Dental care of patients with dementia

Abstract: Dental care of patients with dementia. Clinical and ethical considerations Gunilla Nordenram Department of Clinical Neuroscience and Family Medicine, Division of Geriatric Medicine Huddinge Hospital and School of Dentistry, Division of Geriatric Dentistry, Karolinska Institutet, Stockholm, Sweden, ISBN 91-628-2416-3 To establish guidelines for fair and proper oral care for patients with dementia, the following aims were specified: To develop an appropriate method for analysing ethical problems related to the provision of dental care for patients with dementia; to categorize spokesmen's perceptions of the concept of oral comfort for persons with dementia; to assess the potential benefit of dental treatment for persons with dementia; to determine the influence of stage of dementia on the feasible level of treatment; to reveal the patient's individual adaption to dental treatment, irrespective of the dementia-related impairments; to disclose ethical dilemmas in dental management of patients with dementia experienced by hospital dentists and their reasoning in conflict situations. As dental care for impaired patients includes both close human relationships and technically demanding treatment procedures, the wide range of research questions concerning dental care of patients with dementia reflects this complexity. Thus the thesis combines qualitative and quantitative research methods. The first theme concerns aspects of human behavioural science such as perception, interpretation of feelings, thoughts, evaluations, actions and behaviour (1, 11, Vl). The other theme is formulated in conventional dental scientific terms, such as oral function, oral status and nutritional status (III,IV, V). A safe treatment setting can be created, based on adequate knowledge and explicit ethical insight, realized as morals in action. The dentists' ethical reasoning were dependent on recognition of ethical components in specific situations located in a specific context and could develop understanding - both when the treatment succeeded and when it failed. Benefits of oral care for patients with dementia were identified: The basal benefits, freedom from oral pain and a safe oral environment with no risk of aspiration. Further benefits, a better choice of food and food consistency and a better function in ADL of eating. Realistic treatment need could be identified considering the stage of the dementia, the patient's personality and social circumstances and in consensus with spokesmen. Fair and proper oral care for demented patients requires 3 "T": Time in the treatment situation. To receive, understand and support the patient in the dental setting is time-consuming. Teamwork in the treatment planning. To determine and provide adequate oral care is a task that involves not only the dental team but also non-dental health care providers. Training to develop skill in dental management of patients with dementia. In our heterogenic world, with rapid changes in technology and economics, shifts in contemporary biomedical ethics are evident and an ongoing philosophical dialouge of biomedical ethics is therefore essential. It should be based on actual practice with authentic cases which augment and extend the notion of good and bad, right and wrong within professions as well as within society as a whole. Key words: Dementia, Alzheimer's disease, cognition, ethical reasoning, ethical principles, advocate, geriatnc dentistry, dental management, elderly, nutrition, treatment need.