You can be working towards in a personal apply, a DSO, or an FQHC. No matter your setting, you’ll encounter a affected person with dementia or Alzheimer’s illness. Here’s a quantity price sitting with: 7.4 million.1 That’s what number of Individuals aged 65 and older reside with medical Alzheimer’s dementia as we speak. By 2060, it’s projected to just about double to 13.8 million. A landmark 2025 research2 in Nature Drugs discovered that just about 42% of Individuals over age 55 could develop dementia of their lifetime. Learn that once more. Almost half. These are usually not statistics a few distant future; they describe who’s already sitting in your ready room, and who will arrive in even higher numbers with every passing 12 months.
Recognizing the affected person earlier than the chart tells you
I just lately handled a affected person with superior dementia. Probably the most dependable tip-offs that your affected person has dementia is their remedy record. When you see donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne), memantine (Namenda), or the newer agent donanemab (Kisunla), you’re looking at a dementia affected person. These medication span completely different levels of the illness, so a fast search for in a dental-specific useful resource like MedAssent DDS3 might help you immediately acknowledge them and reframe the way you strategy the appointment. On this affected person’s case, seeing haloperidol (Haldol) on the record instructed me one thing equally vital: this affected person had a historical past of agitation. After I requested the caretaker about it, she defined that he had struck one other resident on the reminiscence care facility.
When the chair turns into unpredictable: Agitation and antipsychotics
There are numerous medicines generally prescribed by physicians to handle aggressive or agitated conduct in aged sufferers. Examples embrace brexpiprazole (Rexulti), haloperidol (Haldol), quetiapine (Seroquel), or lorazepam (Ativan). The selection typically relies on the affected person’s current medicines and comorbidities.
Sufferers with superior dementia can develop into agitated all of a sudden and with out warning. There’s typically no identifiable set off, though the sustained sensory enter of a dental appointment (the sounds, the devices, and the unfamiliar environment) can completely contribute. I do know this firsthand. Throughout one go to, a affected person grew to become acutely agitated with no warning in any way. We needed to shortly temporize and reschedule. Whereas there is no such thing as a magic appointment size that ensures calm, shorter morning visits are strongly advisable to keep away from sundowners. And if a affected person does develop into agitated, by no means argue with them. Converse quietly, acknowledge what they’re experiencing, and de-escalate.
When agitation is recurring or extreme, a dialog with the treating doctor is warranted. The doctor can prescribe a medicine on an as-needed foundation for agitation, administered earlier than or after your appointment. Realizing this has actual pharmacological penalties. Generally prescribed medicines akin to haloperidol (Haldol) or quetiapine (Seroquel) can lengthen4 the cardiac QT interval, and mixing them with epinephrine present in native anesthetics is contraindicated.5 These are usually not hypothetical considerations; they’re the eventualities that produce preventable opposed occasions.
What They’re Already Taking: Alzheimer’s Medicines and the Dental Chair
Most sufferers with gentle to reasonable Alzheimer’s are taking donepezil (Aricept), rivastigmine (Exelon), or galantamine (Razadyne). These with reasonable to extreme illness are generally prescribed memantine (Namenda) as effectively. These are usually not interchangeable from a dental standpoint.
Donepezil, galantamine, and memantine all record xerostomia6 as a acknowledged aspect impact. As we all know, dry mouth accelerates caries.7 Take into account prescribing a fluoride complement akin to PreviDent and likewise instruct the caretaker on the directions.
The medication we prescribe: A extra advanced panorama than It seems to be
NSAIDs are a reflex prescription after dental procedures, however in aged dementia sufferers they require actual warning. Many of those sufferers are already taking an NSAID for arthritis or power ache, and including one other creates critical danger. My husband, a hospitalist, as soon as admitted a affected person for a GI bleed after a dentist prescribed ibuprofen with out realizing the affected person was already taking celecoxib. That affected person required a number of items of blood, and this was a very preventable end result.
Age-related declines in renal and hepatic operate change the pharmacokinetics of practically each drug you prescribe on this inhabitants. The geriatric affected person can also be extra weak to respiratory despair and CNS uncomfortable side effects. If doable, keep away from prescribing an opioid, benzodiazepine, or muscle relaxant. Keep away from co- prescribing an NSAID and a corticosteroid, as the mixture considerably will increase GI bleeding danger and will have an effect on blood stress. If needed, use the bottom efficient dose for the shortest doable period.
Macrolide antibiotics akin to azithromycin, clarithromycin, or erythromycin must be prevented, as they lengthen the cardiac QT interval. Don’t overlook antifungals: fluconazole, typically prescribed for the oral candidiasis that’s endemic on this inhabitants, interacts with a exceptional variety of medicines that aged sufferers generally take.
The factor we hardly ever say out loud
Probably the most pressing challenge in treating dementia sufferers is one we hardly ever focus on instantly: they can not reliably inform us8 they’re in ache. Language deficits emerge within the reasonable stage of Alzheimer’s and will progress to near-complete verbal loss9 in end-stage illness. A affected person with a fractured tooth, a draining abscess, or a spreading an infection could categorical that ache solely by behavioral adjustments by refusing to eat, have a sudden practical decline, or escalating agitation that seems to don’t have any trigger. There are documented instances10 during which what seemed like Alzheimer’s illness development resolved totally as soon as an undetected oral an infection was handled. An undiagnosed toothache will not be merely a dental downside. In a affected person who can’t say “my tooth hurts,” it’s a medical emergency hiding in plain sight.
The usual we owe them
The affected person I handled that day had a household that cherished her deeply and a facility that cared for her with real consideration. And but her mouth instructed a narrative that none of them had been geared up to learn. Take this as each a chance and a accountability. These sufferers can’t advocate for themselves. We will.
References
1. Alzheimer’s Affiliation. 2024 Alzheimer’s illness information and figures. Alzheimer’s & Dementia. 2024;20(5):3708–3821. https://www.alz.org/getmedia/ef8f48f9-ad36-48ea-87f9-b74034635c1e/alzheimers-facts-and-figures.pdf
2. Fang M, Hu J, Weiss J, et al. Lifetime danger and projected burden of dementia. Nat Med. 2025;31. doi:https://doi.org/10.1038/s41591-024-03340-9
3. MedAssent DDS. Alzheimer’s illness article. https://www.medassentdds.com/?utm_source=dentistryiq&utm_medium=affiliate&utm_campaign=alzheimer-article
4. Blom HJ, Tan HL, Roos-Hesselink JW, et al. Differential adjustments in QTc period throughout in-hospital haloperidol use. PLoS ONE. 2011;6(9):e24648. doi:10.1371/journal.pone.0024648
5. U.S. Meals and Drug Administration. Aricept (donepezil hydrochloride) prescribing info. 2009. https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/018701s059lbl.pdf
6. Gil-Montoya JA, Barrios R, Sánchez-Lara I, Carnero-Pardo C, Fornieles-Rubio F, Montes J, Gonzalez-Moles MA, Bravo M. Prevalence of Drug-Induced Xerostomia in Older Adults with Cognitive Impairment or Dementia: An Observational Research. Medicine Growing older. 2016 Aug;33(8):611-8. doi: 10.1007/s40266-016-0386-x. PMID: 27438469
7. Lauritano D, Moreo G, Della Vella F, Di Stasio D, Carinci F, Lucchese A, Petruzzi M. Oral Well being Standing and Want for Oral Care in an Growing older Inhabitants: A Systematic Overview. Int J Environ Res Public Well being. 2019 Nov 18;16(22):4558. doi:10.3390/ijerph16224558. PMID: 31752149; PMCID: PMC6888624
8. Smrke U, Milošič A, Mlakar I, Kadiš M, Mulej Bratec S. Ache Cues in Individuals With Dementia: Scoping Overview. JMIR Ment Well being. 2025;12:e75671. Revealed 2025 Nov 27. doi:10.2196/75671
9. Alzheimer’s Society. Later levels of dementia. https://www.alzheimers.org.uk/about-dementia/stages-and-symptoms/later-stages-dementia
10. De Siqueira SRDT, Rolim TS, Teixeira MJ, Nitrini R, Anghinah R, de Siqueira JTT. Oral infections and orofacial ache in Alzheimer’s illness: Case report and evaluate. Dement Neuropsychol. 2010;4(2):145-150. doi:10.1590/S1980-57642010DN40200012
