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ALZHEIMER’S DISEASE

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ABOUT AD

• Dementia (Alzheimer disease) is defined as an acquired deterioration in cognitive abilities


that impairs the successful performance of activities of daily living
• There are an estimated 5.3 million cases of dementia in the United States with an
expected increase to 18.5 million cases by 2050.
ORAL MANIFESTASION

• AD is a slowly progressive disorder represented by a continuum


• of clinical characteristics. Updated clinical criteria recognizes three stages of AD:
• (1.)Preclinical AD,
• (2) Mild cognitive impairment due to AD: mild changes in memory and other cognitive abilities
that are noticeable to patients and families but are not sufficient to interfere with dayto-day
activities.
• (3) Dementia due to AD: changes in two or more aspects of cognition and behavior that
interfere with the ability to function in everyday life.
ORAL HEALTH CONSIDERATION
• Patients with AD appear to be at higher risk for:
• developing coronal and root caries
• periodontal infections
• temporomandibular joint abnormalities
• orofacial pain compared to healthy subjects.

• Patients with AD can become frustrated, irritable, and possibly combative when
confronted with unfamiliar circumstances or with questions, instructions, or information
that they do not understand so the oral health-care provider must approach AD
patients with empathy and explain all procedures and instructions clearly
ORAL HEALTH CONSIDERATION

Patients with early stage of AD  recommended to complete restoration


of oral health-care because the patient’s ability to cooperate diminishes as
cognitive function declines.

Patients with severe stage of AD  time-consuming and complex dental


treatment should be avoided
ORAL HEALTH CONSIDERATION
 Medications used to treat AD can cause a variety of orofacial reactions and potentially
interact with drugs commonly used in dentistry:
1. Cholinesterase inhibitors cause sialorrhea
2. Antidepressants and antipsychotics cause xerostomia
3. Antipsychotic agents cause dysgeusia and stomatitis
4. Antimicrobials (clarithromycin, erythromycin, ketoconazole) impair the metabolism of
galantamine, resulting in central or peripheral cholinergic effects.
5. Anticholinesterases + NSAID  increase the possibility of gastrointestinal irritation and
bleeding
6. Local anesthetics with adrenergic vasoconstrictors + tricyclic antidepressants  potential
risk of cardiovascular effects (hypertensive events or dysrhythmias)
ORAL DISEASES CAUSED BY AD
Medications used to treat AD sialorrhea
Cholinesterase inhibitors
can cause a variety of orofacial
reactions and potentially interact
with drugs commonly used in
dentistry.

excessive saliva production


ORAL DISEASES CAUSED BY AD

2. antidepressants and antipsychotics xerostomia


ORAL DISEASES CAUSED BY AD

3. Antipsychotic agents stomatitis


TREATMENT

• Cholinesterase inhibitors are approved by the US Food and Drug


Administration to treat mild to moderate cases of AD and are considered
the standard of care.
• The four types of cholinesterase inhibitors currently available are :
• Tacrine
• Donepezil
• Rivastigmine and galantamine
TREATMENT

Effects of these medications include :


• Nausea
• Vomiting
• Diarrhea
• Weight loss
• Bradycardia
• And syncope.
TREATMENT
• Memantine, a noncompetitive n-methyl-d-aspartate receptor antagonist is used for treatment of
moderate to severe AD.
• Antipsychotic agents are used for those patients who display aggressive behavior and
psychosis, especially in the later stages of the disease.
• The clinical value in the treatment of ad include :
1. Antioxidants, such as selegiline and α-tocopherol (vitamin e)
2. Cholesterol-lowering drugs
3. Anti-inflammatories,
4. Herbal remedies, such as ginkgo biloba
MANAGEMENT
• There is no cure for AD, and therapy is aimed at slowing the progression of the
disease.
• Caregivers of patients with AD must be involved in the overall treatment as they are
responsible for maintaining the patient’s general health and ensuring a meaningful
quality of life
• It is often necessary to provide educational, emotional, and psychological support to
these individuals as the task for caring for patients with AD can be extremely
challenging.
MANAGEMENT
• The presence of a caregiver may be beneficial as they can verify patient information,
interpret patient behavior, and alleviate anxiety
• Patients with AD should be placed on an aggressive preventive dentistry program,
including an oral examination, oral hygiene education, prosthesis adjustment, and a
three-month recall
• It is recommended to complete restoration of oral health-care function in the
earliest stages of AD because the patient’s ability to cooperate diminishes as
cognitive function declines.