The significance of maintaining oral health and, more importantly, of continually striving to educate our patients of it, cannot be underestimated. There’s no denying that it can be frustrating to see patients day in and day out who brush their teeth ‘when they get time’ or who ‘keep meaning to floss’. As healthcare professionals we simply mustn’t lose heart. As we know only too well, the repercussions of poor oral health can be severe.
In addition to more immediate problems such as gingivitis and periodontitis, there is an ever growing list of chronic disorders elsewhere in the body that correlate with oral disease. Either a significant factor in the origin of these conditions, or an exacerbating influence, research has demonstrated relationships between periodontal disease and cardiovascular disease, osteoporosis, diabetes, adverse pregnancy outcomes, and dementia.
Dementia is the collective term for the deterioration of intellectual faculties, such as memory and cognitive ability, resulting from diseases or conditions of the brain. A number of risk factors have been identified; however the chances of developing dementia increase significantly as we age. One in 50 people in the UK between 65 and 70 years of age develop some form of dementia, compared to one in five people aged over 80. This is likely to be due in part to a range of conditions more prevalent in older people, such as higher blood pressure, weaker immune system and afflictions such as heart disease and stroke. Having said that, there are over 17,000 people under the age of 65 with dementia in the UK (also known as ‘working age dementia’, ‘early onset dementia’ or ‘young onset dementia’). This figure, however, is considered a conservative estimate and potentially a third of the true number of cases.
Types of dementia are many and varied, though some occur with more frequency, such as Alzheimer’s disease (named after German neurologist Alois Alzheimer), which is the most common, afflicting approximately 496,000 people in the UK. Sufferers experience changes in brain structure and chemistry, which lead to the death of brain cells. It is a progressive disease where symptoms worsen over time as more parts of the brain are damaged.
Scientists continue to identify circumstances surrounding Alzheimer’s disease, giving a better understanding of the condition and helping towards devising strategies for prevention or treatment. Risk factors of Alzheimer’s disease include raised systolic blood pressure and high serum cholesterol concentration, smoking, and even moderate to severe head injury in early adulthood. On the other hand, oestrogen replacement therapy has been found to reduce the risk of developing the disease, as has a strict adherence to the Mediterranean diet.
Results recently published of a long term study in California, which involved monitoring almost 5,500 adults in a retirement home for an 18-year period, demonstrate a connection between oral hygiene habits and dementia. The research concluded that women who brushed their teeth less than once a day had up to 65 per cent increased risk of developing dementia compared to those who brushed three times a day. Men with significant tooth loss who did not wear dentures were found to be 91 per cent more likely to develop dementia than the men who had enough remaining natural teeth for adequate food chewing function.
Interestingly, the latter case study followed the oral hygiene habits of older patients, demonstrating the importance of maintaining oral health at all life stages, rather than assuming that prevention can only take place at an early age to make a difference.
To establish and maintain an oral hygiene routine in elderly patients, and help them to preserve or improve systemic health, we need to recommend products that match their lifestyle and ability. Elderly people are likely to have less manual dexterity than their younger counterparts. Most older patients will struggle to use string floss, for example, either giving up very early on or simply not being able to clean between their teeth properly.
In addition to the standard, basic requirement of regular tooth brushing with fluoride toothpaste, the oral irrigator, or water flosser, is a useful adjunct that has proven highly successful in clinical studies, and is suitable for most patients of varying ages and levels of mobility.
First developed by Water Pik, Inc in the 1960s, water flossers have been shown to drastically reduce plaque biofilm, gingivitis, probing pocket depth and bleeding. The Waterpik water flosser has a wealth of scientific evidence to demonstrate its effectiveness, proving to be 50 per cent more effective than string floss for reducing gingivitis and twice as effective as string floss for reducing gingival bleeding.
Oral hygiene innovations such as these have transformed our ability to help our patients to achieve better health and enjoy a greatly enhanced quality of life. We can protect our patients by recommending scientifically proven methods and be confident of the outcomes. However, first we must keep finding the motivation within ourselves to keep educating and encouraging our patients at every appointment and not give up on them, even when it almost seems as if they have given up on themselves.