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Dental Care in Older Adults

Why is dental care important for the elderly?

Dental care is important for everyone, even if your loved ones have few teeth remaining, or no natural teeth left.

Maintaining daily oral hygiene brings benefits to quality of life in the elderly – it increases self-esteem, enhances social integration and improves absorption of nutrients. Eating is more enjoyable with a healthy mouth, when there is no pain or infection in the teeth and gums. Watch the video below.


Challenges in maintaining good dental care in the elderly

Some elderly persons may have fewer teeth than before, or no natural teeth left. As such, they may feel that it is not important to perform oral hygiene on a daily basis.

The elderly may have difficulties maintaining oral health because of:

  • Poor eyesight
  • Conditions affecting movements of the hand, for example, osteoarthritis, Parkinson's disease
  • Conditions affecting their mood, for example, dementia, depression
  • Conditions affecting their mobility to get to the toilet basin, for example, stroke

A lack of good oral hygiene can increase the likelihood of dental diseases in the elderly.

Dental health in persons with dementia

As dementia progresses, the person with dementia may forget how to brush his or her teeth or forget why it is important. As a caregiver, you may have to assist or take a more hands-on approach. Persons with dementia are susceptible to dental problems because of:

  • Reduced saliva
    Saliva is essential to maintain a healthy mouth and to prevent the onset of dental decay and other oral lesions. Saliva acts as a lubricant and also cleans the mouth and teeth. Lack of saliva can thus lead to a build-up of plaque and increase the risk of dental decay, gum disease and infection. A dry mouth can also cause dentures to become loose and uncomfortable. A moisturising mouthwash may help with dry mouths as well.

    Saliva production decreases as a person ages. In addition, some medications may reduce the production of saliva by salivary glands.

    Denture fixatives and artificial saliva (a fluid to lubricate the mouth) can help some people with denture problems.  Frequent sips of water throughout the day, especially at mealtimes, will help.
  • Medications
    Certain medications can cause involuntary repetitive movements of the jaw and tongue, making it difficult to wear dentures and may cause wearing down of teeth. In some cases, these movements will continue after the drug is stopped. A dentist may be able to advise on what can help, and how best to ensure that your loved one is comfortable.
  • Reduced oral care
    Physical limitations may affect abilities to maintain their oral health.

What to look out for?

Behaviours that may suggest your loved ones are experiencing dental problems include:

  • food refusal
  • refusing to wear dentures
  • facial expressions such as grimacing
  • increased restlessness, agitation, shouting
  • disturbed sleep
  • aggressive behaviour

Tips on toothbrushing for persons with dementia

  1. Mild dementia stage
    Your loved one may find it easier to use an electric toothbrush or a toothbrush with an adapted handle to improve their grip.

  2. Moderate to severe stage

    • Change to an electric toothbrush or a toothbrush with larger handle to improve grip 
      You can modify the toothbrush handle by putting the handle through a tennis ball. Try different types of toothbrushes until you find the best choice

    • Give short and simple instructions 
      Break down instructions step by step. E.g. "Hold your toothbrush." "Put toothpaste on the brush." Then, "Brush your teeth."

    • Use a "watch me" technique and show your loved ones how to brush their teeth 

    • Put your hand over your loved ones' hand to guide them in brushing 
      Give your loved one the toothbrush with toothpaste already on it and put your hand over theirs to start the up and down brushing movement to help get started. It may be easier to stand behind your loved one while doing this.

    • Postpone brushing to a later time if your loved one is not cooperative. 
      Anti-plaque mouth wash can be helpful in preventing gum disease—but ONLY if it won't be swallowed.

My loved one with dementia may swallow toothpaste or mouthwash. What can I do?

Safer options for persons with moderate to severe dementia include:

  1. Fluoride free toothpastes 
  2. Alcohol-free, chlorhexidine gel to clean teeth 
    • Use your fingertip or a very soft toothbrush to apply the gel to the teeth
  3. Any commercial alcohol-free chlorhexidine mouthwash 
    • do not gargle mouthwash
    • instead, dip toothbrush in mouthwash, shake off excess and brush teeth
  4. Sodium bicarbonate solution 
    • mix 1/2 teaspoon of sodium bicarbonate in 200mL of water, dip toothbrush in mixture, shake off excess and brush teeth
  5. Brush teeth with toothbrush and water only 
    • mechanical brushing is more important than the pastes/mouthwash we use

More retail items for dental care in older adults can be purchased at Dental Clinic (Clinic 6B, Level 6, TTSH Medical Centre.)

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