Oral health is as important in long-term care as in acute medical care.

The agents and brokers who sell dental insurance struggle to explain how important good dental care is to improve the quality and hold down the cost of acute medical care.

Virginia officials are trying to spread a similar message about the importance of oral health care to the quality of long-term care (LTC).

The Virginia Department of Social Services is sponsoring a continuing education webinar on the relationship between dementia and oral health aimed at providers of LTC services. Patricia Brown Bonwell, an assistant professor at the Virginia Commonwealth University dental school, has developed a written version of her presentation that covers the overall effects of aging on oral health and strategies for providing everyday oral health care for people with dementia.

Bonwell also summarizes recent research on possible connections between oral health problems and dementia.

She notes that bacteria cause gingivitis — inflammation of the gum tissue — and periodontitis. Periodontitis refers to a gum infection that has caused bone loss.

People who have been exposed to chronic periodontal disease or other inflammation early in life are four times more likely to develop Alzheimer’s than otherwise comparable people, Bonwell reports.

Gum infections may directly cause or contribute to the start of Alzheimer’s, and early Alzheimer’s and other forms of dementia may lead to further deterioration in oral health, by decreasing the likelihood that an individual will brush and floss daily, and by decreasing the individual’s ability to report pain or discomfort, Bonwell says. In some cases, she says, people with dementia may resist caregivers’ efforts to help with oral hygiene.

“Prevention is the key,” Bonwell says.

Bonwell cites researchers who estimated in 2010 that the cost savings from the prevention of dental disease and the treatment of early dental disease may be higher than the savings from HIV screenings or flu shots.

She says caregivers should look for oral care “communication challenges” that might be signs of problems. If, for example, a woman with dementia who is getting care starts sucking on the toothbrush, that might be a natural reflex resulting from Alzheimer’s disease. But sucking on the toothbrush could also be a sign of oral pain, Bonwell says. She says caregivers who see a person sucking on a toothbrush should look for anything unusual in the mouth that might be causing pain.

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