치매 환자에게 ‘씹는 힘’ 중요한 이유는?

As dementia progresses, maintaining proper oral hygiene becomes increasingly difficult for patients. However, dental professionals strongly emphasize starting oral care at the early stages of the diagnosis. Professor Kim, head of the Department of Periodontology at Seoul National University College of Dentistry, explains that in severe cases, patients' ability to manage their own oral care and cooperation with dental treatment significantly diminishes.

This is particularly concerning for those with gum disease, which can lead to inflammation of the gums and gradual deterioration of the jawbone that supports the teeth. Symptoms may include bleeding gums or even pain, but in many cases, the condition progresses silently, and by the time a dental visit is sought, the damage may already be significant.

Research has shown a correlation between gum disease and dementia. A 2020 study published in the Korean Journal of Periodontology found that if the remaining teeth count is nine or less, the risk of dementia significantly increases. Another study suggested that for each additional functional tooth used to chew food, the risk of cognitive impairment decreases by approximately 4.5%.

The connection between teeth and cognitive function is believed to be through the stimulation of sensory receptors around the tooth root by chewing, which sends signals to the brain. This stimulation affects brain blood flow and oxygen supply, potentially reducing activity in multiple brain regions, including the cerebral cortex.

Malnutrition resulting from difficulty chewing food also plays a role in cognitive decline. Maintaining adequate nutrition is crucial for overall health, and a compromised diet can exacerbate the effects of dementia. Furthermore, the chronic inflammation caused by gum disease, particularly the bacteria Porphyromonas gingivalis and its toxin, gingipain, has been linked to the accumulation of beta-amyloid and tau proteins, which are hallmarks of Alzheimer's disease.

However, it is essential to note that gum disease does not directly cause dementia. Instead, as cognitive function declines, maintaining oral hygiene becomes more challenging, potentially leading to further tooth loss and gum disease. Therefore, preserving natural teeth and optimizing chewing function becomes increasingly important for dementia patients.

The timing of starting oral care is critical as well. In advanced dementia, self-care may become impractical, and dental procedures may require general anesthesia or sedation, which can be difficult for older patients with multiple comorbidities. Thus, early intervention is crucial for maintaining the patient's quality of life and functional abilities.

For patients who have already lost teeth, considering dental implants or fixed dentures to restore functional capabilities should be explored. The required oral care methods will vary depending on the stage of dementia. In the early stages of mild cognitive impairment, general dental check-ups and regular cleanings, along with practicing proper brushing and flossing techniques, are essential.

Patients should be encouraged to maintain these habits independently, with the support of caregivers or family members. As dementia progresses, caregivers will need to assist with daily oral care. However, patients who cannot open their mouths or resist oral hygiene practices may require additional assistance, such as specialized oral wipes or assistive devices to safely open the mouth.

In patients using dentures, it is essential to clean not only the teeth but also the gums and tongue to maintain overall oral hygiene. The professor emphasizes that dental management for dementia patients is about more than just preventing gum disease and tooth loss. Proper oral care helps preserve the ability to chew and maintain nutrition, contributing to a patient's overall well-being and quality of life.

The misconception that "dementia treatment comes first, and dental care can wait" must be addressed. Starting regular dental check-ups and oral hygiene practices as soon as possible is the best approach for dementia patients.