One thing I have noted with sadness throughout my career is patients who once cared so well for their teeth undergoing a rapid deterioration in their dental state. Sadly staff in nursing homes do not seem to have training in assisting their residents with their oral hygiene and I have seen cases of patients with complex dental work whose mouths go completely unbrushed. I have also come across a case where staff said they did try and help a lady patient brush her teeth but she had dementia and would become very aggressive so they just weren’t able to.
The main reasons for rapid onset dental deterioration in the elderly are that in advanced old age many people have the following issues affecting their ability to maintain their oral health:
Failing eyesight This makes it harder to see whether they have brushed their teeth properly and harder to see to line up fiddly oral hygiene aids such as interdental brushes.
Reduced dexterity This also makes it more difficult to maintain a good standard of oral hygiene. There is a lack of suitable oral hygiene aids specifically designed for the elderly available. Problems in gripping a toothbrush handle can sometimes be overcome by strapping padding around the handle to make it larger and easier to grip. Using floss or interdental brushes may be very difficult.
Memory problems Failing memory may make it difficult to remember regular toothbrushing
Diet Nursing homes and day centres appear to feed the elderly in their care sugar laden cakes, biscuits and sugary tea.
Reduced salivary flow It seems that old age in itself can lead to a reduction in the quality and quantity of saliva, nature’s defence against tooth decay and gum disease. However, many elderly people are also on a cocktail of drugs for conditions such as heart disease and other chronic illness. Many medications have the side effect of reduced salivary flow.
Gum recession This exposes the root surface. The root is composed of dentine and dose not have the hard outer enamel coating that the crowns of the teeth have and is therefore more vulnerable to decay.
What you can do to help!
If you have elderly loved ones, here are some things you can do to help:
Check their oral hygiene plan Talk to the carers of your loved one and make sure there is an oral hygiene plan in place and that with or without help, the elderly person is able to maintain their oral hygiene
Check their diet If they live alone, talk to them about their diet, make sure they know they are more prone to dental disease and need to be extra careful to avoid sugar in their diet. Talk to carers about what food they are provided.
Liaise with the dentist With the permission of your loved one, liaise with their dentist. They may want to put a preventative plan in place, use fluoride varnish, prescribe a high fluoride toothpaste, and may advise more frequent check ups. They may also be able to advise on the realistic use of oral hygiene aids where eyesight and dexterity are failing