ACE.D triptych

Oral Health and Alzheimer’s Disease

The World Health Organization defines Alzheimer’s disease as a neurodegenerative disease of unknown etiology, characterized by progressive memory and cognitive impairment. There are three major stages of the disease: mild, moderate, and severe. Each stage presents with different behavioral and psychological symptoms. These are accompanied by continuous physical decline, which results in changes in capacity to perform activities of daily living, including oral hygiene.

Oral health is essential for eating, social interaction, and preventing overall health problems. Oral hygiene is the key component of oral infection control. Consistent oral hygiene reduces the incidence of tooth decay, periodontal disease, and pneumonia.

The most important part of caring for the Alzheimer’s patient is supportive care for the family and/or caregivers. However, older adults with dementia often resist caregiving activities associated with mouth care. Care-resistant behaviors (CRB) are the primary reason for the omission of mouth care by caregivers.

This teaching strategy uses Managing Oral Hygiene Using Threat Reduction Strategies (MOUTh), which contains three components: (a) an evidence-based mouth care protocol for older adults with dentition or dentures; (b) recognition of CRBs; and (c) strategies designed to lower the perception of mouth care as a threatening, scary, or assaultive activity (Jablonski, Kolanowski, Therrien, et al., 2011; Jablonski, Therrien, & Kolanowski, 2011; Jablonski, Therrien, Mahoney, et al., 2011).

Oral Health and Alzheimer’s Disease

Learning Objectives

Students will:

  1. Describe differences in oral care needs for the three stages of Alzheimer’s disease.
  2. Discuss barriers to oral care for patients with Alzheimer’s disease.
  3. Demonstrate oral health strategies for CRB in patients with Alzheimer’s disease.
  4. Discuss why promoting consistent oral hygiene is important to overall health in a patient with Alzheimer’s disease.

Learner Prework

The following readings and videos provide background information on oral health and Alzheimer’s disease.

  • Jablonski, R. (2016). Providing mouth care for persons with dementia [Video]. YouTube.
  • Jablonski-Jaudon, R.A., Kolanowski, A.M., Winstead, V., Jones-Townsend, A. M., & Azuero, A. (2016). Maturation of the MOUTh intervention: From reducing threat to relationship-centered care. Journal of Gerontological Nursing, 42(3),15-23. doi: 10.3928/00989134-20160212-05
  • Marchini, L., Ettinger, R., Caprio, T., & Jucan, A. (2019). Oral health care for patients with Alzheimer's disease: An update. Special Care in Dentistry, 39(3), 262-273. doi: 10.1111/scd.12375 

Suggested Learning Activities

  1. Using the article by Marchini et al. (2019), have students complete the Oral Health Interventions for Patients with Three Stages of Dementia chart.
  2. Using the Oral Hygiene Care Plan for a Caregiver of a Patient with Alzheimer’s Disease chart, have students develop an oral hygiene care plan for a caregiver of a patient with Alzheimer’s disease.
  3. Using Maturation of The MOUTh Intervention by Jablonski-Jaudon et al. (2016), have students choose a strategy listed in the Oral Health Interventions for Adults with Alzheimer’s Disease document and demonstrate ways to use this strategy in caring for an adult with Alzheimer’s disease.

Suggested Reading

Gao, S.S., Chu, C.H., & Young, F.Y.F. (2020). Oral health and care for elderly people with Alzheimer's disease. International Journal of Environmental Research and Public Health, 17(16), 5713. doi: 10.3390/ijerph17165713

Jablonski, R.A., Kolanowski, A.M., Azuero, A., Winstead, V., Jones-Townsend, C., & Geisinger, M.L. (2018). Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care. Gerodontology, 35(4), 365-375. doi: 10.1111/ger.12357

Jablonski, R.A., Kolanowski, A., Therrien, B., Mahoney, E.K., Kassah, C., & Leslie, D.L. (2011). Reducing care-resistant behaviors during oral hygiene in persons with dementia. BMC Oral Health, 30. doi: 10.1186/1472-6831-11-30

Jablonskim R.A., Therrien, B., & Kolanowski, A. (2011). No more fighting and biting during mouth care: Applying the theoretical constructs of threat perception to clinical practice. Research and Theory in Nursing Practice, 25, 163-175. doi: 10.1891/1541-6577.25.3.163

Jablonski, R.A., Therrien, B., Mahoney, E.K., Kolanowski, A., Gabello, M., & Brock, A. (2011). An intervention to reduce care-resistant behavior in persons with dementia during oral hygiene: A pilot study. Special Care in Dentistry, 31, 77–87. doi: 10.1111/j.1754-4505.2011.00190.x

Author Information

Erin Hartnett, DNP, PPCNP-BC, CPNP, FAAN
Former Program Director
Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing

Judith Haber, PhD, APRN, FAAN
The Ursula Springer Leadership Professor in Nursing
Executive Director, Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing

Jessamin Elizabeth Cipollina, MA
Program Manager
Oral Health Nursing Education and Practice (OHNEP)
NYU Rory Meyers College of Nursing