Evaluation of patients with Alzheimer's disease before and after dental treatment

Abstract

Oral infections may play a role in Alzheimer's disease (AD). Objective: To describe the orofacial pain, dental characteristics and associated factors in patients with Alzheimer's Disease that underwent dental treatment. Method: 29 patients with mild AD diagnosed by a neurologist were included. They fulfilled the Mini Mental State Exam and Pfeffer's questionnaire. A dentist performed a complete evaluation: clinical questionnaire; research diagnostic criteria for temporomandibular disorders; McGill pain questionnaire; oral health impact profile; decayed, missing and filled teeth index; and complete periodontal investigation. The protocol was applied before and after the dental treatment. Periodontal treatments (scaling), extractions and topic nystatin were the most frequent. Results: There was a reduction in pain frequency (p=0.014), mandibular functional limitations (p=0.011) and periodontal indexes (p,0.05), and an improvement in quality of life (p=0.009) and functional impairment due to cognitive compromise (p,0.001) after the dental treatment. Orofacial complaints and intensity of pain also diminished. Conclusion: The dental treatment contributed to reduce co-morbidities associated with AD and should be routinely included in the assessment of these patients.Keywords: Alzheimer's disease, oral infections, orofacial pain, periodontal disease, dental treatment. RESUMOInfecções orais podem ter um papel na doença de Alzheimer (DA). Objetivo: Descrever as características orofaciais, dor, odontológicas e fatores associados em doentes com DA submetidos a tratamento dentário. Método: 29 doentes diagnosticados com DA por neurologista foram avaliados através do Mini Exame do Estado Mental e questionário Pfeffer. O exame odontológico foi realizado antes e depois do tratamento dentário e incluiu: questionário clínico; critérios diagnósticos de pesquisa para disfunção temporomandibular; questionário de dor McGill; protocolo de impacto de saúde oral; dentes cariados, perdidos e obturados; e avaliação periodontal. Os procedimentos mais frequentes foram raspagem periodontal, exodontias e prescrição de nistatina tópica. Resultados: Houve uma redução na frequência de dor (p=0,014), limitações mandibulares (p=0,011), índices periodontais (p,0.05), e melhora na qualidade de vida (p=0,009) e no comprometimento funcional e cognitivo (p,0,001) após o tratamento dentário. Queixas orofaciais e intensidade de dor também diminuíram. Conclusão: O tratamento dentário contribuiu para reduzir comorbidades associadas à DA e deveria ser incluído na rotina de avaliação desses pacientes.Palavras-chave: doença de Alzheimer, infecções orais, dor orofacial, doença periodontal, tratamento dentário.In the last century the world population got older, and since then there has been a growing interest in maintaining health and an active and functional life in the third age. The frequency of elderly people with chronic diseases is high (20%-35%), and many of them are fragile (2%-10%) 1 .Neurodegenerative diseases cause severe morbidity, and among ...

Oral health and orofacial pain in older people with dementia: a systematic review with focus on dental hard tissues

“…The 99 remaining full text articles were then examined for eligibility, of which 62 were then excluded because they did not meet the inclusion criteria. Only one study was added through scanning the reference lists of the included articles [19]. Thereafter, the quality of the 37 included studies was assessed.…”

“…Although dental hard tissues can be an important source of orofacial pain, only seven of the included studies published data about the presence of orofacial pain [15, 19, 28, 33, 34, 44, 74]. The presence of reported dental pain in older people with dementia varied between 7.4 and 21.7 %.…”

Association between periodontitis and cognitive impairment: Analysis of national health and nutrition examination survey (NHANES) III

“…Nevertheless, the role of periodontal health for cognitive impairment disease should still be emphasized for the need of functional improvement in the current quality of life of these patients. A study also revealed that periodontal treatment had the effect of reducing co‐morbidities associated with Alzheimer's disease, and routine assessment should be included for these patients (Rolim et al, ). The individuals with cognitive impairment require special attention towards overall oral health care, oral hygiene education, and periodontal maintenance, which may improve daily life activities and life quality (Martande et al, ; Rozas, Sadowsky, & Jeter, ).…”

Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer’s Disease?

“…A risk factor relationship between periodontal pathogens/periodontal disease and AD exists, as previously discussed by Olsen and Singhrao [3]. Salient points are that periodontal disease is co-morbid with clinically demented subjects [4][5][6][7]. Tooth loss in early and midlife has consequences for poor memory in later life [4,[7][8][9][10][11][12].…”

“…A prospective longitudinal study reported by Ide et al [7] upholds the view that periodontitis is associated with a marked increase in cognitive decline, which is independent of base line cognition, in men with a mild to moderate clinical diagnosis of dementia. A study following the impact of a dental intervention on patients with a clinical diagnosis of mild AD found over 50% of participants (who also suffered from gingivitis/periodontitis) showed improvements in their memory [6]. Oral bacteria and their virulence factors affect the central nervous system pathology [13,14], and indiscriminate release of inflammatory mediators cause neuronal injury [5,[15][16][17].…”