sore. Antibiotics from your dentist and some oral bandages can reduce secondary infection.
·         Cold sores (also called fever blisters.) Groups of fluid-filled blisters that often erupt around the lips and sometimes under the nose or around the chin. Cold sores are caused by the herpes simplex virus type 1 and are very contagious. The initial infection (primary herpes) may be confused with a cold or flu and can cause painful lesions to erupt throughout the mouth. Once a person is infected with primary herpes, the virus stays in the body and causes occasional attacks. Cold sore blisters usually heal in a week by themselves. Over-the-counter topical anesthetics can provide some relief. Your dentist may prescribe antiviral drugs to reduce these kinds of viral infections.
·         Leukoplakia. Thick, whitish-color patches that form on the inside of the cheeks, gums or tongue, these patches are caused by excess cell growth and are common among tobacco users. They can result from irritations such as an ill-fitting denture or the habit of chewing on the inside of the cheek. Sometimes leukoplakia is associated with oral cancer. Your dentist may recommend a biopsy if the patch appears suspicious. Your dentist will examine the lesion and check the biopsy results to help determine how to manage the disease. Treatment begins with removing the factors that contribute to the lesion: quitting tobacco or replacing ill-fitting dentures or bridges.
·         Candidiasis. This fungal infection (also called moniliasis or oral thrush) occurs when the yeast Candida albicans reproduce in large numbers. It is common among denture wearers. Most often it occurs in people with weak immune systems—the very young, elderly or those debilitated by disease, such as diabetes or leukemia. In addition, people with dry mouth syndrome are susceptible to candidiasis. Candida may also flourish after antibiotic treatment, which can decrease normal bacteria in the mouth.
Controlling candidiasis means focusing on preventing or controlling the condition that causes the outbreak. Good oral hygiene is essential. Clean your dentures to remove Candida and remove them at bedtime. If the cause is dry mouth saliva substitutes and prescription medications may be helpful when the underlying cause of dry mouth is incurable or unavoidable.

Wednesday, July 18, 2012

Oral health: A window to your overall health

Your oral health is more important than you may realize. Get the facts about how the health of your mouth, teeth and gums may affect your general health.

Did you know that your oral health can offer clues about your overall health? Or that those problems in your mouth can affect the rest of your body? Understand the intimate connection between oral health and overall health and what you can do to protect yourself.

What's the connection between oral health and overall health?

Your mouth is teeming with bacteria — most of them harmless. Normally the body's natural defenses and good oral health care, such as daily brushing and flossing, can keep these bacteria under control. However, harmful bacteria can sometimes grow out of control and cause oral infections, such as tooth decay and gum disease. In addition, dental procedures, medications, or treatments that reduce saliva flow, disrupt the normal balance of bacteria in your mouth or breach the mouth's normal protective barriers may make it easier for bacteria to enter your bloodstream.

What conditions may be linked to oral health?

Your oral health may affect, be affected by or contribute to various diseases and conditions, including:
·         Endocarditis. Gum disease and dental procedures that cut your gums may allow bacteria to enter your bloodstream. If you have a weak immune system or a damaged heart valve, this can cause infection in other parts of the body — such as an infection of the inner lining of the heart (endocarditis).
·         Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation from periodontitis — a severe form of gum disease.
·         Pregnancy and birth. Gum disease has been linked to premature birth and low birth weight.
·         Diabetes. Diabetes reduces the body's resistance to infection — putting the gums at risk. In addition, people who have inadequate blood sugar control may develop more-frequent and severe infections of the gums and the bone that holds teeth in place, and they may lose more teeth than do people who have good blood sugar control.
·         HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS.
·         Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — may be associated with periodontal bone loss and tooth loss.
·         Alzheimer's disease. Tooth loss before age 35 may be a risk factor for Alzheimer's disease.
·         Other conditions. Other conditions that may be linked to oral health include Sjogren's syndrome — an immune system disorder — and eating disorders.
Be sure to tell your dentist if you're taking any medications or have had any changes in your overall health — especially if you've had any recent illnesses or you have a chronic condition.

How can I protect my oral health?

To protect your oral health, resolve to practice good oral hygiene every day. For example:
·         Brush your teeth at least twice a day.
·         Replace your toothbrush every three to four months.
·         Floss daily.
·         Eat a healthy diet and limit between-meal snacks.
·         Schedule regular dental checkups.
Also, watch for signs and symptoms of oral disease and contact your dentist as soon as a problem arises. Remember, taking care of your oral health is an investment in your overall health.
You can make an appointment with our dentist by calling our office at (305) 534-2002 or by visiting www.4everteeth.com . We are conveniently located in Miami Beach at 939 Arthur Godfrey Road, Miami Beach, FL 33140

Thursday, June 14, 2012

Dental care and dementia

Dental care and dementia

Good oral health is important for general health, well-being and quality of life. It brings significant benefits to self-esteem, dignity, social integration and general nutrition. Poor oral health can lead to pain and tooth loss, and can negatively impact self-esteem and the ability to eat, laugh and smile. This factsheet describes some of the dental problems that people with dementia at different stages may face and methods for prevention and treatment.

Dental disease

There are two main types of dental disease - gum (periodontal) disease and tooth decay (dental caries, more commonly known as cavities). Both can cause discomfort or pain and can lead to the development of infection. Both pain and infection can worsen the confusion associated with dementia.

Gum disease

Gum disease can cause inflamed and bleeding gums, gum recession (where the gum tissue is reduced, causing the roots of the teeth to become exposed), loose teeth and bad breath. It is caused by the build up of dental plaque. Plaque is a combination of food debris and bacteria from the mouth - everyone has some of it. Plaque leads to gum disease if it is not removed by efficient cleaning as it builds up on the surface of the teeth, particularly where the teeth meet the gum. Good oral hygiene (keeping the teeth, gums and mouth clean by brushing and flossing) and the use of a tooth gel or mouth rinse containing chlorhexidine (an antiseptic and disinfectant agent) can help to control gum disease.

Tooth decay

Tooth decay is caused by the action of dental plaque on the teeth when food and drinks containing sugar are consumed. Essentially, the bacteria in plaque feed on the sugar, producing acid, which in turn attacks the tooth, causing decay. Dentists recommend restricting the intake of sugar to two to three times a day, preferably at mealtimes, as it is the number of times we eat sugar in a day, rather than the total amount of sugar consumed, that is important in guarding against tooth decay. This includes hidden sugars in foods, as well as sugar added to food or drinks. A healthy diet, good oral hygiene, and the use of toothpaste or a mouth rinse containing fluoride will also help prevent tooth decay.

High-energy food supplements contain high levels of sucrose - a form of sugar. If they are used on a regular basis, it is important that the teeth are kept very clean to minimize the risk of decay. Gum recession increases the chances of tooth decay occurring at the necks of the teeth (where the crown of the tooth meets the root at the gum) unless oral hygiene is excellent and dietary sugar is controlled. When food supplements are prescribed for a person with natural teeth, it is important to get advice on prevention from the dental team.

Daily care of teeth

Early stages of dementia

In the early stages of dementia, the person will usually still be able to clean their own teeth. They may need to be reminded to carry out the task, or they may need to be supervised. If they need help, try giving them the brush and toothpaste and show them what to do. As manual ability decreases, an electric toothbrush may help maintain independence. The person with dementia could also try using a toothbrush with an adapted handle to improve their grip. Your dentist or dental hygienist may be able to advise you on this as well as the best methods for prevention of tooth decay and gum disease in the particular circumstances. It is very important to establish an individual long-term preventive programme in the early stages of dementia. This may include a high-concentration fluoride toothpaste and regular application of fluoride varnish for people with natural teeth. Fluoride can be applied by the dentist, dental therapist or dental hygienist under the prescription of the dentist.

Later stages of dementia

As their dementia progresses, the person may lose the ability to clean their teeth, or lose interest in doing so, and carers may need to take over this task. A dentist or hygienist can provide guidance and support on how to assist in cleaning another person's teeth. The technique will vary depending on the individual concerned. Generally, the easiest way is for the person with dementia to sit on a dining-style chair with the carer standing behind. The carer supports the person against their body, cradling their head with one arm. They can then brush the person's teeth using a damp toothbrush and a little toothpaste.

Drugs and dental problems

People with dementia may be prescribed antidepressants, antipsychotics and sedatives. One of the main side-effects of these drugs is a dry mouth. Saliva acts as a lubricant and dry mouth can cause problems with dentures, including discomfort and looseness. Denture fixatives and artificial saliva can help some people with denture problems. The dentist will be able to offer advice. Saliva also has a cleansing effect on the mouth and teeth. Its absence leads to a build up of bacteria and food debris, gum disease and dental decay, particularly at the neck of the tooth. Decay in this area weakens the crown of the tooth, and can cause the crown to break off.

If medication is syrup-based (eg lactulose), there is an increased danger of tooth decay. The doctor may be able to prescribe a sugar-free alternative if asked. The dentist may also be able to apply chlorhexidine and fluoride varnishes to help prevent decay at the necks of the teeth.

Some antipsychotic drugs can cause involuntary repetitive tongue and jaw movements, making it difficult to wear dentures, particularly in the lower jaw. Unfortunately, these movements may continue after the drug is stopped.

Mouth checks

People with dementia are not always able to recognize or express their dental needs, including when they are in pain. It is important to have regular mouth checks, whether the person has teeth, dentures or no teeth at all. Regular mouth checks can highlight any problems so that they can be treated as soon as possible. Cancer of the mouth, while generally uncommon, is more likely to occur in older people than in any other age group. It may start as a small painless ulcer and, if diagnosed early, treatment is relatively simple and has a high success rate.

Dentures can become loose and begin to damage the mouth if they have been worn for a number of years. As these changes happen slowly, the individual can adapt to them without realizing that the mouth is being harmed. In addition, decay at the necks of the teeth is often painless, and may go unnoticed until the crown of the tooth breaks off.

Need for assistance with dental care

As dementia progresses, the person affected may become less able to:

  • clean their teeth effectively
  • understand that their teeth need to be kept clean
  • express the need for dental treatment
  • explain dental symptoms, including pain
  • take part in the decision-making process about treatment
  • give their informed consent for dental treatment
  • feel comfortable with dental treatment.

How to tell if someone has dental problems

There may come a time when the person with dementia is unable to say that they are experiencing pain or discomfort. They will need to rely on other people to notice and interpret their behavior and to arrange a visit to the dentist. There are several behavioral changes that may indicate that someone with dementia is experiencing dental problems. These may include:

  • refusal to eat (particularly hard or cold foods)
  • frequent pulling at the face or mouth
  • leaving previously worn dentures out of the mouth
  • increased restlessness, moaning or shouting
  • disturbed sleep
  • refusal to take part in daily activities
  • aggressive behaviour.

If there is no explanation for the change in behavior, arrangements should be made to identify the cause. This should include a dental assessment as part of the process.

Planning treatment

The dentist, together with the person with dementia and their family or carers, will discuss treatment needs and agree on the best treatment plan. They should take into consideration:

  • the level of independence, co-operation, cognitive and mental state, and physical impairment of the person with dementia
  • what, if any, dental symptoms or problems the person is experiencing
  • whether the individual is able to give informed consent (see 'Consent to treatment' below).

Once these questions have been answered, the dentist will be able to decide on the most appropriate treatment. They may decide to see the person regularly every few months, or they may only need to be seen once a year.

Consent to treatment

It is important that the person with dementia is given the opportunity to make, or take part in, decisions about dental treatment. Ask the dentist to explain in simple terms what is being done and why. Short sentences that are phrased in a way where the person can answer 'yes' or 'no' can be effective.

When dental treatment is irreversible - for example, when teeth are going to be taken out - and where the individual cannot give informed consent, the family and/or carers will usually be involved in the decision-making process. The dentist may also seek a second opinion, from another dentist or a doctor, to make sure that the proposed dental treatment is in the individual's best interests.

Everyone is presumed to have the capacity to make decisions unless it is shown otherwise. If this is not clear, the dentist should carry out an assessment of the person's capacity. If the individual does not have capacity, family, professionals and other carers can be involved in the decision-making process on their behalf as long as these decisions are in the individual's best interests.

People who have capacity can grant a person lasting power of attorney to take decisions about property, finances, health and welfare if they should lose capacity in the future. Where an individual has been granted lasting power of attorney, their wishes should be respectedPeople without capacity who do not have family or friends to support them may be appointed an independent mental capacity advocate to represent them in any decision over serious health care treatment - for example, removal of some or all their natural teeth, and which may involve treatment under sedation or a general anesthetic.

Coping with dental treatment

The progression of dementia varies enormously, as does the ability to cope with dental treatment. Some people are comfortable with a visit to the dentist, while others find the whole experience very distressing.

People who have had regular dental treatment throughout their lives often remember what they are expected to do in a dental surgery. They may have little difficulty co-operating with simple procedures until their dementia is advanced. For other people with dementia, the journey to the surgery, the strange environment and the unfamiliar faces of the dental team can increase their confusion, making treatment difficult or impossible.

In these circumstances, the dentist may be prepared to make a home visit. Alternatively, it can be helpful for the person with dementia to be accompanied into the dental surgery by someone they know. The carer could perhaps remain in the person's sight while they are having treatment and offer reassurance by holding the person's hand. People with dementia can have good days and bad days: dental care is better postponed to a good day, if possible, or scheduled to a person's best time of day.

Types of dental treatment

Early stages of dementia

In the early stages of dementia, most types of dental care are still possible. The dentist will plan the treatment, bearing in mind that the person with dementia will eventually be unable to look after their own teeth. Key teeth may be identified and restored. Advanced restorative treatment (such as crowns, bridges and implants) may only be considered if someone is prepared to carry out daily brushing for the person with dementia should they reach a stage where they cannot do this for themselves. Preventing further gum disease or decay is also very important at this stage. As dementia is a progressive condition, it is important to obtain preventive advice from the dental team.

Middle stages of dementia

During this stage of dementia, the person is often relatively physically healthy but may have lost some cognitive skills. The focus of dental treatment is likely to change from restoration to prevention of further dental disease. Some people may find the acceptance of dental treatment beyond their tolerance and require sedation or general anaesthesia for their dental treatment. The decision will be based on the individual's ability to co-operate, dental treatment needs, general health and social support.

Later stages of dementia

In the later stages of dementia, the person is likely to be severely cognitively impaired and often physically frail or disabled with complex medical conditions. Treatment at this stage focuses on prevention of dental disease, maintaining oral comfort and provision of emergency treatment.


More people are keeping their natural teeth into old age. However, a significant number of older people have partial or full dentures. Plaque can easily build up on dentures. If partial dentures are worn, it is important that oral hygiene is well maintained or the increased plaque accumulation will encourage gum disease and tooth decay.

New dentures may be needed when the person loses all their natural teeth or if they are misplaced. In both circumstances the person with dementia may have difficulty coping with their new set of dentures, and will need to be encouraged to persevere.

Dentures need to be replaced when they become loose. When dentures have been worn successfully in the past, the replacement dentures are best constructed using the key features of the old ones - for example, the overall shape and the tongue space. For this reason it is important not to throw away old dentures, even when they may seem to be of no use. Instead, take them along to the dentist when the new ones are being constructed so that the good features can be copied and any poor features can be improved.

Denture marking

Marking a person's name on dentures does not prevent denture loss, but it does mean that when dentures are found they can, in many cases, be returned. New dentures should be permanently marked during their manufacture. Existing dentures can be temporarily marked using a simple technique that will last for 6-12 months. This can be done using a small piece of new kitchen scourer, a pencil (or alcohol-based pen) and clear nail varnish. The process takes about ten minutes and can be carried out by a dentist, a dental hygienist or a carer.

You need to:

  1. Clean, disinfect and dry the denture.
  2. Select an area near the back of the mouth on the outer surface of the denture just large enough to take the person's name and use a new piece of green scourer to remove the surface polish from this area.
  3. Print the person's name on the denture using a pencil or an alcohol-based pen.
  4. Paint over the name with a thin coat of the varnish and allow it to dry.
  5. Apply a second thin coat of varnish and allow it to dry.

It is important to thoroughly clean, disinfect and dry the denture before marking it. Dentures should be checked periodically to ensure the name is still legible, and the marking renewed as necessary.

Wearing dentures

The person with dementia should be encouraged to wear their dentures, and offered help with putting them in, for as long as possible. Dentures are important for maintaining dignity and self-esteem - if a person does not wear them it may affect their appearance and make speech more difficult.

Denture loss is common when people with dementia are in unfamiliar environments - for example, when they spend time in a residential home for respite care. Replacing lost dentures can present problems. If the person is without their dentures for any length of time they may forget how to wear them, or they may lose their ability to adapt to a new set. The individual may also be unable to co-operate with the dentist over the several visits required to make the new dentures. However, sometimes intervention by the carer (for example, hand-holding or distraction through hand-stroking or talking) may be all that is needed. If co-operation is limited, a realistic approach may be to provide an upper denture only, for the sake of appearance.

It can sometimes be difficult and distressing for relatives and carers when they are told that it will not be possible to successfully make a set of new or replacement dentures for the person with dementia. The decision not to provide new or replacement dentures would only be made after an individual assessment and if it is in the person's best interests.

Eventually, many people with dementia reach a stage where they will no longer tolerate dentures in their mouth even though they have worn them without problems in the past.