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O paciente de Alzheimer e o seu tratamento no consultório dentário
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Abstract(s)
A população portuguesa, à semelhança da restante Europa, tem vindo a registar um envelhecimento progressivo, reflexo direto dos avanços médicos, tecnológicos e da melhoria das condições de vida. Contudo, esta conquista demográfica trouxe consigo um aumento da prevalência de doenças crónicas e degenerativas. Entre elas a doença de Alzheimer distingue-se pelo seu impacto social, mas também pelo impacto na saúde global, nomeadamente na saúde oral.
A doença de Alzheimer caracteriza-se por um processo neurodegenerativo progressivo, marcado pela deterioração das funções cognitivas, motoras e comportamentais. Estes comprometimentos refletem-se de forma direta na autonomia do paciente e na sua capacidade de manter hábitos básicos de autocuidado, incluindo a higiene oral. A acumulação de placa bacteriana, o risco acrescido de cáries e de doença periodontal, bem como as dificuldades na adaptação e higienização de próteses, são problemas frequentes.
Paralelamente, sintomas neuropsiquiátricos como apatia, depressão, agressividade ou psicose complicam ainda mais a adesão aos cuidados. Neste cenário, o papel dos cuidadores é determinante, assumindo funções de apoio diário, supervisão da higiene oral e articulação com os profissionais de saúde.
O objetivo através desta revisão narrativa é de responder à pergunta seguinte: de que forma pode garantir uma abordagem clínica adequada e a preservação da saúde oral em doentes com doença de Alzheimer, tendo em conta as limitações impostas pela patologia?
Depois de descrever as características clínicas da doença de Alzheimer, abordaremos as suas repercussões na saúde oral, bem como as suas manifestações cognitivas, comportamentais e psicológicas. Serão também abordadas as dificuldades terapêuticas encontradas durante o tratamento num consultório dentário. Por fim, serão propostas estratégias de adaptação dos cuidados às diferentes fases da doença no contexto da medicina dentária.
The Portuguese population, similarly, to the rest of Europe, has been experiencing progressive ageing, a direct consequence of medical and technological advances as well as improvements in living conditions. In 2023, life expectancy at birth in Portugal reached 82.4 years, a figure significantly higher than that observed a few decades ago. However, this demographic achievement has also led to an increase in the prevalence of chronic and degenerative diseases, among which Alzheimer’s disease stands out due to its incidence and social impact. Alzheimer’s disease is characterised by a progressive neurodegenerative process, marked by the deterioration of cognitive, motor, and behavioural functions. These impairments have a direct effect on the patient’s autonomy and on their ability to maintain basic selfcare habits, including oral hygiene. The accumulation of dental plaque, an increased risk of caries and periodontal disease, as well as difficulties in adapting to and cleaning dental prostheses, are frequent problems. At the same time, neuropsychiatric symptoms such as apathy, depression, aggression, or psychosis further complicate adherence to care. In this context, the role of caregivers becomes crucial, as they are responsible not only for providing daily support but also for supervising oral hygiene and coordinating care with health professionals. The objective of this narrative review is to address the following question: in what way can an adequate clinical approach and the preservation of oral health in patients with Alzheimer’s disease be ensured, given the limitations imposed by the pathology? After describing the clinical features of Alzheimer’s disease, we will explore its repercussions on oral health, as well as its cognitive, behavioural, and psychological manifestations. We will also discuss the therapeutic challenges encountered during treatment in dental practice. Finally, strategies for adapting care to the different stages of the disease within the field of dentistry will be proposed.
La population portugaise connaît un processus de vieillissement progressif, reflet direct des avancées médicales et de l’amélioration des conditions de vie. Toutefois, cette évolution démographique s’accompagne d’une augmentation de la prévalence des maladies chroniques et dégénératives, parmi lesquelles la maladie d’Alzheimer occupe une place importante en raison de son incidence et de son impact social. La maladie d’Alzheimer se caractérise par un processus neurodégénératif progressif, entraînant une détérioration graduelle des fonctions cognitives, motrices et comportementales. Ces altérations ont des répercussions directes sur l’autonomie des patients et sur leur capacité à maintenir des habitudes élémentaires d’autosoins, notamment en matière d’hygiène bucco-dentaire. L’accumulation de plaque bactérienne, le risque accru de caries et de maladies parodontales, ainsi que les difficultés liées à l’adaptation et à l’entretien des prothèses dentaires, constituent des complications fréquentes. L’apparition de symptômes neuropsychiatriques tels que l’apathie, la dépression, l’agressivité ou la psychose complique encore l’adhésion aux soins et rend la gestion clinique plus difficile. Dans ce contexte, le rôle des aidants devient essentiel : ils assurent un accompagnement quotidien, supervisent l’hygiène bucco-dentaire et coordonnent les soins avec les professionnels de santé. L’objectif de cette revue narrative est de répondre à la question suivante : de quelle manière est-il possible de garantir une approche clinique adaptée et la préservation de la santé bucco-dentaire chez les patients atteints de la maladie d’Alzheimer, compte tenu des limitations imposées par cette pathologie ? Après avoir décrit les caractéristiques cliniques de la maladie d’Alzheimer, nous analyserons ses répercussions sur la santé bucco-dentaire, ainsi que ses manifestations cognitives, comportementales et psychologiques. Nous présenterons également les difficultés thérapeutiques rencontrées lors du traitement en cabinet dentaire. Enfin, des stratégies d’adaptation des soins aux différents stades de la maladie dans le contexte de la médecine dentaire seront proposées.
The Portuguese population, similarly, to the rest of Europe, has been experiencing progressive ageing, a direct consequence of medical and technological advances as well as improvements in living conditions. In 2023, life expectancy at birth in Portugal reached 82.4 years, a figure significantly higher than that observed a few decades ago. However, this demographic achievement has also led to an increase in the prevalence of chronic and degenerative diseases, among which Alzheimer’s disease stands out due to its incidence and social impact. Alzheimer’s disease is characterised by a progressive neurodegenerative process, marked by the deterioration of cognitive, motor, and behavioural functions. These impairments have a direct effect on the patient’s autonomy and on their ability to maintain basic selfcare habits, including oral hygiene. The accumulation of dental plaque, an increased risk of caries and periodontal disease, as well as difficulties in adapting to and cleaning dental prostheses, are frequent problems. At the same time, neuropsychiatric symptoms such as apathy, depression, aggression, or psychosis further complicate adherence to care. In this context, the role of caregivers becomes crucial, as they are responsible not only for providing daily support but also for supervising oral hygiene and coordinating care with health professionals. The objective of this narrative review is to address the following question: in what way can an adequate clinical approach and the preservation of oral health in patients with Alzheimer’s disease be ensured, given the limitations imposed by the pathology? After describing the clinical features of Alzheimer’s disease, we will explore its repercussions on oral health, as well as its cognitive, behavioural, and psychological manifestations. We will also discuss the therapeutic challenges encountered during treatment in dental practice. Finally, strategies for adapting care to the different stages of the disease within the field of dentistry will be proposed.
La population portugaise connaît un processus de vieillissement progressif, reflet direct des avancées médicales et de l’amélioration des conditions de vie. Toutefois, cette évolution démographique s’accompagne d’une augmentation de la prévalence des maladies chroniques et dégénératives, parmi lesquelles la maladie d’Alzheimer occupe une place importante en raison de son incidence et de son impact social. La maladie d’Alzheimer se caractérise par un processus neurodégénératif progressif, entraînant une détérioration graduelle des fonctions cognitives, motrices et comportementales. Ces altérations ont des répercussions directes sur l’autonomie des patients et sur leur capacité à maintenir des habitudes élémentaires d’autosoins, notamment en matière d’hygiène bucco-dentaire. L’accumulation de plaque bactérienne, le risque accru de caries et de maladies parodontales, ainsi que les difficultés liées à l’adaptation et à l’entretien des prothèses dentaires, constituent des complications fréquentes. L’apparition de symptômes neuropsychiatriques tels que l’apathie, la dépression, l’agressivité ou la psychose complique encore l’adhésion aux soins et rend la gestion clinique plus difficile. Dans ce contexte, le rôle des aidants devient essentiel : ils assurent un accompagnement quotidien, supervisent l’hygiène bucco-dentaire et coordonnent les soins avec les professionnels de santé. L’objectif de cette revue narrative est de répondre à la question suivante : de quelle manière est-il possible de garantir une approche clinique adaptée et la préservation de la santé bucco-dentaire chez les patients atteints de la maladie d’Alzheimer, compte tenu des limitations imposées par cette pathologie ? Après avoir décrit les caractéristiques cliniques de la maladie d’Alzheimer, nous analyserons ses répercussions sur la santé bucco-dentaire, ainsi que ses manifestations cognitives, comportementales et psychologiques. Nous présenterons également les difficultés thérapeutiques rencontrées lors du traitement en cabinet dentaire. Enfin, des stratégies d’adaptation des soins aux différents stades de la maladie dans le contexte de la médecine dentaire seront proposées.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Doença de Alzheimer Psicologia Odontologia geriátrica Cuidados dentários