Fitting complete dentures after multiple tooth extraction in a patient with severe dementia

Factors Associated with Denture Non-use in Older Adults Requiring Long-Term Care

BACKGROUND

Evidence suggests that denture non-use is significantly associated with activities of daily living, oral function, and cognitive decline. Few studies have focused on the possibility that the indications for denture use may differ depending on the cognitive and physical functions in older adults requiring long-term care.

OBJECTIVES

The aim of this study was to elucidate the factors associated with denture non-use in older adults requiring long-term care.

METHODS

This cross-sectional study comprised 201 older adults (45 men and 156 women; average age = 86.2 ± 7.1 years) requiring long-term care in Japan. Those who did not require denture treatment were classified by dentists into denture-use and denture non-use groups. The severity of dementia was assessed using the Clinical Dementia Rating scale. Multiple logistic regression analyses were conducted to detect the factors significantly associated with denture non-use.

RESULTS

The proportion of participants without dentures was 58.2%. Multiple logistic regression analyses revealed that a moderate dementia (odds ratio [OR], 4.44; 95% confidence interval [CI] 1.18-16.71, p=0.027) and rinsing ability (OR 3.00; 95% CI 1.12-8.06; p=0.030) were significant factors related to the non-use of dentures.

CONCLUSION

Severity of dementia and rinsing ability were significantly associated with non-use of dentures. These findings indicate the necessity of evaluating oral and cognitive functions while planning denture treatment in older adults requiring long-term care.

Analysis of intravenous sedation for dental treatment in elderly patients with severe dementia-a retrospective cohort study of a Japanese population

Background/purpose

Patients with severe dementia require intravenous sedation during dental treatment. However, few reports have compared the outcomes of intravenous sedation management among sedatives. Intravenous sedation in the elderly with severe dementia undergoing dental treatment was evaluated retrospectively.

Materials and methods

Patients’ characteristics and type of dementia were obtained from medical records. Midazolam (MID), dexmedetomidine (DEX), and propofol (PRO) were administered as sedatives. The systolic blood pressure (SBP), heart rate (HR), SpO₂, bispectral index (BIS) values and complications were evaluated.

Results

Nineteen patients with severe dementia who underwent 62 instances of sedation were included. There was no difference in patient background between sedatives. The sedation time and permission time to return home were significantly longer in DEX than in MID or PRO group. Half the usual dose in MID and lower limits of the routine dose was effective in DEX and PRO. HR was significantly lower in DEX group. There were 3 cases with airway obstruction requiring nasopharyngeal airway and 4 cases of apnea when MID was administered. Two cases of Cheyne-Stokes-like respiration when MID or DEX was administered. SpO₂ <94% was found in 22 cases (35%) irrespective of the sedative. A patient with dementia with Lewy bodies had experienced hallucinations during the recovery period after sedation when MID or DEX was administered. The BIS value of ≤80 was noted during complications.

Conclusion

Intravenous sedation for dental treatment in the elderly with severe dementia, needs a dose titration. All sedatives had respiratory-related complications which mandate close monitoring.

Successful Fitting of a Complete Maxillary Denture in a Patient with Severe Alzheimer's Disease Complicated by Oral Dyskinesia

There is an increasing population of elderly patients suffering from Alzheimer's disease (AD), the most common form of dementia. In dentistry, a critical problem associated with these patients is the use of a new denture, as AD patients often refuse dental management and are disturbed by minor changes in their oral environment. Some AD patients have further complications associated with oral dyskinesia, a movement disorder that can make dental management difficult, including the stability of a complete denture. In this case, we successfully fitted a complete maxillary denture using modified bilateral balanced occlusion after multiple tooth extractions under intravenous sedation in a 66-year-old woman with severe AD complicated by oral dyskinesia. Following treatment, her appetite and food intake greatly improved. Providing a well-fitting complete denture applied by modified bilateral balanced occlusion, which removes lateral interference using zero-degree artificial teeth for movement disorder of the jaw in patients with severe AD complicated by oral dyskinesia, helps improve oral function.

Considerations during intravenous sedation in geriatric dental patients with dementia

OBJECTIVES

We retrospectively assessed the usability and precautions required during intravenous sedation (IVS) for dental treatment in geriatric outpatients with dementia.

MATERIALS AND METHODS

We investigated the intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from the standpoint of local anesthesia usage, water usage during treatment, and content of treatment.

RESULTS

Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n = 65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001). Water usage cases, such as for caries treatment, needed longer sedation and treatment times, resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p < 0.05).

CONCLUSIONS

All the scheduled dental treatments in dementia patients were smoothly performed under IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives, and hemodynamic fluctuations caused by invasive procedures under local anesthesia.

CLINICAL RELEVANCE

In the future, with the growing need for dental procedures in dementia patients, dentists will require training in the general management of such patients.