“Your mouth is a window into the health of your body.”
American Dental Association
Taking care of your oral health is more important than just preventing cavities or bad breath. As you age, it can be the difference between good health and bad health and your confidence in continuing to be socially engaged with others. Keep reading to find out why… and don’t forget to brush and floss your teeth today!
This past week when we were visiting with our senior clients at our weekly Stepping Out Social Activity in Westchester County, one of our most social and upbeat clients was uncharacteristically sullen and looking down at her clay project, rather than smiling and engaging with others across the table. I asked her how she was and she told me," I am uncomfortable and feel awkward today because I forgot to put in my upper dentures before we came and now I am embarrassed to smile."
Common Oral Health Problems for Seniors
Oral health is primarily determined by good nutrition, genetics, and general health and hygiene, and with age, these factors only become more important. Older Americans with the poorest oral health tend to be those who are financially disadvantaged and are members of racial and ethnic minorities. Being disabled, homebound, or living in a nursing home also increases the risk of poor oral health. And don't forget that many older Americans do not have dental insurance because they lost their benefits upon retirement and the federal Medicare program does not cover routine dental care. Options for dental insurance are limited and still can be expensive.
poor oral health in the elderly is caused by:
Dental caries (cavities). Cavities are caused by a breakdown of the tooth enamel by acids produced by bacteria located in plaque that collects on teeth, especially along the gumline and in the crevices on the chewing surfaces of the teeth. Although cavities are largely preventable, they are one of the most common chronic diseases throughout the lifespan. Untreated tooth decay can lead to abscess (a severe infection) under the gums which can spread to other parts of the body and have serious, and in rare cases fatal, results.
Gum disease. A high percentage of older adults have gum disease. About 2 in 3 (68%) adults aged 65 years or older have gum disease. About 4 in 10 adults aged 30 years or older have gum diseases, mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. If early forms of periodontal diseases are not treated, the bone that supports the teeth can be lost, and the gums can become infected.
Tooth loss. Remember being a child and losing your first teeth and proudly showing everyone and waiting for the prize from the tooth fairy under your pillow? Fast forward 70 years and for seniors, tooth loss comes with aging without the joy! If gum disease is present and has led to loss of bone, teeth with little bone support can become loose and may eventually have to be extracted.
Nearly 1 in 5 of adults aged 65 or older have lost all of their teeth. Complete tooth loss is twice as common among adults aged 75 and older (26%) compared with adults aged 65-74 (13%).
Tooth enamel is one of the hardest substances your body produces, but over a lifetime it does wear down and our teeth begin the process of breaking down. This process does not happen overnight, but if preventative steps are not taken it can very easily get to the point where saving the teeth is not an option.
Having missing teeth or wearing dentures can lead to poor nutrition as people without teeth or with dentures prefer soft, easily chewed foods instead of foods such as fresh fruits and vegetables. They also tend to eat the same foods over and over again knowing that there will be less discomfort, leading to deficiency in certain nutrients.
Chemotherapy is the use of drugs to treat cancer. While these drugs kill cancer cells, they may also harm normal cells, including cells in the mouth. Side effects include problems with your teeth and gums; the soft, moist lining of your mouth; and the glands that make saliva.
It is recommended that you visit your dentist before your chemotherapy begins to help prevent serious mouth problems. Side effects can occur because a person’s mouth is not healthy before the chemotherapy starts. Not all problems can be avoided, but the fewer side effects you have, the more likely you will be able to tolerate your cancer treatment.
Polypharmacy means taking many medications and is often a culprit for dry mouth. Many medications list dry mouth as a side effect (see recommendations below).
Chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) may lead to developing gum disease for many reasons above and below.
Disabilities may make it more difficult to physically care for your teeth. An example is arthritis in the fingers and/or hands can make it harder to brush or floss. Cognitive changes with dementia may make it difficult to remember to brush regularly or sometimes brush aggressively over and over again. For some, using an electric toothbrush may be enough to help. Others may need adaptive teeth cleaning equipment. They may need a tooth brush with a bigger handle if they cannot grip a standard toothbrush. They may need a device to help them hold their toothbrush (a holder or a rubber band).
Dry Mouth is reduced saliva flow which leads to food and bacteria attaching to the teeth and gums and increasing the risk of dental caries and gum disease. The American Dental Association recommends the following for those with dry mouth:
Sip on water or seltzer
Suck on ice chips
Use lip balm like Chapstick, Vaseline and Aquaphora
Chew on sugar-free gum and candy
Avoid salty, spicy, dry, or hard to chew foods
Avoid alcohol, tobacco, caffeine which are all irritants
Drink more fluids between and with meals
Use a humidifier at night
Brush and floss daily
Use a fluoridated tooth paste
So What Can We Do to protect
our oral health As we age?
- Brushing and Flossing
A key to good oral health is as simple as it sounds: brushing and flossing your teeth every single day. Older adults (and everyone for that matter!) should be brushing their teeth twice per day with a fluoridated toothpaste. Use a soft bristle brush and be sure to replace it often. In regards to Flossing, you can use traditional string floss or pre-threaded floss picks, water flossers (like a Waterpik Water Flosser*), or wooden plaque removers . The key is cleaning those hard-to-reach tight spots in between the teeth. Try some of these suggestions to alter a toothbrush to make brushing easier.
- Denture Care
Bacteria sticks to dentures the same exact same way they stick to natural teeth, leading to gum irritation, inflammation and sores.
Whether an older adult has full dentures or partial dentures, they should be removed every single day. Don’t just clean the dentures. Brush the gums, tongue, and roof of the mouth with a soft bristle tooth brush.
To clean the dentures, first rinse any obvious food particles. Then use a soft bristle toothbrush and a non-abrasive cleaner to clean the dentures. Brush the dentures thoroughly and rinse. Do this every single day.
Fluoride can help prevent cavities. Check to see if your community has fluoridated water, if not consider purchasing bottled water with fluoride. Keep in mind some water filters can remove fluoride.
- Quit Smoking or Switch to a Patch
Did you know that smoking is also bad for your dental health? Smoking can increase risk of cavities, gum disease, and losing teeth. It can also make it harder for any wounds in the mouth to heal .
- Good Nutrition and Chewing
Eating a healthy balanced diet can contribute to a healthy mouth. Getting good nutrients through a variety of wholesome food choices provides calcium, vitamin D, vitamin C and phosphorous, which are essential for healthy teeth and gums. The Catch 22 is that as we age, we can lose our taste of sense and smell, leading to unhealthy choices laden with sugar, fat and salt rather than fresh fruits and vegetables. Also as your teeth become damaged and there may be pain, you are more likely to avoid eating fresh fruit and vegetables and seek softer foods. Bottom line is ask them if they have trouble chewing.
See Your Dentist on a Regular Basis
The final, maybe even most important habit regarding dental health for seniors, is to see the dentist on a regular basis. At least annually for exams, preferably every 6 months or sooner for dental cleanings. Catching dental issues early can save you pain and money. There are new visiting dentist services available if you are homebound. As mentioned above, a major barrier to accessing dental care for seniors is lack of insurance. It’s estimated that half of older adults living independently haven’t seen a dentist in over a year. The primary reason for this is usually financial – not enough money.
The American Dental Association has a Find-a-Dentist tool that enables you to find dentists in Westchester County and Fairfield County and learn what insurance and payment options they take.
How is Poor Oral Hygiene Linked to Heart disease?
Studies show that poor oral health may be linked to heart disease. Poor oral hygiene causes an increase in the bacteria that infect the gums and cause gingivitis and periodontitis and can also travel to blood vessels elsewhere in the body. These same bacteria may cause blood vessel inflammation and damage; tiny blood clots, heart attack and stroke may follow t oral bacteria which can migrate to your blood stream and bring bacteria to other parts of your body. Supporting this idea is the finding traces of oral bacteria within atherosclerotic blood vessels away from the mouth. Another hypothesis leans toward the body's immune response to oral bacteria – inflammation - that sets off a cascade of vascular damage throughout the body, including the heart and brain.
Supporting Seniors in Getting
the Oral Health Care They Need
Offer to Assist with Oral Care
This includes daily brushing and flossing and ensuring they get regular dental checkups. As mentioned above, if the older adult you are caring for has physical or cognitive decline you can help them brush and floss on a daily basis. It can be by providing verbal cuing for those with cognitive decline. Or helping to modify their toothbrush so they can brush their own teeth. And then providing physical assistance as needed. The National Institute of Health has excellent information for caregivers on brushing and flossing for older adults.You can help to schedule dental appointments and arrange transportation to those visits as needed.
help find Insurance and Financial Assistance
Now that we know a lack of insurance or finances is one of the biggest barriers to dental care among older adults, let's help them find low-cost dental care. The National Institutes of Health has also created a resource for caregivers to help older adults in finding low-cost dental care. Another option is to seek Dental and dental hygiene clinics and community health centers that often offer low cost options.
As always, if you have any questions about caring for your senior loved one's health and dental care, please contact our Patient Care Manager at firstname.lastname@example.org.