The Challenges of Dental Care While Living with Dementia

Laurie Waters and Don Kent share their perspectives on personal oral care and dental care. Laurie is living with young-onset Alzheimer Disease, and Don is living with Lewy Body Dementia (LBD).  

Don and Laurie have quite different feelings about going to the dentist. Having his teeth cleaned is something that has never been a very negative experience for Don. Even after being diagnosed with LBD, he still doesn’t truly mind the process.

However, Laurie has noticed many significant changes in being able to tolerate dental care since her diagnosis. One of her dementia-related symptoms is a constant ringing in her ears, so she finds that the noise of the dental instruments combined with this ringing to create an intolerable sound.

To combat this, Laurie wears earbuds with ASMR messages during dental treatment. ASMR, which stands for Autonomous Sensory Meridian Response, describes a feeling of relaxation and well-being that is triggered by a combination of calming speaking and meditative sounds.

Laurie finds that listening to ASMR audio is incredibly useful in helping her cope with unpleasant sounds. She has also had to find a dental hygienist that was willing to speak quietly and minimally during the appointment so Laurie can focus on the sounds in her earbuds.

Laurie has noticed that she has had more issues with gum disease since her diagnosis, due to the related medications, so she regularly has dental deep cleanings, also known as scaling (removal of plaque and tartar above and below the gum line) and root planing (the process of smoothing the root surfaces and removing any infected tooth structure).

Because this is more involved than a regular cleaning, she finds it works best to only have half of her mouth cleaned at one time. She then goes back the following week for the other half of her mouth to be deep cleaned.

Laurie also communicates with her dentist and hygienist about her needs, and they are happy to allow her to take breaks as needed or even stop the procedure early if she is unable to tolerate any more.

Since her diagnosis, Laurie has also noticed that she is less able to tolerate other sensations during dental procedures, such as having her mouth full of water or having the hygienist reposition her head. She finds that she will experience a panic response, and sometimes will push their hand away involuntarily. Again, openly communicating about her needs and what is helpful and unhelpful for her is one way that Laurie has found to make the process more bearable for her.

For their own oral care at home, both Don and Laurie are still able to brush their teeth regularly. Don reports that his oral care routine at home has not changed much since his diagnosis.

However, Laurie has noticed that she has become much more focused on flossing and brushing since her diagnosis, as the sensation of any food between her teeth is extremely uncomfortable for her. She uses handheld flossers and an electric toothbrush and admits that she often flosses and brushes too much, as she becomes rather fixated on getting her teeth as clean as possible.

Both Don and Laurie report that they are motivated to keep their teeth healthy, since wearing removable partial dentures or having other forms of tooth replacement, such as implants, is not likely something they would tolerate well.

Don shared another experience related to oral care. He has had many issues with snoring and sleep apnea but was unable to wear a CPAP (Continuous Positive Airway Pressure) machine, especially after being diagnosed with dementia.

However, he was referred to a Dental Sleep Medicine Specialist, a dentist who has received additional training in sleep apnea and snoring. This dentist fitted Don with repositioning devices, which are removable appliances that help to reposition the lower jaw to improve breathing and reduce snoring.

Don found them much easier to adjust to than the CPAP machine, and he has now been wearing them for six years. His sleep apnea and snoring have both dramatically improved with the use of these appliances.

Conclusion

We know that all individuals experience dementia differently, and experiences with oral care vary widely. While not every individual experiences or develops sensory changes and intolerances related to oral care, it is very common for this to occur during the dementia journey. Understanding an individual’s current and past experiences with dentistry and oral care, including any traumatic experiences, is essential in being able to effectively support their oral care needs. Communication with the dental team about the individual’s preferences and intolerances is also essential to providing as positive an experience as possible and to encourage healthy oral care habits.

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Image by Steve Buissinne from Pixabay