Good oral care and hygiene is important throughout our lives, but even more so as we age. Reduced independence can mean that maintaining a thorough and consistent approach to oral hygiene can then lead to dental problems in the elderly. If you are a family carer, the importance of oral care in the elderly is something you need to be aware of and take the time to support your loved one to maintain optimum home dental care and prevent decay in the future.
According to a study commissioned by the Royal College of Surgeons in 2017 there are at least 1.8 million people aged 65 and over who could have an urgent dental condition such as dental pain, oral sepsis or extensive decay in untreated teeth. They predict that by 2040, this number could increase by more than 50%.
The importance of good oral care
Poor oral health care can lead to difficulties in eating, and absorbing medications properly. There are also known links between poor oral health care and pneumonia and heart disease. Getting oral health care right is a key part of supporting older people’s health, well-being and dignity.
Barriers to good oral care
Dental health problems in old age are more common for people who have mobility or frailty concerns which impacts there independence, or for those who are living with a condition like dementia or Parkinson’s as their ability to maintain a healthy and consistent oral care routine without support is impacted. When people are living with existing health conditions, it is not always easy to identify a potential oral health problem.
Whilst it is important to have good home dental care, when there is a problem, an older person is likely to have further barriers to seeking the treatment they need.
According to a study conducted by BMC Oral Care, there are five main barriers that impact an elderly person seeking and accessing dental care; cost, fear of treatment, availability of dental care services, accessing these services and lack of perception in needing dental care.
Risks of poor oral health
There are several risks caused from poor oral health and dental problems in old age:
One of the most significant problems of having an oral health concern is that it impacts your ability to eat and drink, which in turn can lead to malnutrition if untreated. This then presents further health consequences, including increasing frailty and recovery time from other illnesses. Malnutrition is prevalent in older people, with a third of older people being admitted to hospital who are at risk of being malnourished.
Oral health problems in elderly include oral cancer and other mucosal diseases. Whilst oral cancer is not specifically caused from poor home dental care, regular dental check ups are vital as we age to ensure early detection and diagnosis. 90% of oral cancers recorded are in those over 50 years old. It is therefore important that you ensure your loved one has regular check ups as guided by your dentist.
There are some studies that have linked poor oral health to aspiration pneumonia. This is more common if someone is living in a residential care setting or is in hospital for a prolonged period of time. Dental plaque can be colonised by types of bacteria that cause pneumonia, which are then subsequently inhaled, potentially causing pneumonia.
Common dental problems in old age
There are several oral health problems in elderly, that can impact their overall health and well-being, which may be avoided with a good oral health routine and regular check-ups:
Tooth decay is one of the most common dental problems in elderly and can cause pain, infection and even tooth loss. Tooth decay is caused by a build-up of plaque and tartar. A sugary diet and a decrease in saliva production as we age contribute to the build up of sugar acid in the mouth. Conditions that elderly people may be living with impact tooth decay, for example arthritis and dementia which make regular tooth brushing either painful or difficult. Tooth decay stresses the importance of oral care in elderly and brushing twice a day with a fluoride toothpaste, preferably with an electronic toothbrush, as well as reducing the intake of sugary foods.
As we age, many people will experience a decrease in saliva production. This is commonly known as dry mouth or xerostomia. Many medications that an older person may be required to take can cause dry mouth. A dry mouth means that sugar and acids build up in the mouth more easily, resulting in tooth decay, receding gums or gum disease. It can also cause sore, dry and cracked lips or a swollen tongue, which makes it difficult to swallow and can impact speech. It is important that you drink water frequently, avoid sugar where possible and try to increase saliva production, for example by chewing gum, sucking a sugar-free lozenge or sweet and by using a mouth rinse regularly.
Receding gums / root decay
Receding gums is a process that occurs overtime, whereby the gums shrink away from the teeth. Good home dental care is important to delay this process, however there are other contributing factors including family history, bruxism (teeth grinding), smoking and drinking.
When the root becomes exposed there is a chance it will decay, which can lead to unavoidable tooth loss. Regular visits to the dentist for cleaning and scaling can significantly improve the outcome and stabilise gum recession.
Periodontal disease, or gum disease as it is more commonly known is caused by bacteria in plaque and tartar that builds up over time. It is easy to detect as it causes the gums to become very irritated, red and in many cases causes bleeding of the gums. Dental problems in old age include gingivitis which is another form of periodontal disease. Gingivitis occurs when bacteria builds up where the gum tissue and tooth meet, which can infect the bone that supports the tooth. If an older person’s ability to chew and swallow is impaired, or they have poor diet and nutrition this can exacerbate gum disease. Regular flossing in between the gums and teeth can significantly reduce the occurrence of periodontal disease.
In addition to the physical oral health problems in the elderly, dental problems in old age can significantly impact a person’s overall well-being. Pain and discomfort can lead to mood and behaviour changes, particularly for people who cannot communicate what they are experiencing and how they feel, for example those who are living with dementia. Speech problems, reduced ability to smile and to communicate freely can impact a persons’ self-esteem. These issues can lead to reduced self-confidence, and for some this may increase social isolation.
How to maintain good oral hygiene
Essential to good oral health and hygiene is ensuring a regular brushing and flossing routine. Whether you are cared for by a family member or have a live-in care service, one key component of your care and support should be your oral health plan.
Top tips to avoiding dental problems in old age
- Brush at least twice a day with a toothpaste that contains fluoride
- Floss at least once a day, more if possible
- Use an electronic toothbrush as this can reach further and supports good gum health. Older people should use a soft or medium brush
- Rinse your mouth with an antiseptic mouthwash once or twice a day, to reduce bacteria and a dry mouth
- Visit your dentist regularly for check ups
- Ensure you have regular appointments with your hygienist for a scale and polish to prevent plaque build up and reduce the occurrence of gum disease
- Replace your toothbrush or toothbrush head regularly
Facilitating good oral care
If you are caring for a loved one who is unable to live independently, then it is important that you facilitate them to have a good oral health routine and positively stress the importance of oral care in the elderly, so they understand why they need to follow the routine.
Providing support and monitoring is critical to ensuring they keep on track. Create a routine that that fits in with their day and is easy to achieve. If they can complete their cleaning routine independently it is still prudent to monitor how they do this to ensure it is being done well, but also to regularly check their mouth for any ulcers, sores or changes in its health. It is important to be positive and encouraging, particular if you are caring for someone living with dementia as they may be resistant to the routine, and/or your support.
Take on the responsibility to schedule all their dentist appointments. This can be done on a yearly basis for convenience and reassurance.
Caring for your dentures
For those without any natural teeth, having a comfortable set of dentures is also extremely important for general well-being and quality of life. However, if dentures are lost or broken this causes significant problems. It can often take several weeks to access a dentist and have a new set of dentures made, a process which usually involves multiple appointments.
It is important therefore in home dental care to look after your dentures and there a few steps you can take to keep them in good shape and maintain good oral hygiene:
- Remove and rinse dentures after eating
- Clean you mouth and palate after removing dentures
- Handle dentures with care
- Clean and brush your dentures at least once a day, more if possible
- Soak dentures overnight following manufacturer’s instructions on which cleaning/soaking products to use
- Rinse your dentures before you put them back in your mouth if you are using a soaking solution to protect your mouth
- Consult your dentist if they become loose of the fit is no longer snug
- Schedule regular dental check-ups
The importance of diet in maintaining oral health
What you eat and drink at any age can have an impact on your overall health and well-being. It also contributes to how good your oral health is as well. The two substances that can cause potential damage to your teeth are sugar and acid.Foods that are rich in sugar react with the bacteria in the plaque on your teeth and produces harmful acids, which can ultimately lead to tooth decay. Acid in food and drink erodes the enamel that protects your teeth, making your teeth sensitive and can cause them to change colour and become unsightly. A contributing factor of periodontal disease is the level of sugar and acid in the diet.
Any sugar can cause tooth decay and damage teeth, the most common being sucrose, fructose and glucose. Processed foods can also contain a high amount of sugar and is not always correctly defined on food labelling – some processed foods state minimum sugar but the sugar content is contained in the carbohydrates.
Acidic drinks can cause tooth erosion. Look out for the PH number – anything lower than 5 has a high acidic content and should be avoided. Fizzy drinks that state they have no added sugar may contain sweeteners that are harmful to teeth. Snacks, including savoury snacks can also include lots of sugar.
To avoid dental problems in old age, maintain a healthy and nutritious diet – eat lots of fruit and vegetables (even as snacks in between meals), consume water or a diluted sugar-free fruit drink as an alternative. Avoid fizzy drinks and processed foods.
Chewing gum is good for oral health. Chewing a sugar-free gum after eating helps produce saliva which then prevents dry mouth syndrome in older people, and some studies suggest can prevent tooth decay.
Oral care in the elderly – useful resources
NHS – provides useful hints and tips on how to take care of your teeth and gums
The Oral Health Foundation – provides a wealth of information and news about how to look after your oral health and supports the National Smile Month, a campaign aimed at creating awareness about health issues that impact oral health.
Public Health England – provides a useful information sheet on how to look after your teeth and gums to avoid the consequences of poor oral health.
Relish (formerly Active Minds), provides a range of interesting products for stimulating activities for those living with dementia.
Meaningful activities for older adults provide advice and guidance on activities that older people would find purposeful.