Jun 18, 2015

15 Strategies to get dementia patients to brush their teeth

Alzheimer's Reading Room
"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. Persons with dementia resist care when they feel threatened. In general, these patients cannot care for themselves and need help.

Dental Hygiene and Dementia | Alzheimer's Reading Room


"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."


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"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, 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." 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.



To watch the longer 28 minute version go here - Oral Hygiene & Care-resistant Behaviors. This video addresses care-resistant behavior exhibited by persons with dementia within the context of oral hygiene. Care-resistant behavior includes any actions on the part of the person with dementia to evade or avoid activities of daily living.

People with dementia are often no longer able to distinguish low or nonthreatening 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.


Dr. Rita Jablonski-Jaudon and her team tested ways to provide mouth care to persons with moderate and severe dementia who resisted care. The study was funded by the National Institutes of Health/National Institute of Nursing Research, RO1 NRO1 2737. We are sharing this video in the hopes that family caregivers may find some of the techniques helpful. Although the strategies were used with mouth care, some of the strategies can be used with other activities of daily living. Dr. Jablonski-Jaudon is currently working on new videos that will help family caregivers with bathing and dressing.

She is interested in your feedback and can be reached at rjablonski@uabmc.edu.

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