What can you do to help keep your oral health in good balance?
The older adult population is the fastest growing age segment of North American society. They are more functional, healthier, and more interested in maintaining their dentitions than were the senior citizens of earlier generations. However, for various reasons, their oral health problems and needs are unique.
Xerostomia (or Dry Mouth) is a potentially serious risk factor for oral disease. The complaint of xerostomia means the physical properties of saliva are altered, and this usually indicates the protective functions of this critical oral fluid may be lost or diminished.
Without saliva the mouth and teeth become more susceptible to infections, ulcerations and decay. This will affect taste, speech, chewing, swallowing, and tolerance to dentures
The causes of xerostomia vary. In the elderly common causes include the following:
- Drug side effect/interaction
- Systemic disease
- History of therapeutic irradiation to the head and neck (e.g., for cancer)
- Salivary gland disease
In developing the differential diagnosis for xerostomia it is important to identify the etiology in order to plan management of the condition. Dry mouth in a patient can also result in:
- Decreased remineralizing ability
- Diminished pH (increased intraoral acidity) and buffering capacity
- Lowered antimicrobial properties that can contribute to the increased development of caries
- Increased retention of oral debris
- Complaints of bad breath/bad taste in the mouth
- Diminished lubrication of hard and soft tissues
- Chewing and swallowing complaints
By the time a dentate patient is seventy years of age, he/she will likely have numerous restorations. A virtual history of dentistry may exist in some mouths. Failing restorations are the primary source of dental decay in the elderly.
As teeth age, they change. Pulp spaces shrink and the pulps contain less and less sensitive, nerve tissue, resulting in minimal sensitivity. This can lead to problems which are asymptomatic. For these reasons, it is uncommon for an elderly patient to complain of a toothache.
What are some warning signs of gum disease?
- Gums bleed when brushing and flossing
- Constant bad breath or bad taste in your mouth
- Gums are red and swollen and/or tender
- Gums are shrinking away from your teeth
- Teeth that appear to be loose
- Teeth seem to have changed position
Periodontal disease and destruction of the gum attachment over years can lead to exposure of root surfaces throughout the mouth. These are prone to trapping debris and plaque because of their greater roughness and because of the gingival embrasures that are created by a loss of soft tissue.
Root surface caries
Exposed root surfaces are more irregular and porous and, therefore, more plaque-retentive than enamel. These surfaces are more susceptible to dental decay.
Oral hygiene difficulty
In older mouths, plaque may be more difficult for the patient to remove due to interproximal and furcal concavities, open gingival embrasures, and use of fixed bridges or dentures. Limited access increases plaque retention
Oral stereognosis – the ability to manipulate and identify objects and textures in the mouth – may be compromised in advanced age. Some older patients may not be able to tell whether the mouth is clean. Oral stereognosis is certainly diminished by xerostomia and/or denture use. This contributes further to food retention and oral disease.
Tooth abrasion may be the result of long-term use of a hard bristle toothbrush or excessive brushing.
Attrition is extreme wear of the dentition. This may be due to the long-term effects of diet, lack of replacement of missing teeth, or bruxism (grinding of the teeth). Severely worn teeth are often food impaction sites and may be associated with localized sites of interproximal bone loss.
Angular cheilitis is inflammation of the corners of the mouth. It can occur spontaneously but more often develops in those who wear dentures.
Oral cancer is the sixth most form of common cancer in the world with a 5-year survival rate of less than 50%. The most common causes of oral cancer are tobacco and alcohol. Oral cancer is typically presents as an ulcer, red patch or white lesion. Since smaller oral cancers have a better prognosis than larger ones, early detection plays an important role in reducing both the treatment associated morbidity and death rate from the disease. Regular examinations are important to inspect the mouth for suspicious lesions . All non-healing sores in the mouth or changes in voice deserve close attention and monitoring.
Optimizing home care
Oral health may be influenced by many non-dental factors, such as:
- Impaired arm and hand range of motion and dexterity
- Impaired vision
- Chronic diseases
It is important to realize these and other factors affecting oral hygiene may not remain constant. We may notice periods of moderately good oral hygiene and periods when hygiene is neglected. The latter is most likely to occur during bouts of illness or hospitalization.
In light of the dental and non-dental factors that affect oral care, it is important to establish a plaque removal routine that is customized. There are several oral hygiene aids and agents that can improve the effectiveness with oral hygiene care:
- Modification of the toothbrush
- Use of interproximal cleaners
- Chemotherapeutic rinses
- Adjuctive care
- Maintenance of Dentures
Modification of the toothbrush
The manual brush can be modified to suit the hands of patients who can no longer grip and manipulate an object with a small handle. Various materials can be used, from foam wrap to a bicycle handle grip. Electric toothbrushes are often easier to grip and will assist in the brushing action.
Use of interproximal cleaners
Interproximal cleaners or other appliances that reach more plaques between teeth, can improve interproximal cleaning.
The use of fluoride and antimicrobial products should be considered as part of the treatment options for the older patient. Fluoride formulations penetrates the tooth to help fight cavities, strengthen weak spots, and reverse the early stage of tooth decay.
- Prevident 5000 – bought at pharmacy
- Fluoride Varnish – applied professionally
- MI paste – applied professionally and dispensed; delivers more Fluoride, calcium and phosphate to the tooth surface; strengthens enamel, reduces sensitivity, and neutralizes acid
- Xylitol mints – dispensed; Anti-caries agent which neutralize decay-causing acids after eating or drinking
Chemotherapeutic agents such as Peridex® (0.12% chlorhexidine) can be used as part of a professional program for the treatment of gingivitis. Adherence to product usage is important, as is the monitoring of the effect. Dry Mouth Products such as Biotene, are specifically formulated to relieve oral dryness and the symptoms of mild to severe dry mouth.
Maintenance of dentures
When plaque is not removed from your denture, the bacteria will spread to other areas of your mouth. A denture toothbrush is designed to make this job easier with a larger brush-head and larger handle for better grip.
What can you do to help keep your oral health in good balance?
- Brush and floss regularly.
- Drink less acidic or acid causing beverages.
- Drink lots of water.
- Use sugar-free gum and sugar-free lozenges.
- Visit the dentist regularly to detect cavities when they are small; before they hurt, and cause more damage.
- Receive frequent ongoing care from the dental hygienist.
- Determination of your specific problems so the correct oral hygiene aids and products can be recommended, for a complete home care routine.