Oral Care Strategies for Older Adults
This article was originally published on agingcare.com by Carol Bradley Bursack.
Most of us find, as years go by, that our teeth become more of an issue. A cracked tooth here, a root canal there, we start to worry about eventually needing dentures like our parents or grandparents did. What many of us don't consider is that, as we age, there's more to periodontal disease than the threat of tooth decay.
The American Dental Association (ADA) says that losing our teeth with age is not inevitable. Good dental care can help us keep our original teeth for life. However, they do call attention to the increasing dangers of periodontal disease.
According to the Centers for Disease Control and Prevention (CDC) over 47 percent of the U.S. adult population aged 30 years and older have mild, moderate or severe periodontitis with nearly two-thirds (64%) of adults over age 65 having moderate to severe forms of periodontal disease.
Because many of us are caring for elders with oral health problems at the same time that we worry about the future of our own teeth, I asked Dr. Jean-Max Jean-Pierre, a board-certified periodontist in Hendersonville, Tennessee, to educate us with a brief Q and A:
Q: Could you please give us an overview of why oral care matters so much as we age? Many of us are worried about serious issues such as brain health.
A: Oral health was once a priority mainly for those entering the golden years, but current research is making strong connections between poor oral health and impaired health overall. Oral and general wellness are closely connected because oral health can influence the onset, strength and persistence of many degenerative diseases.
Inflammation, for example, is one of the top five reasons many degenerative diseases worsen. These include heart disease, stroke, diabetes and neurological problems such as Alzheimer's. New research has found that gum disease, which results in chronic inflammation, may lead to more severe Alzheimer's later in life. Though oral disorders are not a direct cause of conditions such as Alzheimer's, researchers believe there is a strong association between gum disease and Alzheimer's risk.
Q: How about elders who have just a few teeth left? Should the stubs be pulled even if it's unrealistic to think dentures would be viable, considering their deteriorating overall health?
A: People who only have a few teeth left should maintain a regular dental cleaning schedule with their dentist or periodontist. These essential periodic cleanings should include a screening for new signs of periodontal infection and treatment, if necessary. If any remaining teeth have an active infection and the patient also faces deteriorating health, those teeth must be extracted.
Q: How do caregivers best clean the teeth of an elder who has gotten beyond caring or who is in such poor physical condition that any major attempt—such as surgery—to correct matters is beyond practicality?
A: The best way to help those who cannot brush on their own is to wipe the remaining teeth and gums with gauze dipped in prescription Peridex, an oral antiseptic that treats gum swelling, gingivitis and other oral issues such as periodontitis.
Q: How do you handle a situation where a caregiver brings in someone who has dementia but doesn't understand that you are trying to help? I had this issue with my dad. His dentures were next to useless because he'd had to have his teeth pulled when he was young and there was little bone left. Can you give us any tips about what to do to simply give someone like him the ability to enjoy eating?
A: Today, dentists and periodontists have updated options to help examine and treat elderly people. Computerized Tomography (CT) scanning equipment helps dental professionals determine the amount of bone available, and dental implants have become an established, predictable treatment option for replacing missing teeth. Still, many patients are reluctant to try implant treatments, especially if they require a bone augmentation procedure. For these patients, certain products reduce the invasiveness of the procedure as well as increase the speed of osseointegration, the structural and functional connection between bone and an artificial implant.
Q: Many people have elderly loved ones who fight over any medical procedures. What do you suggest for these people when it's obvious that their loved one needs vital oral attention? Would you go as far as sedating an elder in need?
A: I recommend sedating elderly patients to help doctors and hygienists provide the necessary care without upsetting the patient. There are also companies that offer mobile dental care units that can visit community homes or your house.
Q: Are there any further tips you'd like to add?
A: Caregivers should wear disposable gloves when helping the elderly with daily dental cleaning and care. Should you notice any wounds, sores, or abnormalities in the mouth, make an appointment with a dental professional to have it checked out. Talk to your dental care provider to find out which tools, such as special toothbrushes, are best for the patient. Single tuft brushes, interdental brushes, floss holders, or gauze may be appropriate, depending on the patient.
Additionally, a lot of people don't realize that preventive measures can be taken when it comes to dental health. As we age our bone health impacts many different aspects of life, including dental. I recommend my patients use Osteostrong or a similar product.
Dr. Jean-Max Jean-Pierre is a board-certified periodontist in Hendersonville, Tennessee where he has his PerioCareCenter . His passions are patient care, patient satisfaction, and patient education. Dr. Jean-Pierre utilizes the latest technology and treatment modalities to encourage better oral health as well as overall health. He is an active member of several professional and local organizations and currently serves as President of the Tennessee Society of Periodontists.