Oral Health in dementia and Alzheimer’s: Reflections, perspectives and innovative services

One-in-ten seniors die from dental neglect. Most common can be inhaling bacteria found in dirty dentures, gum infections or poorly maintained teeth causing aspirational pneumonia. With Alzheimer’s disease now the sixth leading cause of death in the United States, oral health issues like these can put a loved one in our care at higher risk for heart attack, stroke, diabetes, malnutrition and death.

We’ve been told for years to “take care of our teeth,” however as care partners to a loved one living with Alzheimer’s and related dementias we may not be thinking seriously enough about the impact dental care has on our loved one’s health and mortality.

After an 18-year journey with my mom through dementia and Alzheimer’s disease, I think about the arc of her life from wife, mother and career, to my father’s passing, through the first whimsical and then terrifying delusions she experienced living with dementia, then onto the advanced stages of Alzheimer’s and ultimately her death.

During mid-stage dementia, many visits with mom were marked by the hunt for her dentures. Upon arrival at the memory center I’d begin by looking in all the usual places. After an exhaustive search one day, the last place I looked was her denture cup on the bathroom counter where they were soaking. My mother sat in her favorite Lazy-Boy recliner grinning as I exited the bathroom with our prize. I popped the clean and shiny dentures back into her mouth and she winked at me.

By late-stage, however her dentures simply disappeared. They were likely wrapped in a napkin and found their way into the trash unnoticed. It was hard to look at my mom. It became difficult to see her toothless countenance, which allowed her face to sag in the way only really old faces do. Her appearance became a constant visual reminder of how much this disease had taken from her.

In late 2016 The Centers for Medicare and Medicaid Services (CMS) issued a broad revision of nursing home and care facility regulations. “For the first time, nursing homes must take reasonable care of residents personal belongings and can’t shrug off responsibility for theft or loss which has been a big complaint,” Robyn Grant was quoted in a New York Times piece. Ms. Grant is public policy director at National Consumer Voice for Quality Long-Term Care, a leading advocacy group.

In Arizona, the Department of Health now requires nursing facilities to take financial responsibility for their residents’ denture replacements having to put policies in place by last November (2017).

In my research around these changes, I had the opportunity to meet with the staff of Smiles by Delivery www.SmilesByDelivery.com, an innovative service that brings professional and comprehensive dental care to those in senior retirement communities across the state of Arizona. Their mission: an in-house dental practice committed to helping elder care evolve through the use of innovative technology. Founded in 2012, their goal: promotion of oral health to seniors by bringing dental care directly to patients in the most convenient and cost-effective way possible.

I personally know how important it is to have the right support for a loved one in nursing care, beyond just the family and facility. I also appreciate the astronomical cost that Alzheimer and dementia care brings to bear on a family. Finding professional, caring, dementia friendly organizations that are passionate not only to care, but also driven to educate at reasonable cost is worth so much.

I only wish these services were available when my family needed them most.


If you don’t live in Arizona, take the time to find out what oral health services are available in your state. Your state’s Agency on Aging may be able to help.


Lisa B. Capp is a writer, activist and dementia caregiving survivor. She serves on the Alzheimer’s Association Leadership Board for the Desert Southwest, is a member of the Alzheimer’s Impact Movement (AIM) and AlzAuthors.
As a High Tech Change Consultant, Lisa worked with leaders of global business, governments and non-profit organizations around the globe. Her passion now is focused on empowering dementia caregivers to survive their journey with grace.  
Join Lisa in a conversation about grace on Twitter @lisabcapp and LinkedIn at LisaBCapp.
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