Special Needs Patient: Alzheimer’s

Dental Hygiene III

Josie Wilhelm
 The disability I have chosen to write about is Alzheimer’s. Alzheimer’s disease is a

disease that affects the brain’s neurons. This is a progressive brain disorder that leads to memory

loss, personality changes and problems carrying out daily activities. Dr. Alois Alzheimer first

recognized the disease in 1906 when he was looking further into the death of a person with an

atypical mental illness. He found that there were many more plaques and tangles in their brain

tissue than a normal person. Scientists do not know exactly what role these play in the disease

but they believe that they could be blocking communication among nerve cells and disrupting

processes that cells need to survive. The destruction of these nerve cells is what causes the

memory failure, personality changes and other symptoms of Alzheimer’s disease.

Age is the best known risk factor for Alzheimer’s disease. It is said that one in nine

people around age 65 have the disease and almost one-third of people age 85 and older have

Alzheimer’s. Family history is another huge risk factor for this disease. People that have a

close family member with the disease are more likely to develop it themselves. Risk genes and

deterministic genes are the genes that scientist know are a part of Alzheimer’s. Apolipoprotein

E-e4 (APOE-e4) is a risk gene because it was found that if you are born with this gene, your

chances of developing that disease was much higher. Deterministic genes are found to be a

direct cause of Alzheimer’s, if you have the gene you will inherit the disease. Scientists have

found that variations in certain proteins are deterministic and cause Alzheimer’s. These proteins

are: amyloid precursor protein, presenilin-1 and presenilin-2. When the disease is caused by a

deterministic gene, it is called familial Alzheimer’s disease. Familial Alzheimer’s usually will

affect many family members in future generations. Some of the risk factors that are still being

studied are head injury and “heart-head connection.” There may be a link between repeated head

trauma and the later onset of Alzheimer’s disease. The heart-head connection talks about how
brain health is linked to heart health. The heart pumps blood through blood vessels to the brain,

so if there is damage to the blood vessels the brain may not be getting proper nourishment.

Damage to these blood vessels could be caused by heart disease, diabetes, stroke, hypertension

and high cholesterol. Research also shows that Latinos are one and a half times more likely to

develop Alzheimer’s and African-Americans are about twice as likely as Caucasians. Scientists

are not sure why this is, but they believe that the higher rates of vascular disease in these

ethnicities could potentially put them at a higher risk.

Alzheimer’s mainly affects the persons mind. At first family members may notice

slowed thinking and forgetting certain things. As it progresses, confusion, mood changes, and

serious memory loss will occur. Physical mobility is also affected in later stages of the disease.

Sometimes people with Alzheimer’s will repeat something they had just done because they may

have forgotten they already did it. The person’s hygiene may also decrease because they can

forget to do little tasks such as cleaning their ears frequently.

Currently there is no cure for Alzheimer’s and unfortunately it is a progressive disease

that will get worse over time. There are medications, though, that can help to lessen the

symptoms for that patient. The FDA has approved two types of medications, cholinesterase

inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda). These are to help treat the

cognitive symptoms of the disease. Namzaric is another medication that actually combines one

of the cholinesterase inhibitors with memantine. Some common side effects of cholinesterase

inhibitors are nausea, vomiting, loss of appetite and increased bowel movements. The patient

may also be on medication for behavioral changes such as: antidepressants, antianxiety, and

antipsychotics.
 A huge physical effect that Alzheimer’s has on the oral cavity is the difficulty in

swallowing. This can happen in the terminal stages of the disease. This will affect the way we

can treat them and maybe by sitting them up a little more could alleviate some of the discomfort.

Patients that suffer from Alzheimer’s will need assistance with their oral hygiene, even

something as simple as reminding them to do it. Some patients will have decreased salivary flow

and this should be recognized as it raises their risk of caries and also affects denture placement.

If a patient is not monitored with their brushing, they’re oral health will decrease. They may not

be aware that their oral health is declining, so they are at a risk for dental diseases. The

medications they are on may also cause xerostomia, glossitis, coated tongue, alteration of taste,

dizziness, and orthostatic hypotension.

Making sure to assess the patient’s current abilities is extremely vital to care. We must

know what the patient can and cannot do on their own. As hygienists, we should always involve

the patient and their primary caregiver in the oral hygiene instruction. The caregiver should

know how to help the patient at home, and to make sure to remind them if they forget. The

caregiver should also be able to recognize when dental care is needed, especially if they are

refusing to wear their dentures. In the later stages of Alzheimer’s, the caregiver will need to be

the one to do daily oral hygiene on the patient. Patients may need more dental hygiene visits,

fluoride treatments and saliva substitutes. Using an electric toothbrush could be very beneficial

to the patient as it will help with better plaque removal. The bigger handle of an electric

toothbrush will also help with patients that have lost some of their dexterity. A flossing aid may

also help with patients when they start to lose their dexterity. Keeping them flossing everyday

will be very important. Research has shown that the colors blue and red have worked well in

helping patients with Alzheimer’s remember a little better, so giving them a red or blue
toothbrush could also help. Appointments will also need to change depending on the stage of

their disease. Making sure to give specific brushing and flossing instructions to early stage

patients is extremely important. Tell the patient how to do something, show them how to do it

and then have them do it for you. Explaining every part of the process will help the patient

understand a little better. In early stages of the disease, reviewing the patient’s medical and

dental history every appointment will help to reveal any changes in their memory. This will help

to keep you as the hygienist more updated on their current status.

Alzheimer’s is a very sad disease that I would never wish on anyone, but treating a

patient with Alzheimer’s is not impossible. Extra care must be taken to ensure that their oral

hygiene is being taken care of. Each Alzheimer’s patient will also give new obstacles as not

everyone will have the same exact stage of the disease. Making sure that the patient feels

comfortable and safe will reduce anxiety and stress for them. Keeping directions basic and

always making sure to listen to what they have to say will make each appointment smooth.
 Resources

Alzheimer’s Association. (2017a). What is Alzheimer’s? Retrieved from

http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp#tangles

Alzheimer’s Association. (2017b). Medications for Memory Loss. Retrieved from

http://www.alz.org/alzheimers_disease_standard_prescriptions.asp

Alzheimers’s Association. (2017c). Risk Factors. Retrieved from

http://www.alz.org/alzheimers_disease_causes_risk_factors.asp

Prajer, R. Kacerik, M. (2006). Treating patients with alzheimer’s disease. Dimensions of Dental

Hygiene, 4(9), 24-26.

Wilkins, E. (2013). The older patient., Clinical Practice of the Dental Hygienist (802). Location:

Lippincott Williams & Wilkins.