Toothache and dental treatments

People with the disease Alzheimer's Advanced patients experience difficulty speaking and expressing their feelings. When an Alzheimer's patient suffers from toothache, the only way they can express pain in this situation is by changing their behavior, crying, screaming, restlessness, and lack of cooperation. It follows that in a situation where a dental problem would bring any of us immediately to the dentist, an Alzheimer's patient remains untreated. Later, if the patient is still not treated, as a result of the difficulty in chewing, we can see weight loss, to the point where artificial feeding and hospitalization will be necessary. Hence the importance of early diagnosis and reporting of dental problems.
How can we as caregivers and relatives recognize signs of dental distress? Can Alzheimer's patients be treated with routine dental care? How can we brush and maintain what is available when there is a lack of cooperation?

Dental treatment for Alzheimer's patients in the dental office is challenging. The difficulty stems from the patient's limited intellectual understanding, suspiciousness, and unexpected behavior. The patient may grab the dentist's hand, decide to stand up suddenly in the middle of the treatment, or refuse to open his mouth. To overcome these difficulties, it is advisable to give the patient sedatives before the treatment. During the dental treatment itself, it is advisable to have a therapist and a relative present in addition to the dentist and assistant. Increased presence in the treatment room is of great importance. It is important to have a familiar figure in the treatment room who can talk to the patient and distract him from the treatment. It is also important to have someone to hold the patient's hand and prevent him from making unexpected movements during the treatment. It is also important to consult with the medical team and family before the treatment in order to get to know the patient and learn his typical behavior.
Due to the difficulty for caregivers and family members to diagnose dental problems, I recommend bringing the patient for an initial examination and diagnosis with a dentist, preferably when Alzheimer's disease is in the early-to-moderate stages, as cooperation is better then. In this examination, the patient's dental condition will be determined by a clinical examination by the dentist and X-rays if necessary. If necessary, dental treatments and tartar removal will be performed, with the goal being to bring the Alzheimer's patient to a state where his teeth are treated, and there are no possible sources of pain in the mouth.

During the visit to the dental clinic, a prevention plan appropriate for the Alzheimer's patient will be determined, which will include instruction in brushing, use of fluoride to prevent tooth decay/root decay. Use of a special gel to maintain the condition of the gums. And, if necessary, rinses or gel to increase saliva secretion. The caregiver and family members will be instructed in implementing the prevention plan and brushing the teeth.

Due to the patient's expected lack of cooperation, I recommended frequent dental examinations and checkups and scaling.
How can signs of distress in the oral cavity be diagnosed? The caregivers usually do not have dental training, but they spend many hours with the patient and can identify typical changes in the patient's behavior. As a result of dental-related distress, and due to the inability to express themselves verbally, we see screaming, crying during eating or immediately afterwards, or alternatively, withdrawal and unwillingness to eat or talk, or any other behavioral change than is normal for this patient.

Beyond that, we can see the usual signs of dental distress in the mouth - such as fractures in teeth, bridges or dentures. Unstable dentures, loose teeth. Swelling in the gums, tongue, cheek or face. The appearance of sores in the oral cavity. In any case of one of these conditions, it is necessary to contact the dentist immediately.
What will be the nature of the treatment performed by the dentist? The answer depends on the patient's mental and medical condition. Of course, the initial and immediate goal will be pain relief. As mentioned, the treatment requires adjustment to the patient's condition. For example, in some cases, it will be possible to perform root canal treatment to save the tooth, and in other cases, due to the difficulty in cooperation, we will extract the tooth. In certain situations, the doctor will even extract the teeth that are the source of the pain, leaving the patient without teeth, with the understanding that even if dentures are made, the patient will not use them. In other situations, the patient's behavior will dictate that the treatment be performed under sedation or anesthesia. However, this option will not always be appropriate, due to other medical problems that can make it difficult and constitute risk factors for performing dental treatment under general anesthesia, such as heart problems or breathing difficulties.
It is extremely important to instruct the caregiver regarding post-dental care instructions for an Alzheimer's patient. For example, after dental anesthesia, an Alzheimer's patient may bite their cheek, tongue, or lip out of ignorance. Or in another case, after an extraction, the patient may spit or rinse their mouth contrary to accepted instructions, and the result can be significant bleeding.

In conclusion, the importance of dental care in Alzheimer's patients is not emphasized enough. Dental care is an integral part of maintaining the patient's overall health and quality of life, and therefore there is great importance in diagnosing and treating dental problems in the early stages of the disease.

The author of the article is Dr. Avishai Reisner , a dentist with experience in treating the elderly, and Alzheimer's and Parkinson's patients in particular. His clinic is located in the "Mishan Neot Afek" assisted living facility and is fully accessible. In addition, Dr. Avishai Reisner has a mobile dental clinic for the treatment of housebound/bedridden and hospitalized patients.