Mrs. Smiley

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by Dr. Cameron, D.D.S.

We often will ask a 7 year old if they brushed their teeth today? But we almost never ask a 70 year old this same question…

I started this article with the above question, because unfortunately more and more these days I often find myself asking both these groups and their care takers this question.

About 8 years ago in my practice, I saw a regular long-term patient of mine, she was 71 years old. She had been coming to me for her dental care for close to 20 years. She always had great teeth. She had been very fortunate to receive very good dental care through out her life and her oral hygiene and dietary habits were excellent.

During this one particular exam, this patient, who I will call Mrs. Smiley, seemed just a bit off to me, while I was talking with her before I started my examination. It was during her actual examination where I noticed a huge difference. Mrs. Smiley who had always had immaculate oral hygiene and nice teeth presented with a very different mouth then I was used to seeing. She had plaque and food debris all through out her mouth. Her gingival (gum) tissues were extremely inflamed, very swollen, red and bleeding. She was starting to get decay especially on exposed root surfaces she had on her teeth. After seeing Mrs. Smiley just about every 6 months, for the past 20 years, this came as quite a shock to me. I couldn’t figure out what had caused this change. I immediately sat up Mrs. Smiley, and started to ask her a few questions about her oral hygiene … but she seemed a bit confused and did not quite seem to understand what I was trying to ask her.

I then went out to the waiting room and I asked her husband (Mr. Smiley) if could come into my private office to speak with me. When I started explaining to Mr. Smiley what I saw during my examination, he was very surprised.

So I asked him, “When was the last time you saw your wife brush her teeth?”

He told me, Why she brushes her teeth 3 to 4 times a day, she has done this her whole life.”

Then I had to stop him and ask him again, but this time I asked him, “No, when was the last time you actually saw your wife physically in the act of brushing her teeth?”

When he took a few minutes to think about it, he told me, he can’t remember actually seeing her brush her teeth, but she must have been doing this. Sadly, I had to tell him that she was not, she looked like she had not brushed her teeth in over a week or so.

Even though I am certainly not an expert in dementia, one of the things I do know is that in the early stages of the disease, one of the traits that is noted, is that individuals will sometimes stop performing everyday basic hygiene tasks. Often times these traits start happening so gradually, that the people closest to them do not notice them at first. We are finding that members of the dental team, hygienists and dentists, can sometimes be the first health professionals that can spot some of these early changes that are associated with dementia. We know that cognitive decline has a very significant negative effect on oral health, which of course leads to a decline in the patient’s overall health.

Sadly, Mrs. Smiley did go on to develop dementia, and she was in the very early stages when I first noticed the decline in her oral hygiene. Due to the fact she was diagnosed rather early, and with a very good support system in place (her husband and her adult children), we were able to put into place an oral health plan which would greatly aid her in her oral health care. This plan included increasing the frequency of her routine dental recall visits, so we could provide better and more frequent cleanings and catch any small problems, i.e. cavities, early and treat them easier. She had her support group help her with her home care, brushing and flossing. But still… every now and then, someone has to ask Mrs. Smiley, “Did you brush your teeth today?”

Dr. Cameron is a full time General dentist who practices in Antigonish. He is a past president of the Nova Scotia Dental Association, and a past Board Member of the Canadian Dental Association’s Board of Directors, and he has served on a provincial working group dedicated to the Oral Health of Seniors in our province.

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