Surprising Link Between Oral Health, Cognitive Decline & Brain Fog

Welcome back to this presentation on oral health, cognitive decline and chronic conditions. I'm your host, Dr. Donnelly Snipes. In this brief presentation, we'll explore the relationship between oral health, inflammation, cognitive decline, irritability and the worsening of chronic conditions, and then identify strategies to improve outcomes. Talking with some of the executive directors of alfs around here, one of the things that they lament is the fact that, yeah, we've got a lot of people coming in, but our back door is wide open. And people's. Which meaning that people's conditions are worsening, well, they come in so much later than they used to, they're so much more ill or struggling with their independence before they even come to an alf, but then by the time they get there, their condition worsens so rapidly that they are transferring to a higher level of care in no time flat. And a lot of these strategies we're talking about today are designed to slow that progress. Not only are you going to slow the progress of chronic diseases and chronic illnesses if you can reduce inflammation and reduce stress in most cases, but you are also going to reduce turnover on your staff, because happy residents means happy staff and unhappy residents. The staff generally bear the brunt of their unhappiness. So it's going to make your life a lot better. It really is. So gum disease is something that we don't think about impacting mental health, but it kind of makes sense when you think about it. Think how closely your gums are to your brain and think about how irritable you get when you've got a toothache. Gum disease or periodontitis triggers chronic inflammation. When you've got gum disease, your gums are inflamed. That's inflammation which sends it and has bacteria in it, which gets into your bloodstream, which triggers or gets into your system, which triggers chronic inflammation. They found a direct correlation between having gum disease and an increased risk of neurodegenerative disorders like Alzheimer's and other dementias. So we start seeing the chronic inflammation have negative impacts on the structure of the brain. A lot of the people, as I mentioned earlier, more than 40% of U.S. adults are, are either insulin resistant or have some type of diabetes. Okay, so there's a lot of people. Diabetes has a connection with poor oral health. Chronically high blood sugar promotes inflammation, vascular damage and immune system dysfunction, all of which impair oral health, the health of oral tissue. So if you're having problems, just like people with diabetes, when they get a. A wound somewhere, it takes longer to heal. If they get a wound in their mouth, it takes longer to heal, and that wound is an open gateway for bacteria to get into the body. Additionally, we see salivary gland changes in diabetes. Now, I bet you didn't know that our saliva output is actually higher and in the morning and in the early afternoon than it is at night, because it's partially regulated by our circadian rhythms, our body. Just like the dog that would salivate when he heard the bell ring, our body prepares for food by increasing saliva production. So when we increase our hunger hormones, then we're also going to have an increase in saliva production. Who knew? And lack of saliva is a whole other problem that we'll get to. But salivary gland, gland changes in people with diabetes reduce saliva flow, causing dry mouth, which result in increased glucose concentration in their saliva. Well, that's the last thing somebody with diabetes wants is increased glucose concentration in their saliva. We also see increased oral infections, and those infections worsen systemic inflammation and glycemic control because. Drumroll, please. Stress triggers the release, release of blood sugar and the release of insulin. And if we've already got difficulty regulating that, then adding more to the pot is just going to make it more difficult. More than a third of older adults and over 50% of older adults over 80 struggle with dry mouth. And you're like, okay. And dry mouth increases gum disease and inflammation and difficulty chewing, swallowing, and tasting food. Ah, now we start to see the problem, because the food that we eat has to be broken down into its component parts and reassembled into neurotransmitters and hormones and tissues and whatever it needs to be. But we've got to break the food down first. Saliva has enzymes in it that help start pre breaking down the food. If we don't have good saliva, that's not going to happen. Then we're also going to have this sticky, dry, crumbly, hard to swallow mass of food. And that's uncomfortable. We get it down in our, our belly all of the time. And when saliva starts breaking down food, it also makes the flavors available to our taste buds. Well, if that's not happening, we're not really tasting the food. So. So it's kind of like eating cardboard. For a lot of these people, there's no pleasure in it at all. And for some people, it's actually either painful or challenging. Tooth pain or loss can significantly reduce chewing ability, leading to nutritional deficiencies that worsen cognitive decline and chronic illness. We need nutrients in order to heal. And when, when we're nutrient deficient, our body registers that as A stressor. And that stressor increases inflammation. Think of the body again, when you're nutrient deficient, it's like the factory not having all the parts it needs in order to assemble whatever it is it makes. And so the CEO is going to start getting freaked out and say, hey, we're not going to make our productivity quotas. And it triggers the stress response. Each missing tooth has been found to be associated with an increased risk of cognitive impairment in a dose response fashion. Now, that's just a general gauge, but for each, for each tooth that has been lost, it generally equates to worse oral health. And the worse the oral health, the worse worse the cognitive impairment may be. Because of neuroinflammation. Older adults missing all of their teeth have up to a 40% greater risk of dementia compared to peers with no tooth loss. Is that only because of gum disease? Heck no. There's a lot of reasons for that. Part of it is potentially gum disease. Part of it is lack of adequate quality nutrition. Their body's not able to absorb a lot of what they eat, and some of them just don't even want to eat because, you know, they've got dry mouth, they can't chew their food, they can't taste much, much. What's the point? Poorly fitted dentures cause pain, reduce food intake, and discourage social interaction, which further worsen chronic conditions by lowering nutrient absorption and increasing isolation and depression when you're not. When you're eating with people. The research says that we tend to chew more when we are eating in a social situation than we do do when we're eating by ourself. Because when we eat by ourself, I guess we wolf it down. Whereas when we're eating in a social situation, we may take our time. That's what the research says. I know I'm so busy trying to chew my food so I can start talking again that I think I chew less. But it's. The important point here is poorly fitted dentures. And I have run into so many people, especially in nursing homes, so many people who have either no teeth at all and no dentures or their dentures just are so painful they don't want to wear them. And it's heartbreaking. It's heartbreaking because it so significantly improved. Impairs their nutritional balance. Cognitive and physical decline make oral hygiene maintenance difficult, fostering a vicious cycle where worsening oral health impairs cognition and chronic disease management. Poor cognition or difficulty brushing teeth can lead to neglect of oral care, increasing infections and inflammation, and accelerating the underlying disease process. So let's just unpack this. If you've got somebody who has cognitive decline for whatever reason, maybe it's oral related, maybe it's not. They've got cognitive decline and they keep forgetting to brush their teeth, then they're going to start developing bacteria and all kinds of other stuff. They're eventually going to get gingivitis or some sort of oral infection, and that's going to contribute to more inflammation, which is going to worsen their cognition, make it even harder for them to remember to brush their teeth. We also have people who have difficulty, whether it's Parkinson's or arthritis or something else, have difficulty engaging in the activities of oral care. Brushing their teeth, that fine movement, holding the toothbrush can be too difficult. And they're using mechanical toothbrushes can be helpful. They're more ergonomic. They're not. They have a much wider body for you to hold on to. Using water picks for flossing teeth, because flossing, I don't care what age you are, that's just awkward. It's just awkward. And if you're having difficulty with your fine motor movements anyway, flossing is probably the last thing you want to do. And if they've already got inflammation and gum disease, it may be painful to floss, whereas the water picks generally are not nearly as painful. Work with their dentist. Have them work with their dentist. Chronic conditions like diabetes, cardiovascular disease and respiratory illnesses share risk factors with poor oral health, mainly inflammation. All of these chronic conditions have an underlying factor of inflammation, which means that all of these underlying factors make it more likely that the person will also develop oral inflammation and oral health deterioration, which is going to increase the deterioration of their overall health. So what can we do? We're not dentists. We're not going to be brushing their teeth for them most of the time. Now, some people may have caregivers that do brush their teeth for them, but what can we do to help people maintain their independence and maintain their oral health? Push notifications on their mobile devices if they have one. If you're in a facility that has Amazon Echoes or something else in every room where you can push out a notification to every resident at 6 o' clock in the afternoon, push out a notification. Don't forget to brush your teeth. If they don't need that reminder, they'll just ignore it. If they do need that reminder, then it'll be like, oh, okay, thanks. Use ergonomic electric toothbrushes. Have them try different ones. Some, some have bigger bodies than Others figure out what feels comfortable in their hands. But when you use those, the vibration of the toothbrush takes away the need to do this, which can be very difficult for somebody who's got mobility issues. Use water flossers, as I mentioned. Rubber, rubber dental picks. They have little. It looks like the cleaners that you use to clean straws in the kitchen, but much smaller where it's got a little rubber tip with little tiny fingers protruding from it that you, you can use to put between your teeth. Now, it doesn't get up where the teeth are really tight together. It's not as good as dental floss, but it can be helpful. Something's better than nothing, right? Oral swabs. If somebody has dry mouth or if somebody for some reason, maybe they just had a hip replacement and they just can't get up to brush their teeth and the only thing they can do is use oral swabs with proper cleaner on it and then obviously spit into a pan, not swallow it. That is an option. Dry mouth is a big issue for increasing oral health problems, so addressing dry mouth as best as possible is important. Mouthwash and I have here if no history of alcoholism. I did the first 20 some years of my career working in dual diagnosis facilities and mouthwash and hand sanitizer were consumed if they couldn't get their hands on anything else. So if you've got an older adult that has a history of alcohol abuse, mouthwash probably isn't something that is ideal for them to have. You may or may not be able to control that in your facility. But mouthwash can certainly be helpful because they can swish it and try to push it through their teeth, which can help, especially if they have difficulty with flossing. It's not a replacement. Dry mouth care work with their dentist. There are a lot of toothpastes and lozenges and mouthwashes and other things you can use. Never occurred to me. There used to be sort of a joke that, you know, everybody's grandmother always had a little tray of butterscotches on butterscotch hard candies. And in their house it's. It just was a thing. And it was a thing in my grandma's house. It was a thing in my husband's grandma's house. And I never really understood it. I've got them now. I have become that person that has butterscotches in the house. Mine are sugar free, but it does help with dry mouth. If for people who struggle with dry mouth, having hard candies around may be an option. If they don't have diabetes, you know, obviously check with their doctor, blah, blah. Ensure foods are moist. People with oral health problems have difficulty chewing really dry foods. If their gums are raw or fragile, dry foods can cut them. If they have dry mouth, then they don't have the saliva that's used to make the bolus that's going to be swallowed. So in ensure your food, the foods that they're eating are moist. Whether it's casseroles or any breads they have, make sure they're moist or they've got some sort of broth that they can dip them in. You can use mechanical blending or smoothies. Now, obviously there are some things you don't blend. When my son was little, he loved pizza and I loved pizza. And he said, hey, mom, I bet a pizza smoothie would be awesome. And I said, hey, I bet you're right. Let's try it. Oh my gosh. That was the most disgusting thing I've ever had in my life. You can't just blend food and think it's going to taste the same. I found that out the hard way. But I digress. You can get an, I drink a superfood smoothie every single morning. You can get freeze dried powders like freeze dried broccoli, freeze dried tomato, freeze dried blueberries, or you can get it in just a superfood powder that has a bunch of vegetables and fruits in it and you can blend it up and make a really yummy smoothie. I mean, I love mine. I really love mine. I have to, you know, be careful not to have more than one a day because then I'd kind of OD on antioxidants. But the, my point is there are ways to make the food taste good. There was one woman at a facility I worked with around here who, God bless her, she had recovered from three bouts of, of cancer and one of them being throat cancer. And I mean, she was great. She is smart as a whip. She is wonderful. But apparently because of her chemotherapy and radiation or whatever, I didn't ask her to explain, but she has difficulty swallowing and she has dry mouth. So they blend all of her foods and she said, it just tastes disgusting. I don't even want to eat because it tastes nasty. Um, and we've got to remember when we're feeding people, if, if we are feeding them or it maybe they, they can still feed themselves. But we have to encourage them to find foods that are healthy that they will eat, that they find palatable. And it's not like taking castor oil at Every meal. So talk with them. Do you like fruit smoothies? Do you like chocolate smoothies? What is it that you like? And then work with the dietitian, nutritionist, doctor, whomever you have to get clearance with to find something that works for that older adult drinking. A lot of older adults drink Ensure. Well, that's great, but I don't know about you, but drinking the same thing every single day at every single meal for a year isn't appealing to me. I'd be like, yeah, no, that, that ain't gonna work for me. So again, even if you find something that they like, don't assume that they are going to want to have it for every single meal. The importance here is if they don't have the nutrients in a way that their body can actually use those nutrients, you know, so they can digest it, then they're not going to be able to heal the infections and reduce the inflammation. Try different toothpaste flavors. Not everybody. My son hates mint. Always has hated mint. He likes cinnamon. I used to have to find cinnamon toothpaste for him. But as people age, their taste buds change. You lose the sweet and salty and you keep the sour and bitter. Really, I think that's just God's funny trick. But anyhow, recognizing that a toothpaste that tasted good to you when you were 20 may actually be off putting when you are 60, 70 or it may be too strong. So try different toothpastes there. I'm sure there are some that are unflavored somewhere. I know there are some that are. Berry, cinnamon, etc Ensure people with dentures have adequate denture supplies. You have to have the stuff to clean the dentures, the denture adhesive, etc. Some older adults can't drive and a lot of them are still resistant to using click and pull. And we are trying so desperately hard to get Papa Snipes and my my in laws to start using click and pull. Go online, go to Walmart, go to Publix, go to Kroger, whatever store, identify, put your order into shopping cart, pay for it, have it delivered. Most places deliver for either nothing as part of a subscription or for a very, very small fee. And for the older adult who can't drive, it's a game changer. It is truly a game changer and it's totally worth it. Even if they can drive, saves a lot of time. So encouraging them to identify ways that they can maintain their independence even if they can't drive. But lack of supplies is one of the things that comes up a lot. Well, why aren't you wearing your dentures? Well, I don't have the, the cleaning things or I don't have this or I don't have that. Oh my gosh. You know, Let me show you how to order them. You can even go on Amazon for a lot of them. If you use Amazon and set up a subscribe and Save so it delivers to their house every three months and they don't run out. There are ways to make sure that people have the supplies. Because of their declining independence, a lot of older adults are hesitant to ask for help, to ask for things if they run out of something. They don't want to bother anybody, so they just don't say anything. Bother me. Please bother me. Let me help you figure out a way that you can make sure that you've got this stuff. It takes two seconds and then you're good. Indefinitely. Encourage social eating as longer chewing stimulates saliva release. I'm not one of those people who chews 36 times or whatever it is. I'm just not going to do it. I never have, never will. But I also don't have dry mouth. So for those who have dry mouth, encourage them to chew for a little bit longer and chew. Encourage them to take smaller bites because the saliva release isn't proportionate to the amount of food in your mouth. It's just what it is. So if you have a smaller amount of dry material in there and the same amount of saliva and then it's going to work better. So smaller bites, chew longer will help the swallowing process, will improve taste of a lot of the foods, regulate circadian rhythms and eat in the morning and early afternoon. Since salivary flow is lowest during sleep when you're not supposed to be eating, and peaks in the late morning and early afternoon. Gum disease, tooth pain and dry mouth all affect nutrition, health and inflammation. Diabetes, impaired fine motor abilities, just forgetting to brush your teeth and disrupted circadian rhythms all impact the ability to attend to oral health. Tends to make people forget or have more problems with their oral health. Help older adults understand the connection between their quality of life and oral health. It's not just about bad breath. It's so much more than that. And let me help you understand why. If you don't take care of your oral health, then you're going to get inflammation which is going to make your thinking worse. It's going to make your memory worse, it's going to make your energy lower. It's whatever issues that are most poignant or problematic for them, help them see the connection between poor oral health and making all those things worse and good oral health and improving all those things, that's motivational interviewing. It's about finding a win win. I want you to do this, and I know all the reasons why. I need to find out what's going to motivate you. Well, what motivates, what I want you to do is to stay healthy and to be happier and less irritable. But what you want may be something different. So how is what I want you to do going to help you achieve your goals for your rich and meaningful life?