Dementia is a group of related symptoms associated with an ongoing decline of brain functioning. Studies have associated poor oral health with and increased risk of dementia. Although poorer oral hygiene habits are reported in the elderly which could be related to reduced ability to perform routine oral care or inattention to care.

The aim of this review was to assess the oral health status of people with dementia.

Methods

Searches were conducted in the Cumulative Index
to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Scopus, and ISI Web of Science databases for English language publications.  Studies assessing the oral health status of patients with dementia where examination was conducted by a dentist were considered. Studies in which all, or a portion of, participants had secondary dementia syndromes, such as Huntington disease, Parkinson disease, Creutzfeldt-Jacob disease, or AIDS-related dementia, were excluded.

2 reviewers screened the studies with a single reviewer extracting data which was verified by the second reviewer.  Results were reported qualitatively with meta-analysis being conducted if more than 3 studies reported the same outcomes.

Results

• 28 studies were included.
• 15 studies were cross sectional, 8 prospective, 4 case-controls, 1 retrospective.
• Assessments were conducted of tooth status, active dental caries, hygiene (plaque/calculus) of natural and artificial teeth, periodontal diseases, denture status (retention, stability, denture-related mucosal lesions), and oral health–related quality of life.
• Across all evaluations, persons with dementia generally had scores/results suggestive of poor oral health.
• In meta-analyses, compared with persons without dementia, those with dementia had
  • significantly fewer teeth MD, = −1.52; (95%CI; −0.2.52 to −0.52) P = 0.003; [13 studies]
  • more carious teeth SMD = 0.29; (95%CI; 0.03 to 0.48) P = 0.028 [9 studies]
  • significantly worse oral hygiene SMD = 0.88; (95%CI; 0.57 to 1.19) P < 0.000 [7 studies]
  • significantly poorer periodontal health SMD = 0.38; (95% CI, 0.06 to 0.70) P = 0.02; [6 studies].

Conclusions

The authors concluded: –

The findings from a systematic review of 28 studies indicated that, across the continuum of the disease progression, persons with dementia living in the community or in residential care facilities experienced poor oral health. Compared with persons without dementia, those with dementia had significantly fewer teeth, more carious teeth, and significantly worse oral hygiene, along with frequent reports of bleeding gums, loss of tooth attachment, poor denture hygiene, unsatisfactory denture stability and retention, and prosthetic-associated stomatitis. Determining the independent role that dementia contributed to these findings is challenging given the observational nature of the included studies.

Comments

While this review has searched large number of databases only English language studies have been included so relevant studies could have been missed.  A majority of the studies are cross sectional. As already noted a person’s oral care may deteriorate due to prolonged or progressive inattention to care or neglect due to dementia. They may also be come uncooperative with oral care and some care facilities may not afford oral care full attention.  Assessing the contribution of dementia to poorer oral health is problematic as age changes and previous dental treatment has an impact and many older people may be on multiple prescriptions medications which can affect salivary flow. The review suggests that those with dementia have poorer oral health highlighting a need to ensure appropriate continuing oral care for this group of patients.

Links

Primary paper

 Foley NC, Affoo RH, Siqueira WL, Martin RE. A Systematic Review Examining the Oral Health Status of Persons with Dementia.   JDR Clin & Trans Res. Vol: 2 330-342 Article first published online: July 7, 2017;Issue published: October 1, 2017.