With dental practices preparing to re-open, there is likely to be a huge backlog of patients who are going to have their dental appointments delayed and rescheduled over the coming weeks and months. It is now more important than ever to keep the public and our patients informed on how to maintain good oral hygiene.
Older patients
Older patients are especially vulnerable during this time, as many are required to strictly isolate themselves due to health problems. Access to dental services may take longer for this patient group due to the risk it poses to them. Oral health may not be a priority at this time, and some older patients may be struggling with some aspects of their routine. This article will cover the main oral health problems associated with older people and some of the advice you could provide to help reduce the chance of them occurring.
Dry mouth
It is common to experience dry mouth during periods of stress and anxiety, but this usually resolves itself without causing any other problems. However, for some individuals dry mouth can be a chronic condition which affects overall quality of life. A chronic dry mouth increases the risk of dental caries, reduces taste, makes swallowing more difficult and can cause bad breath. Dry mouth, also known as xerostomia, is one of the most common side-effects of medications. Older patients are more at risk of xerostomia; saliva production can reduce over time and they are more likely to be on multiple medications. Here are some tips on managing xerostomia and reducing the chance of resulting oral health problems:
- Take regular sips of water throughout the day. As far as possible, carry water with you when away from home.
- Use sugar-free chewing gum, which can help to stimulate the salivary glands.
- Use a fluoride toothpaste twice daily, using the spit-but-do-not-rinse technique.
- Consider using a fluoride mouthwash at a separate time to toothbrushing.
- Try to avoid adding extra salt or sugar to meals.
- Visit a dentist regularly.
- Reduce the frequency and amount of sugary food and drink consumption, and try to keep these foods to mealtimes where possible.
- Consider saliva replacement therapy such as sprays, lozenges, and mouth rinses.
Medical conditions
As a population, we are living for longer, which is great news. However, we are also living with chronic health conditions which can be impacted by our oral health. Evidence shows that poor oral health can worsen and even contribute to conditions such as diabetes, respiratory problems, stroke, heart disease and Alzheimer’s disease. This is particularly concerning for any patients who are already at risk of these conditions. The bacteria present in periodontal disease can travel through the bloodstream to other parts of the body, so managing periodontal disease with good toothbrushing, daily interdental cleaning and regular dental visits is essential.
Difficulties with brushing
Conditions such as rheumatoid arthritis can make effective toothbrushing very difficult. Electric toothbrushes require less wrist movement from the user. However, they are heavier than manual toothbrushes, so bear the patient’s needs in mind when you are making recommendations. Brushes can easily be adapted to make them easier to hold. For example, make a hole in a tennis ball and place the toothbrush handle inside this, or use putty from the surgery to mould around the brush – this can even be shaped to the patient’s hand. Interdental cleaning can also be difficult for patients, as floss and interdental brushes require good manual dexterity. If a patient cannot use these, consider recommending a water flosser or an air flosser as an alternative.
Respiratory problems and Covid-19
Evidence is building on Covid-19. We now know that it significantly affects the respiratory system and that those with existing medical conditions suffer much more. Older patients are more likely to have existing respiratory problems and may be less likely to fight off the condition. They therefore may require hospital treatment and assistance with breathing from a ventilator. Evidence already exists showing the link between poor oral health and aspiration pneumonia. This is because the bacteria in the mouth can be inhaled directly into the respiratory system. The bacteria can also travel through breathing tubes. If a patient is already struggling to breathe after contracting Covid-19, it would be acceptable to assume that lots of oral bacteria (including bacteria present on dentures) entering the respiratory system could only worsen this condition further. This highlights the importance of maintaining good plaque control at home regardless of whether a patient is unwell or not, as it has a much wider effect on our general health than many people realise.
Denture care
Dentures are a great replacement for missing teeth. However, if they are not cared for properly, they can cause problems such as oral thrush and denture stomatitis. Dentures must be cleaned thoroughly twice daily with a denture brush or a separate toothbrush using soap and water; toothpaste can be highly abrasive on acrylic and so should be avoided. A sterilising solution can be used, but it is important to follow the manufacturer’s instructions on how often and how long to soak dentures, as this can differ depending on the brand. Dentures should also be rinsed after eating to remove food debris. It is really important that dentures are removed at night to allow the tissues in the mouth time to breathe. Not removing a denture creates an ideal breeding ground for bacteria. Any natural remaining teeth should be cleaned twice daily with a fluoride toothpaste in the same way that we would usually recommend. If a patient is completely edentulous, they should still visit a dentist as regularly as recommended to check their dentures and soft tissues.
How do we provide oral health messages to older patients?
If patients are struggling to maintain their own oral health at home, they should try to get help where possible. Family members and carers can assist with brushing and flossing.
Conditions such as dementia may cause a patient to forget some of the advice that you provide. Consider providing the patient with some simple written instructions to take home.
Access to a dental practice can be incredibly difficult for some older people, especially those in residential settings. Visits to care homes to provide oral health advice can be hugely beneficial. This can be done as an individual if you are confident enough, or with other members of the dental team.
Written by Melanie Pomphrett MSc, RDH, PTLLS
