As part of SCI’s vision to drive authentic conversations about quality-of-life for the elderly, we will publish posts throughout the year that focus on best-in-class organizations that are committed to a future of healthy and happy seniors.

In our third article on oral health, take a closer look at implant care and diseases and how people living with dementia can be supported in taking good care of their implants.  We spoke with TePe Oral Hygiene Products AB to understand why maintaining your implants is just as important as keeping teeth and gums clean. We also collated information from various Alzheimer’s organizations to provide tips on helping people living with dementia follow good oral care practices.

In the event that you suspect inflammation or other symptoms of oral diseases, contact your dental professional for further advice and service. 

Similar to following good oral healthcare practices for healthy gums and teeth, dental implants must also be cared for in order to avoid disease. If implants are not maintained properly, bacteria can grow at the base near the gum line and spread to other parts of the mouth. One study (Daubert et. al, 2015) found the development of peri‐implantitis in one in six implants in 96 patients through a period of 11 years. Another investigation (Holland, 2016) found that “46% of people with implants have peri-implant mucositis and of that figure, 22% have peri-implantitis. As a result, peri-implantitis has been quantified as ‘an emerging public health issue’”.

For people living with dementia, poorer oral health status has been observed (Chalmers and Pearson, 2005). A study from Japan (Kimura et. al, 2013) found that about 20% of people living in caregiving facilities have dental implants and that “there is a low level of understanding regarding implants and their care among nurses and care providers.”

Additionally, as mentioned in our previous articles, scientific research is increasingly pointing to strong links between oral health diseases and Alzheimer’s disease. Depending on the country and social welfare system, treatment for oral health disease may be expensive and sometimes not covered by insurance. Therefore, in most cases, the best option is to take preventative measures against such diseases through practicing good oral care. TePe Oral Hygiene Products AB suggests some ways to spot early signs of disease and ways to care for your implants,

Healthy gums

Healthy gums do not bleed or hurt when you clean around your implants.

The implant is attached to the bone through the osseointegration. The gum tissue covers the bone and is formed around the implant like a collar. The small crevice between implant and gums is called the sulcus.

Peri-implant mucositis
Inflammation in the gums around the implants is known as peri-implant mucositis. This disease causes redness and swelling but it is not always obvious. One indicator is sensitive gums which may bleed when you clean around your implants.

If implants are not cleaned properly, a sticky film may start to build up around the implants especially along the gum line. The continuous build-up of this film can cause gum inflammation (peri-implant mucositis).

 

Peri-implantitis
If the plaque is not removed, it continues to grow into the sulcus, the space between an implant and surrounding gums. It is impossible to reach this space with a toothbrush or interdental brush. The plaque hardens into tartar which has a rough surface that attracts more plaque. In time, the bone around the implant will start to break down, meaning that the implant gradually loses its attachment. This loss of bone is known as peri-implantitis.

This disease often goes unnoticed and without pain. It is important to get professional treatment as soon as possible to stop the process. Without treatment, the bone loss will continue and the implant may eventually lose its bone support. Factors like poor oral hygiene, previous tooth loss and smoking heighten the risk of peri-implantitis.

Prevention and treatment

You can prevent peri-implant disease through good oral hygiene. Bleeding when brushing, and red, swollen gums are signs of inflammation, but the symptoms may not be very obvious.

If you suspect an inflammation, contact your dental professional. Professional treatment includes deep cleaning and removal of plaque and tartar. You may also seek guidance on how to properly care for your implants at home.

Your dental professional is there to help you achieve a high standard of oral hygiene. Regular check-ups in combination with your own home care are important to prevent diseases from developing and returning.


Cleaning different types of implants

Depending on the type of implants and your specific needs, the following are some recommendations on how you can keep your implants clean, and your mouth healthy.

Toothbrushes
Choose a toothbrush with a small brush head which enables you to reach the irregular implant surfaces easily. A brush with both shorter as well as longer filaments facilitates reach further in between the implants.

 

 

Special brushes
You may also need a special brush to be able to clean the area where the implants meet the gums. A brush with an angled neck is recommended for reaching the implant surfaces from the inside. A slim brush head is best for for easy cleaning of the outside implant surfaces.

Single tufted brushes
A single tufted brush is ideal for precision cleaning of areas where it is difficult to reach. Choose a brush with a firm rounded tuft or a slim pointed tuft depending on individual needs.

Floss
Floss made of an elastic material makes it easier to clean where space is limited. Insert the floss between the implant bridge and the gums using the stiff end. Clean the sides of the implants as well as the area where the implant construction meet the gums.

 

 

 

Interdental brushes

Brushing cleans the outside and the inside of the implant surfaces. To reach the sides of the implants, an interdental brush is often recommended. Interdental brushes are available in different sizes, texture and design to fit individual needs.

 

Overdenture
With a removable overdenture it is easy to clean properly thanks to good accessibility and sight.

Single tufted brush

A single tufted brush is ideal for cleaning around the implant abutments of different shape and design.

 

Interdental brush

Use an interdental brush under the connecting bar

Denture brush

For efficient cleaning of the removed overdenture, use a denture brush with long and extra strong filaments.

 

With age and the progression of diseases such as dementia, a person might need additional support in caring for their implants. In such cases, a care plan tailored to the individual’s needs may be required. Alzheimer’s Society and Alzheimer’s Association UK suggest some ways in which a person living with dementia may be assisted with their oral care practices:

  1. Creating a sense of familiarity

Assign a place and routine for brushing. Whether it’s the bathroom or another sink, try to understand where a person is most comfortable and make it habit to always brush at the same place. Switching from place to place brings unnecessary confusion and can be disorientating for a person living with dementia.

  1. Use aids

Try to support the person to be independent as much as possible. Invest in special equipment to help reduce shaking and increase stability. The use of a mirror may be useful in helping the person find their mouth and recognize their surroundings. Instead of jumping in to brush someone’s teeth, try to break the process down to simple steps and help them to follow or ‘copy’ the process.

  1. Be vigilant

Note and observe developments of new habits which may affect oral health. Examples might be misplacing dentures or having a preferred side for chewing. If you suspect any oral health problem, try to investigate it gently. Do not force open someone’s mouth. Respect their autonomy and talk to them to try and figure out any problems. If you believe the person is describing symptoms of a disease, consult a professional at the soonest.

Taking care of implants is just as necessary as taking care of gums and teeth. By following good care practices and investing a little more time and resources into maintaining your implants today, you can ensure a healthier smile for years to come.