Dental Problems and Alzheimer’s Disease

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

Dental problems can be a challenge for people with Alzheimer’s disease. Their gums often show signs of aging. They may forget to brush their teeth, or they might not remember how to use the toothbrush and toothpaste. They also may not be able to tell someone if they’re in pain.

Take your loved one to an emergency room or a doctor as soon as possible if they have a fever and their face or jaw is swollen, or if they can’t breathe or swallow.

Call their dentist if they have a tooth that’s a darker color than the teeth around it, or if it seems to hurt when they eat or press on the tooth.

They may not be able to tell you, so look for signs that they’re in pain. They might:

  • Wince when they chew
  • Stay away from foods that are too hot or cold
  • Bite their inner cheek or lip
  • Drool
  • Act aggressively or try to bite you or other objects
  • Have a white film on their tongue
  • Have bad breath even though they’re brushing their teeth
  • Have a swollen spot or a pimple on their gum underneath a tooth
  • Not let you look at or clean their mouth

If your loved one has a broken tooth, rinse their mouth with warm water if you can. If there’s blood and they’re able to follow directions, have them bite down on a piece of gauze or a wet tea bag for about 10 minutes or until the bleeding stops. Don’t put your fingers in their mouth.

Put a cold pack on their cheek or lip over the broken tooth to make the swelling go down. If they’re in pain, give them acetaminophen. Stay away from ibuprofen or aspirin. They can cause the injury to bleed more and bruise.

Common Dental Problems

Mouth care doesn’t just keep the mouth healthy. It also lowers the chances that someone with Alzheimer’s disease will get pneumonia. Some studies show that as many as half the cases of pneumonia among nursing home residents are caused by poor dental hygiene.

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Some of the more common dental problems in older persons with Alzheimer’s disease are:

Cavities . If you don’t brush or floss your teeth, bacteria and food can collect in your mouth. This bacteria, or tartar, can build up and eat away the outer layer of the tooth, called the enamel. This makes holes in the teeth, called cavities. These usually happen in areas where plaque and tartar build up, such as the pits or grooves in the teeth. Once cavities reach deeper into the tooth, you might have a toothache.

Broken teeth or dental work. This can be minor or serious. If just the tooth enamel is chipped, then it's minor. But if the break goes into the inner part of the tooth, called the dentin or the pulp, you should take your loved one to a dentist in the next few days. If you ignore a seriously broken tooth, it can lead to an abscessed tooth. In older people, dental work such as fillings, crowns, and root canals can fall out or chip when they chew.

Abscessed tooth. This is an infection inside the tooth’s pulp, which is the inner part of the tooth fused with blood vessels. From there, the infection spreads to the gum. This is very painful. It’s usually caused by a cavity that spreads too deep within the tooth. This lets bacteria into its pulp layer. As the tooth tries to fight off the cavity, the pulp inflames and sometimes causes a toothache. Molars (the teeth in the back of the mouth) are usually the ones that form abscesses because it’s harder to keep them clean.

Dry mouth. If your mouth doesn’t make enough saliva, it can get too dry. Medications for Alzheimer’s disease, blood pressure, depression, and allergies can also cause it. If you don’t treat it, dry mouth can lead to ulcers, sores, and cavities. It can also make you unable to taste things and have problems digesting food.

Bad breath. There are many causes of bad breath, such as poor dental hygiene, dry mouth, mouth infections, dental problems, medications, and certain foods.

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Basic Mouth Care

To keep your loved one’s mouth healthy, follow the basic dental hygiene tips provided by the American Dental Association. Brush teeth twice a day with a fluoride toothpaste. Use a soft-bristled toothbrush with a small head to get the hard-to-reach areas, and replace it every 3 to 4 months.

Clean between teeth daily with floss or an interdental brush. Drink water with fluoride. If they wear dentures, clean them and take them out for 4 hours every day to keep the lining of the mouth healthy. Get a dental checkup every year.

Help Your Loved One With Dental Hygiene

How you help your loved one take care of their mouth and teeth depends mostly on how clearly they’re able to think and if they can follow directions. In the early stages of Alzheimer’s disease, many people can brush their own teeth while you watch to be sure they do it right.

Later on, they’ll likely need help. They may be more likely to be scared and not want to cooperate. They may lash out. But you can do some things to make it easier to take care of them.

When you clean and check their mouth and teeth, start gently. Move and speak slowly, and make eye contact. You may want to talk with them for a while and then explain what you need to do. Let them know that you’ll do your best not to cause any pain. Tell them to tell you if anything you do hurts, and that you will quickly stop.

You can put on latex or rubber gloves, or wrap your finger with gauze, then gently massage their gums, cheeks, and roof of their mouth. Have them spit. If this is hard for them, play some music or their favorite TV show to distract them.

If they won’t open their mouth, clearly and gently tell them what you want to do. Try to touch their mouth with the toothbrush and see if they’ll let you slip it in. You may touch their jaw or cheek to tell them that you’d like them to open their mouth, but don’t force the toothbrush in. You can ask them if they can smile for you, or have them sing a song. This will make them open their mouth so you can get a toothbrush in. If they open wide, brush the back teeth first, since these are the hardest to clean.

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If they won’t let you take care of their mouth, try to tell them in simple terms why it’s important. Get them involved in their own care by asking them if they want to try it themselves. It may help to make them more at ease if you give them a familiar item to hold while you get started. When they do let you care for their mouth, give them positive feedback.

Try to make mouth care a routine. Do it at the same time every day. Your loved one may be OK with it if they aren’t surprised by it. If they still won’t let you, tell them you’ll try again later. If they won’t let you at that time, you can skip it that day, but try again the next day.

Other Dental Tools

If your loved one lashes out and you’re afraid they might bite you, there are tools you can use so you don’t have to put your fingers in their mouth. For example, you can use an interdental brush to go in between teeth and get rid of debris.

If they’re in the late stages of Alzheimer’s disease, it may not be possible to brush their teeth with toothpaste. If you can’t, try an oral sponge soaked with a mouth rinse. Be sure to keep their mouth moist, and use ointment to keep their lips from chapping. Help them to get enough fluids every day.

Care of Dentures

If your loved one wears dentures, you should take them out of their mouth for at least 4-8 hours every day. Clean them and then store them in a cup or bowl filled with water. Never use toothpaste on dentures, as this can damage them. Instead, rinse them under running water and brush with a wet toothbrush.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Michael Friedman, DDS on August 30, 2018

Sources

SOURCES:

Journal of Advanced Nursing: “Oral Hygiene Care for Residents with Dementia: a Literature Review.”

Nursing Older People: “Guide to Providing Mouth Care for Older People: Oral Disease Has a Significant Effect on Quality of Life, so Caregivers Need to Know How to Keep Patients’ Teeth and Gums Healthy.”

Oral Surgery Oral Medicine Oral Pathology Oral Radiology: “Oral Health of the Elderly with Alzheimer’s Disease.”

Alzheimer’s Society: “Dental care and oral health.”

American Dental Association: “Be Smart About Your Smile!”

Cecil G. Sheps Center for Health Services Research: “Mouth Care Without a Battle.”

Family Caregiver Alliance: “Dental Care (for Dementia)."

Harvard Medical School: “When Teeth Get Damaged.”

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