Don't let residents throw their oral care under the bus
Joel Glicksman, DDS
I hear it all the time: “I'm too old; I don't want to fix my teeth.” Older patients easily give up on their oral health not realizing the importance of teeth to their overall health. Unfortunately, poor oral health has been linked to serious systemic illnesses, including diabetes, stroke, hypertension, myocardial infarction and aspiration pneumonia.
Additionally, periodontitis (infection of soft oral tissues resulting in gingival and tooth loss) develops as a consequence of poor oral hygiene, which has been linked to an increased risk of ischemic stroke. Staying healthy, avoiding infections and maintaining one's energy level is best achieved through chewing solid foods and giving the digestive tract a good workout. Since an estimated third to one half of health problems of the elderly may be associated with their food intake, the importance of having a healthy mouth reaches its zenith in the later stages of life.
The first order of business in a long-term care facility is establishing a standardized oral care system for residents. Everyone is familiar with the brush, floss and rinse mantra. No need to repeat those instructions here. However, other suggestions include:
- To make brushing easier for residents with their natural teeth who may have some physical disabilities, place a tennis ball or foam sleeve on their toothbrush. This will make it easier to grip the handle.
- Use an inexpensive battery toothbrush from the grocery or drug store. This reduces the amount of effort necessary to clean the teeth.
- Get an egg timer (3 minutes) to make sure the resident brushes for a sufficiently long period of time.
- The perception of time in the elderly with cognitive issues can be skewed. Brush teeth after breakfast, not when the residents first wake up in the morning.
For edentulous residents, the nurse or resident should use a moist gauze or sponge on a stick to clean the gums. Also, clean the tongue with a tongue brush or toothbrush. This simple act will clean out a significant amount of bacteria. Rinse with a non-alcoholic mouth rinse or plain water. A mouth rinse with alcohol will dry out the mouth and gum tissue even further.
Always, always supervise a resident's daily oral care routine.
For residents with removable appliances (i.e. dentures, partials), you should be aware these must be taken out every night, cleaned and placed in a designated receptacle. The same reason you take your shoes off at night is the same reason appliances must be removed. The gum tissue in the mouth must be allowed to breathe and oxygenate. If you suffocate these tissues with dentures or partials, the tissue and bone will pull back losing its retention and elasticity. The result is loose or ill-fitted appliances. Denture stomatitis, epulis and other painful conditions can occur with ill-fitting appliances. All appliances must be cleaned before being placed in the designated receptacle. Appliances are loaded with bacteria, food and plaque. They must be manually scrubbed clean. I recommend using a denture brush or toothbrush and toothpaste or denture cream. Dissolving tablets in water with the appliance will not remove the bacteria. Placing the appliances back in a resident's mouth without proper cleaning will re-introduce bacteria into the mouth.
Another way to promote oral health is to keep a bag of sugarless hard candy at each nursing station. Why? These can help those who have dry mouth or Xerostomia. Dry mouth is common in the elderly and leads to rampant, quick decay of the remaining teeth. The decay is not only on the biting surface but circumferential around the whole tooth. Elderly people who are not producing a lot of saliva like hard candy to help with their saliva production. Unfortunately, they choose candies that contain a lot of sugar or acid. These additives eat away at the enamel which, of course, causes cavities. If these cavities are not addressed, these teeth literally rot out at the gum line and break off. Biotene® makes a line of products for oral dryness and chronic dry mouth or Xerostomia symptoms. However, these products must be used on a constant basis. Sugarless hard candies are a simple, affordable solution for residents who are not at risk for choking.
When feasible, encourage family members to take their loved ones to the dentist once or twice a year. Most dental offices are handicap accessible. It is very common in my practice to treat patients in their wheelchair. Make sure the resident has a familiar face accompany them to the dentist.
Remember, oral health is important at every age, including for seniors.
Joel Glicksman, DDS, is a dentist in Aventura and Pembroke Pines, FL, and has extensive experience with geriatric dentistry.