How Alzheimer's medications impact oral health

As the prevalence of Alzheimer’s disease rises,¹ dental hygienists are increasingly likely to care for patients affected by its cognitive and behavioral symptoms. Those with the disease are often prescribed a variety of medications to help manage memory loss, mood disturbances, and disease progression.

While these drugs can provide therapeutic benefits, they also carry oral side effects that may compromise a patient’s comfort, function, and overall oral health. That’s where tools such as the MedAssent DDS Digital Drug Handbook come in handy, making it easy to understand complex medications and quickly apply the info to patient care.

For dental hygienists, understanding how Alzheimer’s medications impact the oral environment is critical to providing safe, effective, and compassionate care. We’ll explore the most common classes of Alzheimer’s medications, outline their oral health implications, and offer practical guidance for adapting care to support this growing and vulnerable population.

Understanding Alzheimer's medications

Alzheimer's disease is managed with a variety of medications aimed at slowing cognitive decline and managing behavioral symptoms.² Here are the most common classes:

• Cholinesterase inhibitors such as donepezil, rivastigmine, benzgalantamine, and galantamine are commonly prescribed in the early to moderate stages of Alzheimer’s.³ These meds work by increasing levels of acetylcholine, a neurotransmitter that supports memory, attention, and other cognitive functions.
• Monoclonal antibodies such as lecanemab and donanemab are FDA-approved for early-stage Alzheimer’s or mild cognitive impairment. These drugs target beta-amyloid plaques in the brain and have been shown to slow cognitive decline in some patients.
• Memantine, an NMDA receptor antagonist, is typically used in moderate to severe stages of Alzheimer’s. It helps regulate the activity of glutamate, another important neurotransmitter involved in learning and memory, preventing overstimulation that can lead to neuronal damage.⁴
• Antipsychotics and antidepressants are often prescribed off-label to manage behavioral symptoms such as aggression, agitation, and depression.⁵ Common antidepressants used alongside Alzheimer’s medications include citalopram, sertraline, mirtazapine, and trazodone. Antipsychotics are prescribed with more caution due to potential side effects, but drugs like quetiapine, risperidone, and olanzapine may be used to help manage more severe behavioral symptoms.⁶

Each of these medications carries potential side effects that can directly or indirectly influence oral health.

Direct oral health effects of Alzheimer's medications

1. Xerostomia (dry mouth): Xerostomia is one of the most frequent oral side effects seen in patients taking Alzheimer’s-related medications.⁷ When saliva production is reduced, the oral environment becomes more acidic and less protected, leading to an increased risk of dental caries, particularly root caries, as well as periodontal disease. Patients may also experience oral candidiasis (thrush), and difficulty chewing, swallowing, and speaking, all of which can impact nutrition and quality of life.

Medications associated with dry mouth include:⁸

• NMDA receptor antagonist: memantine⁹
• Antidepressants: citalopram, sertraline, trazodone,¹⁰ mirtazapine¹¹
• Antipsychotics: risperidone, quetiapine, olanzapine¹²

2. Sialorrhea (excessive salivation): Although dry mouth is more common in patients with Alzheimer’s, some may experience the opposite effect—sialorrhea, or excessive salivation. This can present as drooling, frequent swallowing, or difficulty managing oral secretions. Sialorrhea may lead to social discomfort, skin irritation, and challenges with speech or denture retention. In some cases, excessive moisture in the oral cavity may also increase the risk of aspiration or fungal infections.

Medications associated with sialorrhea include:¹³

• Cholinesterase inhibitors: rivastigmine, donepezil, galantamine, benzgalantamine

3. Bruxism and involuntary movements: Some medications used in Alzheimer’s care can cause extrapyramidal side effects such as bruxism, jaw clenching, and dystonia. These involuntary movements can result in tooth wear, enamel erosion, fractured restorations, TMJ disorders, and myofascial pain. These symptoms may make eating, speaking, and even routine dental care more difficult for patients, especially as their cognitive or physical function declines. It is important to speak with the supervising dentist about evaluating the patient for a nightguard in these cases.

Medications associated with bruxism and involuntary movements include:¹⁴

• Cholinesterase inhibitors: rivastigmine¹⁵
• Antidepressants: trazodone, sertraline, citalopram
• Antipsychotics: risperidone,¹⁶ quetiapine, olanzapine¹²

4. Taste alterations (dysgeusia, hypogeusia): Altered taste perception can significantly affect appetite and oral health. Patients may report metallic or bitter tastes, a diminished ability to taste food, or changes in food preferences—often leading to a higher intake of sugary or soft foods. This shift can increase the risk for decay and make oral hygiene less of a priority for some patients, especially if eating becomes less enjoyable or satisfying.

Medications associated with taste alterations include:

• Antidepressants: citalopram,¹⁷ mirtazapine,¹¹ trazodone¹⁸

Indirect oral health impacts

Cognitive decline, along with medication-related side effects such as confusion, drowsiness, extrapyramidal symptoms, or sedation, often leads to a reduced ability to perform daily oral hygiene.¹⁹ As Alzheimer’s progresses, patients may forget to brush and floss, brush inadequately, resist caregiver assistance, or neglect proper denture care.

In addition, many individuals with Alzheimer’s shift toward diets that consist of soft, sugary, or processed foods that are easier to chew and swallow. These changes, especially when combined with dry mouth, significantly increase the risk for dental caries.²⁰

Complicating matters further, many older adults with Alzheimer’s are also managing multiple chronic health conditions, resulting in polypharmacy, or the use of numerous medications concurrently.²¹ The combined effects of numerous medications can worsen dry mouth, contribute to gingival overgrowth, and increase the likelihood of oral bleeding, all of which present additional challenges to maintaining oral health.

Clinical implications for dental hygienists

Dental hygienists are on the front lines of identifying and managing oral health issues in patients with Alzheimer's. Key strategies to support these patients. include:

Managing dry mouth and preventing caries

Dental hygienists play a key role in identifying and addressing dry mouth and caries risk in patients with Alzheimer’s. When dry mouth is present, hygienists can suggest frequent sips of water throughout the day, or over-the-counter options such as sugar-free lozenges or gum to help stimulate saliva. Discussing the use of a humidifier in dry environments may also be helpful. Inform patients and caregivers about the potential drying effects of alcohol-based mouth rinses and recommend gentler alternatives when appropriate.

To support caries prevention, hygienists can apply topical fluoride varnish during routine hygiene visits and educate patients or caregivers about the benefits of using high-fluoride toothpaste, if deemed appropriate by the supervising dentist. Recommending a toothbrush with an enlarged or ergonomic handle can also make brushing easier for patients with reduced dexterity, helping them maintain better oral hygiene between visits.

Partnering with caregivers and reviewing medications

Caregivers are often deeply involved in the daily care of those with Alzheimer’s and play a vital role in sharing accurate medical histories during dental appointments. Dental hygienists should routinely review and update each patient’s medication list and remain attentive to any recent changes in prescriptions or dosages.

In many cases, caregivers are the ones providing this information and completing forms, making it essential to engage with them directly. Open communication with caregivers and the broader health-care team helps the hygienist better understand the purpose of each medication and remain aware of potential oral side effects that could impact care.

Hygienists can also support caregivers by offering written and visual instructions for at-home oral care, encouraging them to assist with brushing, flossing, and denture hygiene. Caregivers should also be guided to watch for signs of oral discomfort or infection and be reminded of the importance of maintaining regular dental visits. This collaborative approach enhances the continuity and quality of oral health care for patients living with Alzheimer’s.

Conclusion

Caring for patients with Alzheimer’s demands more than clinical skill—it requires compassion, collaboration, and a clear understanding of how medications intersect with oral health. By staying informed about the side effects of commonly prescribed drugs, dental hygienists can better anticipate and manage complications such as xerostomia, bruxism, or taste changes, ultimately improving patient outcomes.

Partnering closely with caregivers, reviewing medication lists at each visit, and using tools such as the MedAssent DDS Digital Drug Handbook can empower hygienists to deliver safe, responsive care. In a world where Alzheimer’s disease is becoming more common, hygienists’ knowledge has never been more essential to protect quality of life, one patient at a time.

References

1. Older people projected to outnumber children. U.S. Department of Commerce U.S. Census Bureau. March 13, 2018. Accessed February 4, 2025. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
2. How Is Alzheimer's Disease Treated? National Institute on Aging. Updated September 12, 2023. Accessed March 28, 2025. https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated
3. Singh R, Sadiq NM. Cholinesterase inhibitors. Updated July 17, 2023. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK544336/
4. Jewett BE, Thapa B. Physiology, NMDA receptor. Updated December 11, 2022. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519495/
5. Antipsychotic Drugs. Alzheimer's Society. July 2021. Accessed March 28, 2025. https://www.alzheimers.org.uk/about-dementia/treatments/dementia-medication/antipsychotic-drugs
6. Ohno Y, Kunisawa N, Shimizu S. Antipsychotic treatment of behavioral and psychological symptoms of dementia (BPSD): management of extrapyramidal side effects. Front Pharmacol. 2019;10:1045. Sepember 17, 2019. doi:10.3389/fphar.2019.01045
7. Xerostomia (dry mouth). American Dental Association. Accessed March 28, 2025. https://www.ada.org/resources/ada-library/oral-health-topics/xerostomia
8. Dry mouth: are your medications to blame? GoodRx Health. Accessed March 28, 2025. https://www.goodrx.com/drugs/side-effects/dry-mouth-are-your-medications-to-blame#medications-at-fault
9. Gil-Montoya JA, Barrios R, Sánchez-Lara I, et al. Prevalence of drug-induced xerostomia in older adults with cognitive impairment or dementia: an observational Study. Drugs Aging. 2016;33(8):611-618. doi:10.1007/s40266-016-0386-x
10. Trazodone hydrochloride tablet. DailyMed. Updated February 20, 2024. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed3039d8-3d27-4b71-a4b0-812943c9457f
11. Mirtazapine tablet, film coated. DailyMed. Updated September 26, 2024. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9675333e-3064-c8cb-a4b4-6c74d9a82f17
12. Olanzapine tablet. DailyMed. Updated October 31, 2022. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e8626e68-088d-47ff-bf06-489a778815aa
13. Drug-induced sialorrhoea and excessive saliva accumulation. Prescrire Int. 2009;18(101):119-121.
14. de Baat C, Verhoeff MC, Ahlberg J, et al. Medications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism. J Oral Rehabil. 2021;48(3):343-354. doi:10.1111/joor.13061
15. Rivastigmine tartrate capsule. DailyMed. Updated February 19, 2018. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3d257f22-b504-4707-9b29-5ce9032667ca
16. Risperidone tablet, coated. DailyMed. Updated May 31, 2010. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c0c3eeb6-8a75-0b20-2008-396e63cddcdb
17. Citalopram capsule. DailyMed. Updated August 24, 2023. Accessed March 28, 2025. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2f815b0c-6da7-cb61-e89c-7de628092d0d
18. Tekdemir R, Kandeğer A. A case of trazodone induced prolonged hypogeusia. Eur Psychiatry. 2022;65(9):S719-S720. doi:10.1192/j.eurpsy.2022.1856
19. Shirobe M, Edahiro A, Motokawa K, et al. Association between dementia severity and oral hygiene management issues in older adults with Alzheimer's disease: a cross-sectional study. Int J Environ Res Public Health. 2023;20(5):3841. doi:10.3390/ijerph20053841
20. Gao SS, Chu CH, Young FYF. Oral health and care for elderly people with Alzheimer's disease. Int J Environ Res Public Health. 2020;17(16):5713. doi:10.3390/ijerph17165713
21. Nakamura J, Kitagaki K, Ueda Y, et al. Impact of polypharmacy on oral health status in elderly patients admitted to the recovery and rehabilitation ward. Geriatr Gerontol Int. 2021;21(1):66-70. doi:10.1111/ggi.14104