By Cynthia Santos
When a resident living with dementia begins exhibiting responsive behaviours, care teams often ask: what has changed?
The answer may be pain or discomfort that the resident cannot easily communicate. And one potential source can be easy to overlook: their mouth.
A sore tooth, inflamed gums or ill-fitting dentures can affect eating, communication, social participation and behaviour. For long-term care teams, recognizing oral health as part of a resident’s overall health can help identify problems earlier and support more person-centred care.
Oral health and quality of life
At Baycrest, where teams care for older adults with complex health and cognitive needs, oral health is viewed as an important part of overall health, comfort and quality of life.
For older adults with complex medical needs, the consequences of unaddressed oral health issues can be devastating. Difficulty eating, for example, can impact nutrition. One 90-year-old patient lost her dentures while hospitalized and subsequently lost 20 pounds because she was unable to eat properly. The weight loss left her unable to walk. It was only after she received new dentures that she was able to regain the weight and, ultimately, her ability to walk.
Another common complication of poor oral hygiene among aging adults with complex health needs, for example, is aspiration pneumonia, which occurs when bacteria from the mouth cause an infection in the lungs.
A painful or unhealthy mouth can make it impossible to communicate and participate in social activities.
These concerns can become increasingly challenging to address as dementia progresses. A person who was once able to brush their teeth independently may eventually require assistance. Someone who previously accepted dental care without hesitation may become fearful or resistant. Changes in mobility and physical health can also make dental appointments painful and even distressing.
Seeing the person behind the behaviour
The relationships long-term care staff build with residents give them an important perspective when changes occur. Through day-to-day interactions, staff develop a familiarity with each person’s personality, preferences and routines, putting them in a strong position to recognize subtle changes that might otherwise go unnoticed.
Oral discomfort should be one of the possibilities considered when a change is unexplained, but it shouldn’t only enter the conversation when something has gone wrong. That starts with understanding the individual. Oral care routines that once worked may no longer be appropriate as a resident’s needs change. The timing of care, the environment, who provides it and how it is introduced may all need to be reconsidered. A familiar caregiver, a quieter setting or simply allowing more time can sometimes make care more manageable.
In some cases, specialized technology may be required to safely meet more complex health or cognitive needs. For example, at Baycrest’s Alpha Omega Dental Centre, a state-of-the-art wheelchair lift allows patients to stay safely in their own wheelchairs during examinations and procedures. Collaboration between long-term care staff and dental professionals can help ensure that care is tailored to the resident’s abilities, needs and preferences.
Dr. Banafsheh Abbasnezhad-Ghadi, General Dentist at Baycrest, emphasized that improving oral health for older adults will also require changes beyond the point of care. “With Canada’s aging population, there is a need for more dentists trained in geriatric care, greater investment in oral health research and interventions, and stronger education for both dental and health-care professionals,” says Dr. Abbasnezhad-Ghadi, while also pointing to the need for policy changes to ensure oral health is treated as an essential component of long-term care.
Oral health should not sit apart from the rest of long-term care. By recognizing oral health as part of overall health and quality of life, long-term care teams can identify concerns earlier, adapt care to the individual and help residents remain comfortable, engaged and able to participate in daily life.
Cynthia Santos is Operations Lead at Baycrest’s Dental Clinic