Angina Blog on Angina.com

Nurses who care for patients with dementia now have a tailored approach to dental hygiene for their charges, thanks to a pilot study by a team of nurses.

“Poor oral health can lead to pneumonia and cardiovascular disease as well as periodontal disease,” said Rita A. Jablonski, even though these illnesses are not usually associated with the mouth. According to Jablonski, assistant professor of nursing, Penn State, persons with dementia resist care when they feel threatened. In general, these patients cannot care for themselves and need help.

Jablonski and her team introduced an oral hygiene approach called Managing Oral Hygiene Using Threat Reduction (MOUTh) specifically for dementia patients. Many of their strategies focus on making the patient feel more comfortable before and while care is provided, the researchers report in the current issue of Special Care in Dentistry.

“We have come up with 15 strategies — techniques to help reduce threat perception,” said Jablonski. These strategies include approaching patients at eye level if they are seated, smiling while interacting, pantomiming, and guiding patients to perform their own care by placing a hand over the patient’s hand and leading.

People with dementia are often no longer able to distinguish low or non-threatening situations from highly threatening situations. This happens when the parts of the brain that control threat perception — particularly the fight, flight or freeze responses — begin to deteriorate. The amygdala is the part of the brain that houses the fear response. The hippocampus and cerebral cortex receive and send messages to the amygdala, telling it how to react.

“Think of the hippocampus, cerebral cortex and amygdala as being in the woods,” said Jablonski. “In a person with dementia, the path in the woods is blocked with tumbleweeds and the message from the cortex and hippocampus can’t get to the amygdala.” In turn, patients with dementia often react to something as intimate as a nurse brushing their teeth as a perceived threat.

In the past 30 years the number of nursing-home residents who still have their own teeth has risen significantly. Many of these people need assistance with their dental hygiene, as well as with other hygiene.

Jablonski and her team conducted a pilot study with seven people who had either moderate or severe cases of dementia. The researchers used the MOUTh technique on the subjects for two weeks, recording the state of the patients’ mouths and how the patients reacted throughout the study.

At the beginning of the study all seven subjects had poor oral health, as determined by the Oral Health Assessment Tool. Eight categories concerning oral health are scored between zero and two. The lower the score the healthier the mouth. The average score for the subjects at the start of the study was 7.29. By the end of the study the average score was 1.00.

“To my knowledge, we are the only nurses in the country who are looking at ways to improve the mouth care of persons with dementia, especially those who fight and bite during mouth care,” said Jablonski. “Our approach is unique because we frame resistive behavior as a reaction to a perceived threat.”

Other researchers on the project were Ann Kolanowski, Elouise Ross Eberly Professor; Mia Gabello and Alexandra Brock, graduate students, all in the school of nursing, Penn State; Barbara Therrien, associate professor in nursing, University of Michigan; and Ellen K. Mahoney, associate professor in nursing, Boston College.

SOUTH BEND, Ind., Feb. 11, 2011 /PRNewswire/ — More than just teeth and gums, a dentist may help detect a wide range of health conditions, including heart disease, diabetes and oral cancer, but for many people an intense fear of dental treatment prevents them from getting the care they need.

To bring attention to the connection between good oral health and overall health, Heraeus, the leader in advancing dental esthetics and overall dental wellbeing, is acknowledging Heart Failure Awareness Week, February 13-19, 2011.

“Recent scientific studies and data show that dentists can spot early warning signs in the mouth that may indicate disease elsewhere in the body,” says Christopher Holden, President of Heraeus Kulzer. “Importantly, dentists’ significant training and education enables them to recognize conditions that merit referring patients for care by dental specialists or physicians,” he adds.

According to the U.S. surgeon general’s report on oral health in America, approximately one-third of adults in the United States had not visited a dentist for treatment within the previous year.(1)

The barriers to adequate dental care can range from low income to lack of dental insurance to dental anxiety, but the end result is the same: oral health extends beyond dental health and forgoing a trip to the dentist inhibits optimal oral health and may even retard the detection of serious diseases.

For those with dental phobias, there’s good news. New products and technologies are helping to eliminate sensitivities.  Gluma® Desensitizer PowerGel by Heraeus is one such product. Scheduled to launch in March 2011, the product helps eliminate sensitivity due to gum erosion. “Patients who forgo annual cleanings may have gum recession, and as a result, they may experience some sensitivity during a professional cleaning,” says Rachel Wall, a renowned dental hygienist and founder of Inspired Hygiene. “Gluma® Desensitizer PowerGel promotes patient comfort by eliminating pain associated with dentinal hypersensitivity,” she adds.

The American Dental Association recommends that individuals brush and floss every day, and see their dentist at least twice a year for regular cleanings and oral exams.