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Special Care Dentistry for people with dementia

Monday, October 22, 2018

At our October Open Meeting, we welcomed Dr Robert Emmanuel, a Consultant in Special Care Dentistry with the Sussex Community Foundation Trust who explained the work his team had been undertaking in preventative dentistry for people living with dementia.

We thank Reuters for granting permission to use part of their research article by journalist Carolyn Crist.

Preventive dental care provided in the early stages of dementia could help limit major tooth problems later, researchers say.

“Dementia is associated with a change in health habits, including two major ones - diet and teeth cleaning,” said Robert Emanuel of Sussex Community NHS Foundation Trust in Sussex in the UK, a speciality care dentist who is often consulted to help patients with late-stage dementia.

Sometimes their teeth are nearly untreatable, he said.

“Especially when patients go to residential care, they tend to have a more sugary diet and have problems cleaning their teeth,” he told Reuters Health by phone. “If not looked after, their teeth can deteriorate quite quickly.”

Emanuel and colleague Anne Sorensen of Brighton and Sussex Medical School surveyed 51 patients about 10 weeks after these individuals had received a dementia diagnosis. They asked whether patients were registered with a dentist and if they received preventive dental care.

Forty-one patients, or 80 per cent, were registered or seen regularly by a dentist, and 35 said they had been to the dentist in the past year. About half of the patients attended regular hygienist sessions.

At the same time, however, preventive care appeared to be lacking. Most patients didn’t receive diet advice or oral hygiene instructions. Most also weren’t offered fluoride treatments, particularly fluoride varnishes, which can help prevent cavities and tooth decay.

“With dementia patients, we tend to be treatment-oriented and there’s not as much talk of prevention,” Emanuel said. “Early in the disease, we should build positive habits so patients don’t forget what their dentists advise.”

The full article can be read here

It was a very enlightening presentation and lots of interesting facts came out of the ensuing discussions with the most important being the use of Duraphat, a high strength fluoride toothpaste which can be prescribed by your dentist but is not available to purchase over the counter.

Here are a few tips which can be encouraged at home.

•        Brush twice daily with fluoridated toothpaste. Once, last thing at night and again, during the day.

•        Spit out after brushing and do not rinse.

•        Use a fluoridated toothpaste. Ask your dentist if he thinks a high strength fluoride toothpaste would benefit you which he can prescribe you (e.g. Duraphat)

•        Limit food and drink containing sugar to mealtimes only if possible.

•        Sugars should not be consumed more than four times per day.

Dental treatment or advice you may benefit from – Discuss with your regular dentist


•        Apply fluoride varnish to teeth twice yearly.

•        Consider prescribing high strength fluoride toothpaste and/or a daily fluoride mouth rinse.

•        Consider using a diet diary over 3 days, to check for possibly harmful dietary patterns.

Preventing Gum Disease


Patient - This is what you need to do at home


•        If your gums are red or bleed it is a sign of gum disease.

•        Brush teeth and gum line systematically twice daily.

•        Use either a manual brush or powered toothbrush with a small head and a medium texture.

•        Clean daily in-between the teeth with dental floss, tape or small interdental brushes before brushing.

•        A diet for good general health will benefit your gum health including lots of fruit and vegetables.

•        Do not smoke.

Dental treatment or advice you may benefit from. – Discuss with your regular dentist.


•        Advise best methods to remove plaque.

•        Eliminate factors that prevent effective oral hygiene including calculus and faulty fillings.

Dental Check-ups


Time intervals between check-ups should be patient specific and take into account the increased risk of tooth decay and gum disease.

Patients with early dementia should be considered as being at risk from dental disease so more frequent intervals should be considered.

Dental check-ups are an important opportunity for prevention advice.

Read more on our website or ring 01903 327 327