Oral Health Risk, Chronic Disease and Re-Hospitalization

Oral Health Risk, Chronic Disease and Re-Hospitalization: Ethical Considerations and the Practicalities of Person Centered Care
By Pamela D Wilson CSA, CG, MS, BS/BA

Oral health becomes more important as we age. Research indicates poor oral health to be a factor in the diagnosis of poor cognitive function (a diagnosis of dementia and related diseases)1,3, increased risk for heart disease, metabolic disease and stroke1 and poor oral care results in frequent hospitalizations due to a diagnosis of pneumonia2.  Numerous studies have identified mouth care in nursing homes as inadequate4. Research indicates the positive benefits of a person centered approach to mouth care.

These statements lead to questions and ethical dilemmas.

  • Is cognitive function affected by poor oral health and tooth loss?
  • Does tooth loss in mid-life lead to a diagnosis of Alzheimer’s disease?
  • What side effect of poor oral health is a common cause for hospitalization and mortality in older adults?
  • Do care community staff have an ethical obligation to support good oral health similar to support provided for hygiene related to toileting?
  • Are there proven benefits of person centered mouth care?

In relating a diagnosis of dementia to poor oral health, which comes first, the chicken or the egg? Does tooth loss promote dementia or does dementia promote tooth loss?

Tooth loss, one of the indicators of periodontal disease has been reported to be associated with Alzheimer’s disease and dementia. A history of ‘lost all teeth or lost half of teeth before age 35’ was a significant risk factor for AD.5  It is well known that different types of inflammation, for example inflammation from periodontal disease may decrease cognitive function through systemic inflammation relating to cardiovascular disease. Other diseases like diabetes, high cholesterol and lifestyle factors such as smoking, alcohol, drug abuse, diet and stress are risk factors for dementia.

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