confounders that have not been taken into account. Further studies are needed to determine if a true association exists between oral health and dementia. The following are recommendations for dental practitioners who have patients diagnosed with Alzheimer’s disease: ● Make sure patients and families know the importance of excellent oral hygiene. ● Provide oral hygiene instruction. ● Ensure that patients and families know the importance of maintaining recall appointments for professional cleanings and examinations. It may be necessary to schedule more frequent recall appointments. ● Suggest special oral hygiene tools, as appropriate. ● Create an aggressive daily oral hygiene plan for patients for home care. ● Consider using fluoride varnish as a preventive for root caries. ● Alternatively, dental professionals may create handles that are easier to grip by inserting the handle of a regular toothbrush into a tennis ball or bicycle handle. ● Denture brushes with suction cups offer a solution for individuals who have trouble gripping a denture brush or who require one-handed denture care. The handle of this brush is secured to a base that has two suction feet, allowing the brush to sit upright without moving so that the dental prosthesis may be moved over the denture brush’s contoured bristles to brush away plaque and debris. ● Floss holders and proxy brushes with long handles may also prove useful. However, the handles may also need to be modified for ease of gripping. ● Curved toothbrushes allow greater ease and speed in toothbrushing. Three layers of curved bristles are designed to clean the buccal, lingual, and occlusal surfaces of the teeth simultaneously. The National Institute of Dental and Craniofacial Research provides instructions for toothbrush adaptations available at http://www.nidcr.nih.gov/imagegallery/oralhealth/ ToothbrushAdaptations.htm. Occupational therapists in long-term care facilities and rehabilitation centers can help modify toothbrushes. The following are recommendations for dental practitioners who have patients diagnosed with osteoarthritis: ● Assess for functional limitations regarding oral home care. ● Recommend oral hygiene tools as appropriate. ● Encourage the patient to maintain excellent oral hygiene. ● Provide oral hygiene instruction. ● Encourage the patient to keep recall appointments for professional cleanings and examinations. More frequent recall appointments may be necessary to ensure good oral hygiene. ● Recommend over-the-counter or prescription fluoride rinses and antibacterial mouth rinses. likely triggered by a combination of factors, including an abnormal immune response. Rheumatoid arthritis is likely influenced by genetics, interactions between host and environmental factors, hormonal factors, immunological function, diet, infectious factors and socioeconomic factors that can cause an autoimmune reaction that leads to the progressive inflammation and destruction of cartilage and bone (Romao & Fonseca, 2021). Smoking is a strong
later developed Alzheimer’s disease compared with controls (Hamza, et al., 2021). Related studies have looked at the effect of oral care on cognitive decline. In the Leisure World Cohort Study, 5,468 older adults with no signs of dementia were followed over time, from 1992 to 2010. Men in the study were found to be at 89% greater risk of developing dementia if they had not seen a dentist in more than 12 months compared with men who had visited a dentist more than twice in the previous year. Women in the study who reported not brushing their teeth at least once a day were more likely to develop dementia than women who brushed their teeth three times a day (Paganini-Hill, White, & Atchison, 2012). However, the use of self-reported data is a limitation of this study. However, causation should not be attributed based upon the current literature on this topic. Although some research has indeed been suggestive of an association, there may be Osteoarthritis Osteoarthritis is one of the most common chronic diseases in older adults; it affects 34% of those 65 years of age or older with about equal occurrence in both sexes before the age of 55, after which it is more predominant in women. Most people 80 years of age or older have some form of osteoarthritis (Jaul & Barron, 2017). Functional disabilities associated with osteoarthritis may impair an older adult’s ability to effectively provide his or her own oral care. Gripping the thin handle of a toothbrush, using the fingers to negotiate floss between the teeth, removing dental prostheses, and manipulating denture brushes to clean dental prostheses may prove difficult – if not impossible – for older adults suffering from osteoarthritis. It is important that dental professionals screen for potential dexterity issues and determine the patient’s ability for self- care. Dental professionals should take a careful medical history and make inquiries about osteoarthritis and the patient’s functional ability. In addition, careful observation of the patient’s hands is important to determine if joints of the fingers are swollen and potentially arthritic. If a dexterity problem exists, dental professionals may consider more frequent recall appointments to ensure good oral hygiene. Based on the patient’s oral exam and self-care ability, over- the-counter or prescription fluoride rinses may be indicated, as well as antibacterial mouth rinses to help reduce the risk of periodontal disease. Some compromised patients may need assistance from the dental team in developing strategies to overcome obstacles for oral self-care. Oral hygiene education is essential. The following brushing and flossing aids may be helpful: ● Electric toothbrushes make cleaning easier for a patient with impaired dexterity because they require less effort to achieve a good cleaning action. ● Manual toothbrushes and denture brushes with enlarged handles provide easier gripping. Alternative handles include grip aids, which may be purchased commercially (e.g., the cylindrical foam handle from North Coast Medical & Rehabilitation Products, the Adapt-A-Grip System from Sammons, and the Gripeeze from Brickroth, Inc.) or created at home. Rheumatoid arthritis Rheumatoid arthritis is not as common in older adults as osteoarthritis. Rheumatoid arthritis has a prevalence of 0.5-1.0% in the general population with women affected about three times more often than men (Iqbal, et al., 2019). However, most cases are diagnosed in older adults; the onset of rheumatoid arthritis most often occurs in adults in their 60s (CDC, 2017b). Although the cause of rheumatoid arthritis has yet to be determined, the condition is most
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