Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Alzheimer's Society (D14)


  1.1  The Alzheimer's Society is the leading care and research charity for people with dementia and their carers. It was founded in 1979 as the Alzheimer's Disease Society. It provides information and education, support for carers, and quality day and home care. It funds medical and scientific research and campaigns for improved health and social services and greater public understanding of dementia.

  1.2  The Society has over 22,000 members and operates through a partnership between some 250 branches and support groups and the national organisation in England, Wales and Northern Ireland. The Society brings together carers, family members, health and social care professionals, researchers, scientists and politicians through shared concern for people with dementia and those who care for them.

  1.3  Dementia is one of the most significant health and social care challenges of the next century. There are over 700,000 people with dementia in the UK. Dementia affects one person in 20 aged over 65 and one person in five as they reach 80 years of age in the UK. As the population ages so the number of people with dementia will grow. While age is the most significant risk factor, there are 17,000 people with dementia aged under 65 years of age in the UK.

  1.4  The Society welcomes the Committee's enquiry into the Government's strategy Modernising NHS Dentistry and in particular the focus of the strategy on improving access. Access to dental services is of major importance to people with dementia and their carers, irrespective of residential setting. Approximately one third of people with dementia in the UK live in a care home/hospital, a third live with a relative or friend and a third live in their own home on their own. The difficulties that people with dementia and their carers face in accessing appropriate dental services has been highlighted in the Alzheimer's Society report Food For Thought published in July 2000 (copies enclosed and available at


  2.1  Food for Thought draws on nearly 4,000 questionnaire responses from people with dementia, their carers and health professionals. The survey illustrates the high degree of concern surrounding oral health:

    —  80 per cent of carers said they were worried about the problems a person with dementia has with eating and drinking;

    —  oral health was the most frequently cited factor associated with problems with eating or drinking;

    —  nearly half (47 per cent) of all respondents felt that "oral hygiene or dentures" was a problem for the person with dementia that they cared for.

  2.2  The survey highlights the lack of professional awareness surrounding good dental care for people with dementia, including those with dentures. People with dementia represent a vulnerable group—not only because they have particular difficulties in accessing dental health services but because the impact of dementia has important implications for oral health.

  2.3  Where carers are able to access specialist advice, it can be often invaluable:

    "The dentist gave me great encouragement to persist in trying to educate the staff about eating problems."

    "The dentist suggested buying an electric toothbrush. The care home staff said it was a great help—made teeth cleaning easier and more effective. A good set of dentures is easier to care for—much less trouble."


  3.1  Skilled/specialist support is required to meet the complex physical and mental health needs that result from the damage to the brain caused by Alzheimer's or another form of dementia. Dementia will affect a person's memory, speech, and their ability to carry out every task of daily living such as brushing teeth. People with dementia become increasingly dependent on the provision of quality care for the determination of their quality of life and dentists have a key role to play.

  3.2  Many people with dementia develop a preference for sweet foods and drinks. This may be due to damage to the hypothalamus. Moreover, people with dementia may forget that they have eaten at all or eaten too much. Many carers expressed concern over the possible adverse health effects from the consumption of large amounts of sugary foods and drinks. This is clearly an area that both carers and care staff want greater advice and support.

  3.3  Healthy teeth and gums are vital for chewing food. Moreover, some people with dementia simply forget how to chew or swallow. Other people who are unable to swallow may hoard food in the side of their mouths. Dentists have a key role in maintaining good oral health and in minimising pain and infection. Dementia may also mean that people forget how to brush their teeth and may require assistance to do this.

  3.4  People with dementia may experience great difficulty in accessing appropriate dental services and support. Not only will people with dementia have communication problems that will make it harder for them to articulate a need to see a dentist, such as pain relief, there may also be additional problems associated with mobility that may make it hard to physically attend a dentist's surgery;

    "My mother still has all her own teeth and I have had difficulties encouraging the care staff to ensure that her teeth are cleaned several times daily. She has developed several severe gum infections, which have been treated in what I feel have been a haphazard way. At present, teeth care is quite good, but is not consistent. She was not referred to a dentist until we insisted, but the dentist said she was unable to help unless my mother could be taken to the surgery. She has been bed-bound for over two years now and this would be an impossibility."

  Community dental teams should have responsibility for ensuring that older people in care homes have access to dental health services.

  3.5  Difficulties with communication can result in paid and other dental problems not being detected. A person with dementia may become severely agitated or behave in ways which appear to be aggressive or violent because they do not understand what a dentist is doing. This will mean that there may be additional problems in providing appropriate care. Several carers noted that the person that they care for "refused to be treated" and had to be anaesthetised. The use of anaesthetics raises additional concerns because its impact can increase confusion. Dentists should receive adequate training to ensure that the best interests of people with dementia are upheld. Carers also highlighted the problems that can arise surrounding a lack of capacity and consent:

    "My cousin is in a home. Her teeth are in a shocking state. I cannot see how she can eat sufficiently. All attempts to get her teeth and oral hygiene improved are frustrated by her refusal to see a dentist. The home has given up."

    "The dentist would not remove rotten/broken tooth as patient could not give permission."


  4.1  Despite extremely high levels of concern, less than half the carers had sought professional advice and help—with only 8 per cent seeking help from a dentist. Few carers seemed to be aware of the existence of community dental health services and suggests that community teams need to do more to promote their services to groups who are hard to reach.

  4.2  Carers criticise both hospitals and nursing homes for their inattention to the health of teeth and gums of people with dementia. Dental health practitioners clearly have an important role in raising awareness and in improving standards of care for people with dementia. Moreover, many carers reported that dentists do not have adequate knowledge or understanding of dementia amongst dental health practitioners:

    "The advice was hopeless. They all said he should have false teeth. He would not know what to do with them."

    "No practical advice was given. The dentist was "in-the-dark".

  4.3  The difficulties that people with dementia face in obtaining appropriate and quality dental services appear to be exacerbated by living in a care home. Both carers and health and social care professionals reported a high level of concern over the way in which care home staff sought to maintain or improve a person's oral health. There appears to be a lack of clinical leadership in improving standards of dental care to older people in residential/nursing care homes. Carers reported problems with the care and fitting of false teeth as well as general oral hygiene:

    "Nursing home staff did not ensure teeth were cleaned—leading to mouth ulcers—leading to reluctance to eat—hastening difficulties with swallowing."

    "They broke his teeth in the washing machine and had to be constantly hounded to get them replaced by the visiting dentist. Meanwhile, they made no special provision for his eating, this went on for six months."

    "The nursing home have removed my mother's false teeth with the excuse that she might swallow them. So they feed her with scrambled egg sandwiches broken up and soaked in soup! So, of course, she is losing interest in eating."

  4.4  The difficulties that people with dementia face in eating, drinking and taking medication as well as self-care make them a priority group for specialist dental services. The Alzheimer's Society therefore welcomes the strategy on NHS dentistry but is concerned that there is no direct reference to older people, or to people with dementia specifically.

January 2001

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