Basic Dental Health for Older Adults
Jerry D. Michel
School of Dentistry
Good oral hygiene and dental care is valuable to the health and well-being of older adults. Yet many older people have significant dental problems. Many of these problems could be removed or improved through simple care and through good routine care by a dentist who is competent in handling dental problems more typical in later life.
The purpose of this guide is to describe:
- The dental changes often evident in the older adult
- Methods of improving and maintaining good oral hygiene
- Denture care
- How to locate dental care for the older adult
- Why older adults may neglect care
Changes in teeth and supporting tissue
Tissues in your mouth, like other body tissues, change as you grow older. Soft tissues (gums and cheeks) lose their ability to stretch, and muscles become soft and weak. The amount of saliva produced by glands in your mouth is frequently reduced. As a result, chewing becomes more difficult, and your mouth becomes more easily irritated and heals more slowly than when you were younger. Other changes may occur.
The rate of tooth decay may be increasing as you grow older. This is especially true when the amount of saliva is reduced. Tooth decay in older adults appears most frequently around the teeth at the level of the gums. The root portion of a tooth, when exposed, is especially subject to decay. Gumline or root decay is difficult to restore with fillings, because decay often reoccurs around this type of filling soon after it is placed.
Evidence of periodontal disease is red or swollen gums that bleed with the slightest irritation. Pockets often develop between teeth and gums and can pack or trap food debris. This disease is generally found in varying degrees in older adults. If not treated, the disease becomes more and more destructive. In the elderly, periodontal disease is a primary cause for loss of teeth.
Brittleness and wear of teeth
Nerve tissue and blood vessels are found in the pulps of teeth. When you were young, these nerves were very responsive to pain or to anything hot or cold. As you have aged, the pulp gradually became smaller with fewer blood vessels and less nerve tissue supplying the teeth. As a result, your teeth have less fluid content and have become brittle. Your brittle teeth may be easily broken or chipped. Fortunately, due to the reduced nerve tissue, little if any pain is experienced when even severe fractures occur.
Teeth wear because of the grinding action of chewing. Tooth enamel becomes thinner. In severe cases, the hard enamel covering is completely worn away leaving a softer part of the tooth (dentin) exposed. Dentin can be dissolved by acidic oral fluids. Teeth with only a fragile enamel shell may result. These teeth are easily chipped or broken.
Tolerance to dentures
If you wear a complete or partial, removable denture, you want it to be comfortable and work well. Your satisfaction with dentures depends largely on the ability of the remaining ridges in your mouth to provide the necessary support.
After teeth are removed, the remaining bone (ridge) continuously shrinks to a smaller size. The gum tissue covering the ridge becomes thinner and is more easily irritated. The rigid, non-changing dentures become progressively less adapted to the ridges in the mouth. As a result, chewing hurts and you don't chew as well. It is estimated that nearly half of the dentures worn by elderly persons are ill-fitting and potentially harmful.
Other factors can cause additional dental problems
The incidence of oral cancer appears to increase with age. About 3 percent of all cancers detected are found in the jaws, lips, tongue and palate (roof of the mouth). The effect of oral cancers and their treatment can be devastating. Surgical treatment often results in loss of a portion or all of the jaws, tongue or palate. Facial disfigurement and serious impairment of chewing ability accompanies treatment of more extensive cancers.
Radiation (x-ray) therapy used to treat some oral cancers generally results in a reduced amount of saliva. The cleaning and lubricating effect of saliva is diminished, leaving tissues easily irritated and teeth subject to rapid decay.
Evidence of a disease occurring elsewhere in the body is sometimes noted in the mouth. Disorders such as those of the blood system (anemia) or diabetes are sometimes accompanied by inflammation and reduced healing capacity of the gums.
Treatment of some diseases (heart disease, high blood pressure, depression, Parkinson's disease) uses a regimen of many medications. A common side effect of these medications is a decrease in the amount of saliva, which results in a very dry mouth. An increase in the incidence of decay, periodontal disease, and an inability of gums and ridges to tolerate dentures can be expected.
Improving dental hygiene
Accumulation of food debris, plaque ( a white residue adhering to the teeth) or calculus (solidified plaque) increases the rate of tooth decay and gum disease. Good oral hygiene is perhaps the simplest and most efficient means to promote comfort and help reduce the dental problems associated with aging.
A medium soft brush and dental paste is recommended. For those incapable of gripping the handle, a rubber strap can be fastened to fit snugly around the hand. The brush may be easier to hold and control if a larger handle is made. A bicycle handle bar grip can be filled with plaster or silicone sealant and pushed over the handle. If limited arm movement is a problem, a longer handle can be made by attaching plastic plumbing pipe to the handle. Teeth, gums and tongue should be brushed at least once a day.
Flossing removes materials from areas difficult to reach with a toothbrush — between the teeth and at the gum line. Flossing takes practice and is difficult if you have limitations in arm and finger movements.
With a decrease in saliva, food particles adhere more readily to the teeth and gums. Rinsing with warm water will dislodge the particles. This is especially important if you have difficulty brushing. Rinsing, however, should not be considered a substitute for brushing.
Use of mouth washes may prove irritating to dry tissue because of their high alcohol content. If used, dilute the mouth wash with water.
Wiping with gauze
In some severe cases, it may be impossible for older adults to brush or rinse even with assistance. Wiping teeth and gums with a wet piece of gauze will remove some of the debris from around the teeth and gums.
Many mechanical aids have been developed to improve oral hygiene. Some have practical application for the elderly.
Electrical tooth brushes have been shown to be effective in cleaning teeth. The larger handle can be held more easily and the mechanical movement of the brush compensates for those with limited movement.
Water irrigators can be useful in removing particles from between teeth. If you have pockets between your teeth and gums, use a water irrigator with care. Rather than being washed away, food particles can be forced into those pockets and can cause severe irritation.
Interdental cleaners are handles with small changeable brushes. They allow for cleaning between teeth. This is especially helpful when the gums have receded, creating large spaces between the teeth.
Oral lubricants can ease some of the problems created by a dry mouth. Glycerine, flavored with a few drops of lemon, can provide a lubricating effect. This will ease the irritation caused by dentures rubbing on the underlying tissue or dry cheeks rubbing on the denture teeth. Several prescription medications are available that can stimulate the production of saliva or act as a saliva substitute.
Denture care is necessary because wearing dentures does not mean that good oral hygiene can be neglected. If you wear dentures, they should be removed after eating and rinsed with warm water. The mouth should also be thoroughly rinsed.
Dentures accumulate calculus like the teeth they replaced. Dentures should be scrubbed with a stiff brush and cream to remove these deposits. Commercial denture cleaning solutions by themselves will not adequately clean dentures.
Do-it-yourself denture liners should be avoided. They become rough and irritating and harbor bacteria and food debris. Such liners are difficult to keep clean.
For more detailed information on any of the dental aids or cleaning procedures, consult your dentist. Dentists can help establish a routine to provide you with the most efficient means of cleaning your teeth and gums.
Locating dental services
The number of dental professionals in Missouri has recently increased. Many rural areas that previously lacked dental services now have dental care facilities. However, some dentists still are reluctant to treat older adults, especially those with extensive medical and/or psychological impairments, because their training has not offered specific experiences in dealing with the dental problems of this age group.
Dental care is usually provided by the dentist at his office. Call or visit the dentist and ask about his willingness and experience with treating the elderly. Inquire if treatment is made possible for those confined to wheel chairs. In metropolitan areas, the local dental society may keep a list of dentists who are active in treating the elderly.
If long-term hospitalization or care in an extended care facility is necessary, become familiar with what provisions are made for maintaining good oral hygiene, emergency or routine dental care. Since few nursing homes have dental treatment facilities, look for a dental office nearby where the dentist is willing to treat elderly persons. These are important considerations when selecting a hospital or nursing facility that may be yours or a loved one's home for the remainder of your or their life.
Why older citizens don't seek dental care
Unfortunately, many older adults fail to use dental services that are available. There are several common explanations for this reluctance.
Fear of pain often associated with dental procedures may prevent some older adults from seeking dental care. This deterrent, however, appears to be less prevalent in the older adults than those of middle age. Most dental procedures, with the exception of surgery, can be performed without anesthesia because of the decrease in nerve fibers. Painless dentistry is more easily accomplished with older adults than any other age group.
Preoccupation with impending death creates a feeling of "since I am old and will die soon, I do not need dental care." Comfort, function and appearance are important at any age. These positive aspects of good dental care can often improve the older adult's psychological outlook.
Cost, unfortunately, is perhaps the greatest single deterrent to those seeking dental care. Many elderly, because of their low fixed income, feel that they cannot afford dental care. Medicare, at this time, does not provide for dental care other than hospitalization for surgical procedures. In Missouri, Medicaid has some provisions for dentistry.
A series of instructional programs for nursing homes, hospitals, and long-term care facilities, and for individuals who care for the elderly are available from the University of Missouri-Kansas City School of Dentistry.
The Missouri Gerontology Institute develops and coordinates instruction, research and extension activities on aging among the university campuses (Columbia, Kansas City, Rolla and St. Louis), Lincoln University and MU Extension.
GG5, reviewed October 1993