Читать книгу The Pocket Guide to Mouth and Dental Hygiene in Dementia Care - Dr Daniel Nightingale - Страница 5

CHAPTER 1

The Impact of Neglected
Oral Hygiene

Although this chapter discusses the physical implications of poor dental and oral care, it is important first to consider the psychological issues that are likely to compound the existing journey of dementia, and the day-to-day effects of living with mental health challenges.

The three areas of concern here relate to body image, confidence and self-esteem. To demonstrate the malignant impact on these three areas of an individual living with dementia, I would like to introduce you to Anne (name changed to protect anonymity and adhere to doctor/patient confidentiality). Figure 1.1 illustrates how these three states of emotional being converged to add further challenges to an already vulnerable individual.

Figure 1.1: The tripacted model1

Anne was an 83-year-old lady living independently in the home she had shared with her husband for over 50 years. Sadly, he passed away approximately 12 months prior to Anne slipping on the ice and breaking one of her upper front teeth to such an extent that only a small piece of it remained intact. Though Anne was living with Alzheimer’s disease, she continued to be a very proud lady, taking great pride in her appearance. She was sociable and very popular within the community, attending many functions throughout the week. After her fall, other members of the community noticed that she was beginning to go out less and less. Her son, who had recently become her power of attorney, had suggested this may be due to her dementia getting worse. However, her friends believed it was more to do with the damage to her tooth, though Anne had not spoken with her son about it. His belief was that at her age nobody cared how she looked. However, he had not asked her about this.

I was asked to see her because the GP thought she may have clinical depression or that her reluctance to go out was due to progression of the Alzheimer’s disease. From my initial interview, it was apparent that Anne was experiencing negative emotion, leading to malignant social psychology, within the three emotional states. Let’s address each one as they affected her.

Body image is defined in psychology as a person’s emotional attitudes, beliefs and perceptions of their own body. It has been defined as the multifaceted psychological experience of embodiment. As you can see by viewing the tripacted model in Figure 1.1, this was affecting not only Anne’s body image, but her body language too. She didn’t want to smile because of how it looked, therefore, her body language expressed an air of seriousness along with a closed personality. As we know, this was not Anne’s true character. People’s perception of her, based on this initial body language, was incorrect. She felt embarrassed to smile, which in turn meant she felt ugly, and as she put it, ‘It makes me feel weird.’

Confidence is defined by the English Oxford Living Dictionary as a feeling of self-assurance arising from an appreciation of one’s own abilities or qualities. In this situation, the change in Anne’s body image and expression of body language was suppressing her confidence. During our consultation and spotlighting exercise, I discovered that her lowered confidence was the main reason she had not spoken to her son about how she was feeling. Her self-confidence was sinking fast.

Self-esteem relates to how one feels about oneself. In psychology, the term self-esteem is used to describe a person’s overall sense of self-worth or personal value – in other words, how much you appreciate and like yourself. Anne had always felt good about herself. She was brought up to take pride in both her appearance and the way she looked. Now her self-esteem was at an all-time low, and she had even stopped looking in the mirror when getting ready for the day ahead. Therefore, her hair was not brushed properly, she had stopped applying make-up and had begun to look very unkempt.

Malignant social psychology is a term that was coined by the late Professor Tom Kitwood when he was referring to the overall impact of certain behaviours in care delivery that lead to a reduction in the individual’s personhood. We can easily see from the above that Anne’s personhood was beginning to disintegrate at a rapid rate.

Solution

First, I facilitated a discussion between Anne and her son. She was anxious about sharing her feelings with him as she didn’t want to upset him, put him out or cause him any problems. I coached her through this challenge by utilizing a technique called ‘empty chair therapy’. I encouraged Anne to imagine her son was sitting in a chair and she was able to express her feelings, needs and wishes in a structured, unthreatening manner. After doing this a few times, she felt ready to speak with her son Alan. I facilitated the meeting and, as she explained how she was feeling and the reasons for her withdrawal, Alan reached over and gave her a big hug! The following day, she was at the dentist’s office beginning the process of having her broken tooth replaced. Over the weeks that followed, we all witnessed a return of the Anne everyone had grown to know and love.

When supporting people through their journey – whatever that journey may be – it is imperative that carers are familiar with the individual’s personality, character and life story. We all have a responsibility to help maintain a person’s identity, dignity and self-worth. Failure to do so results in diminished personhood and we, as caregivers, provide the nutrition that fuels disintegration of a fellow human being.

Neglected dental treatment and oral hygiene is never acceptable, and we will now see the physical impact of such neglect.

There is a well-known adage that says, ‘Ignore your teeth and they’ll go away.’ That’s exactly what happens when good oral hygiene practices are neglected. For patients living with dementia or other mental health challenges, maintaining good or even minimal levels of acceptable oral hygiene becomes an increasingly challenging task, yet a very important one.

The most significant dental health problems for dementia patients are caused by a deterioration in their ability to perform self-care oral health practices. This progressive neglect of good oral hygiene practices, like brushing teeth and gums, flossing, rinsing with recommended mouthwashes and cleaning dentures is due in part to a loss of the manual dexterity required for these tasks. Those living with dementia reach a point where they forget the need (or even how) to brush their teeth, gums or dentures. This neglect of oral hygiene unfortunately increases as the severity of dementia progresses.

These challenges put added demands on caregivers to assume the responsibility of maintaining good oral health in the people they are supporting. Caregivers need to assist and eventually completely take over good oral health practices.

The oral health complications of poor oral health are significant. They include:

• Loss of teeth

• Inflammation of the gums

• Halitosis

• Tooth ache

• Loose teeth

• Tooth or gum abscess

• Loss of ability to adequately chew food

• Difficulty swallowing.

When you have a healthy mouth, you can speak, smile, eat and drink. An unhealthy mouth means discomfort, severe pain and disease.

Good general health is about so much more than a nice smile and healthy teeth and gums, since the mouth is a primary entry point into the body. Poor oral health can have negative consequences throughout the entire body. Teeth that ache, gums that bleed and breath that smells are all indicators of poor oral health. Bacteria from the mouth can easily get into the bloodstream or lungs and spread infection and inflammation throughout the body.

Here are some common, yet serious, general health problems linked to poor oral health:

• Increased risk for heart disease. This means a greater chance of having a heart attack, stroke, hypertension or endocarditis (an infection of the heart’s inner lining, usually involving the heart valves).

• Infected gums may release substances that kill brain cells. This can lead to memory loss and enhance dementia symptoms.

• Respiratory infections are caused when bacteria in the mouth are breathed into the lungs or travel through the bloodstream. This causes pneumonia, acute bronchitis or even chronic obstructive pulmonary disease. As mentioned in the Introduction, aspiration pneumonia, a leading cause of death among seniors, is exacerbated by poor oral hygiene.

• Gum disease can lead to high blood sugar levels, increasing the risk of developing diabetes. Since diabetics are more susceptible to infections, this can lead to periodontitis. Periodontal disease in turn can make diabetes more difficult to control.

• Poor oral hygiene puts one at risk for kidney, pancreatic and blood cancers as well as kidney disease and possible renal failure.

• People with gum disease are four times more likely to get rheumatoid arthritis (Garrard 2016).

When patients who live with dementia benefit from the best oral hygiene possible, they will improve their quality of life and experience increased longevity. In the next chapter, I will consider how this can be achieved.

1 The tripacted model relates to the three major components (tri) that impact on a given issue (in this case, confidence, body image and body language, and self-esteem).