Ed i to r ia l

Dementia, oral health and the failing dentition

Dementia is in the news again. It would appear that

politicians and care administrators are beginning to

listen to those who have been at the forefront of

caring for this group of individuals for many years.

The London School of Economics and the Institute

of Psychiatry are predicting that more than

1.7 million people will develop dementia in the UK

by 2051 and the author of the report stated that

‘this research highlights the desperate need for

dementia to be made a national priority’. Cur-

rently, there are 700 000 – or one person in every

88 people – incurring a yearly cost of £17 billion.

The total number of people with dementia will

increase to 940 000 by 2021. By 2051 the figure

will have increased by 150% from now and will

affect the lives of around one person in three, ei-

ther as a sufferer, or as a carer or a relative. One in

20 people over 65 years and one in five over 80 has

a form of dementia, and approximately two-thirds

of those affected have Alzheimer’s disease. The

large numbers reflect the ageing population of the

UK, but are also comparable to many other coun-

tries in Europe, North America and the Far East.

However, it is thought that conditions such as high

cholesterol, blood pressure and lack of exercise are

risk factors. As there is no cure for dementia, those

with the condition need increasing care as the

disease progresses. Research has indicated that

caring for one person with late-onset dementia

costs an average of £25,500 per year and that at

present most of this cost is met by people with

dementia and their families. Most of these people

live at home either alone or with friends or rela-

tives. As was reported in a previous editorial, there

is widespread variation in the levels of provision

and spending across the UK and there seems to be

an increase in respite care for the carers of people

with dementia, but unfortunately the support is

mostly delivered on an ad hoc basis.

Recently, it has been suggested that elderly

people with dementia could be tagged to make it

easier to track their movements. With the use of

satellite technology, these individuals could lead a

fuller life and would have a greater freedom to

roam around their communities. However, con-

cerns have been raised regarding whether this

would interfere with their dignity and independ-

ence and permission would have to be sought from

the individual or at least from the family or carers.

Obviously, a balance is necessary so that techno-

logy can be used in a sensitive way and there is a

fear that this could be just another ‘quick fix’ rather

than providing effective overall care. A more

straightforward approach has been adopted in one

area of the UK in the form of a ‘Safely Home’

scheme and this has involved the introduction of

identity bracelets. These contain a unique ID code

and telephone number which links to a 24-hour

support service. It is anticipated that they would be

provided for elderly people with dementia to help

identify them should they wander away from

home and become lost and confused.

Dementia is one of the main causes of disability

later in life and yet the funding for research is

significantly lower than for cardiovascular disease,

stroke and cancer. It has been suggested that even

delaying the onset of dementia by five years would

reduce the number of related deaths significantly,

saving nearly 30 000 lives annually. It is interesting

to note that two drug companies – Pfizer and Eisai-

are currently seeking a judicial review to try and

overturn a decision of the National Institute for

Clinical Excellence (NICE) not to recommend the

use of three drugs for patients with early stages of

Alzheimer’s disease. NICE ruled that donepezil,

rivastigmine and galantamine ‘did not make

enough of a difference’ and should only be used

to treat Alzheimer’s disease once it had progressed

to its moderate or severe stages.

Dementia was also a major topic for discussion at

the recent meeting of the IADR in New Orleans

(March 2007). At a symposium sponsored by the

Geriatric Oral Research, Nutrition and Prostho-

dontics Research Groups entitled ‘Frail older adults,

dementia and the failing dentition’ it was evi-

denced from cross-sectional and longitudinal oral

epidemiological studies, that there were an ever

increasing number of dentate and edentulous frail

older adults, especially those with dementia.

Studies showed that there was decreased use of

dentures and possible successful use of implants,

increased denture-related oral mucosal lesions,

high and rampant levels of coronal and root caries,

high levels of retained roots, very high levels of

plaque accumulation and related prevalence of

aspiration pneumonia and associations of these

conditions with older adults with weight loss and

carer burden. The presenters provided data from

around the world – North America, UK and Eur-

ope, Japan, and Asia and Australasia – and how it

contributed to the understanding of the onset and

progression of oral diseases and conditions in frail

� 2007 The Author. Journal compilation � 2007 The Gerodontology Association and Blackwell Munksgaard Ltd

Gerodontology 2007; 24: 65–66 65

older adults, especially those with dementia. This

symposium will be published as a literature review

and should provide key data for those interested in

the fields of dementia and old age.

Also at the meeting, other researchers reported

caries prevalence in the elderly with and without

dementia (Ellefsen B et al. abstract 0962 IADR

2007; Chalmers JM et al. abstract 1363 IADR 2007).

They found that patients with dementia already

had a high level of untreated dental caries and this

was related to dementia severity and type. One

group indicated that at one year follow-up differ-

ences between demented and non-demented par-

ticipants diminished over time, underscoring the

importance to encourage these individuals to access

regular dental services and maintain oral hygiene.

The latter group reported that caries incidence and

increments at two years were related to dementia

severity and not to specific dementia diagnoses and

that these individuals had a significantly higher

coronal and root caries incidence and increments.

Other researchers had focussed on oral hygiene

care for residents with dementia. Here, they

observed the disruptive behaviour during oral

hygiene care and mealtime care and found that, as

might have been expected, disruptions during

mealtimes were significantly less (Pyfferoen M et al.

abstract 0955 IADR 2007). They concluded that the

nursing assistants needed further education with

regard to providing successful oral hygiene inclu-

ding physical behaviour intervention techniques.

Cody et al. (abstract 0957 IADR 2007) reported

more disruptive behaviour episodes in this group,

in the morning, during oral hygiene care and that

this could lead to a decreased amount of effort

made by staff in providing this provision. It was also

reported by Poul Holm-Pedersen (abstract 0244

IADR 2007) that tooth loss was significantly related

to mortality at 85 years of age and further analysis

showed that tooth loss was strongly and inde-

pendently associated with the onset of disability

and mortality in old age. Although the biological

pathway was not obvious, the findings indicated

that tooth loss may be an early indicator of accel-

erated ageing. When examining what factors were

most predictive of tooth loss, Michael MacEntee

found that psychosocial variables and caries

strongly influenced tooth loss in old age, and

elderly people who had avoided significant loss of

teeth in younger years continued to retain their

natural teeth with advancing years (abstract 0245

IADR 2007). As well as caries, periodontal disease is

a significant factor in tooth loss, but the nature of

periodontitis in the older population requires

further evaluation. As might be expected, current

research shows that a high proportion of healthy

elderly have evidence of severe periodontal

destruction and those with the highest risk, smoke

and do not have regular dental visits. This could

have a significant impact on the ability of the

care team to provide appropriate preventive and

therapeutic care.

It is common knowledge that keeping your mind

active is as important to your overall health as it is

to keep your body active. In Japan, many older

people feel that an active mind can also prevent the

onset of dementia and one easy way they have

found to exercise their mind was to use non-tra-

ditional games, such as computer-based brain

training games. An example of one of these is Brain

Age: train your brain in minutes a day and following

completion of a series of exercises, the programme

calculates your ‘brain age’. Although there is no

significant scientific evidence that these games are

effective, millions have been sold in the Far East.

They now are about to be marketed in Europe and

North America. However, there will still come a

time when these unfortunate people will have to

be cared for by their nearest and dearest and all the

consequences that it brings to a family.

‘Your life just disappears, your family disappears and your

friends. Each day a little bit of him went further away…it

was agonising to see him decline. Then it dawns on you that

you can’t cope on your own but you don’t know who to

turn to.‘

Carer of a husband with dementia (2007)

James P. Newton

Editor

� 2007 The Author. Journal compilation � 2007 The Gerodontology Association and Blackwell Munksgaard Ltd

Gerodontology 2007; 24: 65–66

66 Editorial