Cognitive decline and dental care during COVID-19
The sooner patients with degenerative diseases and poor oral health are treated, the better for their overall health, urges Cemal Ucer.
The coronavirus pandemic has resulted in unprecedented disruption to everyday life and patient care.
The massive vaccination programme currently underway promises an eventual return to normality. The government states an aim to vaccinate every willing adult before next winter. This will be a factor for dental practitioners to grapple with for the foreseeable future.
The NHS has been put under immense strain. It has had to make difficult decisions regarding patient care in order to adapt to the circumstances. According to www.independent.co.uk, many patients are facing significant delays to treatment, with ear, nose and throat procedures. Even cancer treatment is among the work being postponed.
The expected consequence of this will be a rise in patient morbidity and mortality.
In the case of cancer treatment, a recent systematic review found that for every four weeks that treatment was put back the risk of death increased by 6-8% on average (Hana et al, 2020). And, of course, many patients have been delaying seeing their doctors, which will also have decreased early detection efforts.
Beyond the immediate challenges to patients in accessing care, the effects of the lockdowns, tier system restrictions and economic conditions are likely to have taken a toll on many people’s mental and general health, which may in turn contribute to oral issues.
One of many areas of specific concern regarding the long-term health of patients is that of cognitive decline.
The number for dementia and Alzheimer’s disease have fallen in the past year. Public Health England (PHE) partially attributes this to patients not accessing services where detection and diagnosis could have occurred.
Many older people have followed advice and maintained distance from other family members and friends for much of the pandemic. This is to better protect themselves from the potentially life-threatening virus. We may expect that this lack of contact will have also reduced detection and the availability of help. Those closest to a person are the most likely to notice initial signs and changes in behaviour.
Additionally, substantial evidence points to loneliness and social isolation as significant risk factors for cognitive decline and the development of dementia. So, this period may actually drive an increase in cases in the foreseeable future (Sutin et al, 2020).
Depression is another related factor. It is one which also negatively influences oral hygiene and raises the risk of edentulism (Sutin et al, 2020; Cademartori et al, 2018). This should not be taken as an argument against shielding and social distancing. The threat to life posed by the virus is substantial. However, it is rather used to anticipate patient needs.
Dementia is capricious, progressing differently between patients, and can affect a given patient quite variably on any particular day. The nature of the condition can significantly impact a patient’s ability to care for themselves. This includes their maintenance of oral hygiene and ability to book and attend appointments.
As dementia is currently incurable, the best-case scenario is that detection occurs early. Dental practitioners can create a treatment plan that aims to realistically resolve active oral diseases. This minimises the need for complex treatment later on.
Because of the progressive nature of degenerative diseases, the patient’s oral health and ability to maintain compliance over time will decline. The late stages of dementia and associated frailty are far from ideal for complex surgical procedures and complicated dental plans.
Therefore, patients should be rehabilitated however possible prior to reaching this point. Attention should be paid to how easily maintained their dentition or prosthesis will be. Because of the current and ongoing lapse in early detection of neurological degeneration, dental practitioners should be braced to receive comparatively more patients who have entered the middle and late stages of dementia, and adjust treatment plans accordingly (Geddis-Regan et al, 2020).
Poor oral health contributes to chronic systemic inflammation. This is a risk factor for cognitive decline and a host of other health issues. This underscores that the sooner these patients receive routine dental help and access to oral hygiene maintenance, the better for their overall health, as well as specific dental issues (Ki et al, 2019).
It is vital that these patients receive appropriate care as soon as possible. Many elderly people have complex overlapping health issues, which can complicate treatment even in the best of circumstances.
If you are dealing with a complicated case, consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction. The practice offers a wide variety of advanced procedures for rehabilitation of edentulous patients with functional problems, as well as maintenance implant-supported prostheses. With state-of-the-art facilities and a wealth of experience, the well equipped team can handle high-risk cases.
At its most basic, the strain of the pandemic means that we should expect a sicker, less healthy populace. This will be multifactorial, seen not just among those who have had COVID-19.
An increase in patients facing cognitive impairment, or further progressed into dementia before detection, is but one foreseeable ramification of the difficult choices the pandemic has forced.
However, while this will present challenges, with appropriate care patients can enjoy substantially better quality of life. The sooner this occurs the better the prognosis.
Cademartori M, Gastal M, Nascimento G, Demarco F, Corrêa M (2018) Is depression associated with oral health outcomes in adults and elders? Clinical Oral Investigations 22: 2685-2702
Geddis-Regan A, Kerr K, Curl C (2020) The impact of dementia on oral health and dental care, part 2: approaching and planning treatment. Primary Dental Journal 9(2): 31-37
Hanna T, King W, Thibodeau S, Jalink M, Paulin G, Harvey-Jones E, O’Sullivan D, Booth C, Sullivan R, Aggarwal A (2020) Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ 371
Ki S, Yun J, Kim J, Lee Y (2019) Association between dental implants and cognitive function in community-dwelling older adults in Korea. Journal of Preventive Medicine & Public Health 52(5): 333-343
Sutin A, Stephan Y, Luchetti M, Terracciano A (2020) Loneliness and risk of dementia. The Journals of Gerontology series b 75(7): 1414-1422