When Dementia Steals, and What We Can Still Give
- Tia the OHT
- Feb 21
- 4 min read
This week I saw a woman living with dementia for her first dental visit in about five years. When I arrived, she was sitting on her reclining couch wearing a sparkling coloured cap. I introduced myself gently and explained that I was there to check and clean her teeth. She studied my face for a few quiet seconds before nodding. Her movements were slow, her speech softer than expected, but she was cooperative and present in her own way.
As I began setting up my equipment, I noticed the walls around her were filled with artwork and photographs. Although the room itself was modest in size, it carried a fullness that told a story. Colour layered upon colour, framed canvases leaning against one another, small details of a creative life lived with intention. Even before she spoke about it, I could sense that art had once been central to who she was.
When I knelt down beside her to speak at eye level before we began treatment, I saw something bright in her expression. I asked whether she had been an artist. Her face shifted, almost imperceptibly, and she pointed toward one of the walls while describing her favourite pieces. Her words were sometimes unclear and I could not always tell if I understood her correctly, but I listened carefully and responded with warmth. I hoped she did not feel frustrated if I missed parts of what she was trying to say. In those moments, communication is less about perfect words and more about shared presence.
Clinically, there was significant plaque accumulation and visible gum inflammation, which is not uncommon when someone has not had professional care for several years. Daily oral hygiene often becomes inconsistent as dementia progresses. Dexterity changes. Sequencing becomes difficult. Sometimes even recognising a toothbrush requires prompting. I completed a thorough cleaning, carefully working around areas of inflammation, and applied fluoride varnish to strengthen the enamel and reduce the risk of decay. Throughout the appointment, I paused often to check whether she was comfortable. She assured me she was, and then, unexpectedly, she asked if I was alright, noticing that I was kneeling and leaning forward to treat her. That small gesture of concern felt deeply human. I smiled and told her I was perfectly fine and simply glad she was doing well.
When I finished, she touched her teeth lightly with her tongue and said, “Thank you so much. My teeth feel so good.” There are moments in clinical practice that stay with you, and this was one of them. For a brief second, I did not see a diagnosis. I saw a woman who still appreciated comfort, who still noticed others, who still responded to care.
Later that evening, I searched her name online and discovered she is a respected local artist. Just eight years ago there were interviews of her speaking fluently and passionately about her creative process. She looked vibrant and animated, immersed in her work. Seeing that contrast felt confronting. Dementia does not only alter memory; it gradually reshapes identity, language, confidence, and the visible expression of self. It can feel as though pieces of a person are quietly being taken away.
What many people do not realise is that oral health is increasingly recognised as part of this broader neurological story. Over the past decade, research has identified associations between active periodontal disease and an increased risk of cognitive decline, including Alzheimer’s disease. One of the key bacteria involved in advanced gum disease, Porphyromonas gingivalis, has been detected in the brain tissue of individuals with Alzheimer’s. Its toxic enzymes, known as gingipains, have also been identified in affected brains. Scientists propose that chronic gum infection creates persistent low grade systemic inflammation. When gums bleed, bacteria and inflammatory mediators can enter the bloodstream, contributing to an inflammatory environment that may influence the formation of amyloid beta plaques, a defining feature of Alzheimer’s disease. While gum disease is not considered a direct cause, it is increasingly viewed as a modifiable risk factor, which makes prevention deeply meaningful.
For individuals already living with dementia, oral health often declines rapidly without support. Brushing may be rushed or forgotten, discomfort may go unreported, and attending a traditional dental clinic can feel overwhelming or logistically impossible. Untreated gum disease can lead to pain, infection, difficulty eating, and further systemic inflammation. At this stage, oral care is not about aesthetics. It is about preserving comfort, maintaining nutrition, reducing inflammatory burden, and upholding dignity. It is about ensuring that a person, regardless of cognitive decline, does not quietly suffer from preventable oral disease.
Families sometimes ask whether continuing dental care is necessary once dementia has progressed. I understand the question. It can feel as though so much has already been lost. But I believe it still matters. We cannot restore memory, but we can reduce pain. We cannot reverse the disease, but we can lower inflammatory stress in the body. We cannot return someone to who they were eight years ago, but we can offer an hour of calm, focused care that affirms their humanity.
As I reflect on that visit, I am reminded how small acts in healthcare are often not small at all. Kneeling beside someone’s couch, cleaning their teeth thoroughly, speaking gently at eye level, these are practical skills, but they are also relational ones. They are ways of saying, you still matter. Your comfort still matters. Your identity is not erased simply because your memory is changing.
For families in Wellington with loved ones living in rest homes or receiving care at home, preventive oral care remains an essential part of whole body health. Active gum inflammation is not just a local issue; it contributes to systemic inflammation that affects overall wellbeing. Regular professional hygiene, even in later stages of life, can reduce discomfort, minimise infection risk, and preserve a sense of freshness and dignity.
Even when dementia steals many things, comfort can still be protected. Presence can still be offered. And sometimes, in a quiet room filled with artwork, that feels like enough.
References and Further Reading
Dominy, S.S. et al. Presence of Porphyromonas gingivalis in Alzheimer’s disease brains and evidence for disease causation. Science Advances, 2019.
Kamer, A.R. et al. Periodontal disease and risk of Alzheimer’s disease and mild cognitive impairment. Journal of Alzheimer’s Disease, 2008.
Noble, J.M. et al. Periodontitis is associated with cognitive impairment among older adults. Neurology, 2009.
National Institute on Aging. Inflammation and Alzheimer’s disease overview.
And a great podcast episode about preventing cognitive decline:
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