The dental care needs of the elderly are not very different from those of other adults, but they are complicated by a number of impairments – physical, sensory, and cognitive Aging and Dental Health related to age and aging. Also, for the elderly, the connection between dental health and overall health is even more important as the elderly are generally less robust in fighting off infections and in healing from injuries.

For that reason, the need to prevent cavities and gum disease is greater for the elderly. For example, oral bacteria can be inhaled and cause pneumonia, a result particularly dangerous for the elderly.

Also, the elderly are an increasing demographic, and while retaining natural teeth into old age is entirely possible, many elderly people have lost teeth over the years and are using plates and dentures.

Focus on the basics

For the elderly, the fundamentals of good dental care remain important but are at times difficult to achieve. Nonetheless, the following should be key parts of dental care for the elderly.

• careful brushing and flossing
• appropriate choice and use of toothpaste
• drinking lots of tap water to avoid a dry mouth, and to supply a source of fluoride
• maintaining a good diet, particularly avoiding sweets and sugars
• avoiding tobacco
• limiting alcohol
• making regular dental visits

Tooth care and dementia

Dementia is common and increasing among the elderly, and with it comes increased risk for caries, periodontal disease, and oral infection. Those with dementia find it hard to follow instructions on hygiene, or to complete required after dental work.

Proper denture care and cleaning can be difficult, and with aging the gums can change, leading to problems with denture fit. People with dementia will need assistance with dentures and plates, as the importance of hygiene cannot be overstated.

Dentists with experience with elderly patients are usually more skilled in identifying and dealing with dememtia, as well as adapting to their patients’ hearing loss, vision loss, and so forth, and may also be ready to engage with caregivers for elderly patients. Communications techniques and tools on the practioner’s side are very important.

Physical challenges

Among the elderly, arthritic patients might need assistance with tooth care such as brushing and denture insertion. Disabilities with mobility can lead to problems with access to dental services as well, and the elderly might simply not be able to get to a dentist without assistance.

Financial challenges

In many cases the financial situation of elderly people will present challenges for dental care. Retirement might lead to the loss of dental coverage, and elderly persons on fixed incomes might lack the necessary supplemental dental coverage. They might need professional assistance in finding financing options.

[heading]Dental health, medications, and dry mouth

Many elderly people are receiving a variety of medications for things such as allergies or asthma, high blood pressure, high cholesterol, pain, anxiety, depression, Parkinson’s and Alzheimer’s diseases.

Such medications can have a link to dental health: among their side effects, they can lead to a dry mouth (xerostomia). That dryness in the mouth makes it easy for bacteria to gain a foothold, leading to increased risk of cavities and the attendant health problems. A dentist treating elderly patients should know what medications they are taking.

Solutions to xerostomia include drininking lots of water, oral moisturizers and toothpastes specifically for those with a dry mouth, sugar-free gums and lozenges, maintaining a moist environment through humidification, and avoiding dessicating things such as coffee, alcohol, carbonated soft drinks, and acidic fruit juices.

Preventative measures can include fluoride gels and tooth varnishes.

Natural consequences of aging

While dry mouth is not a requirement of aging, it nonetheless affects 30% of patients older than 65 years and up to 40% of patients older than 80 years.

Increased gastric pH that can accompany aging can lead to acid reflux that can be damaging to teeth.

Also, increased gingival recession that exposes root surfaces is a potential problem for the elderly, and loss of nerve sensitivity with age can give cover to dental problems that should receive early detection. Elderly people might just not feel developing tooth problems.

Among the elderly there is increased incidence of mouth, throat, tongue cancers and dentists need to be aware of this risk. The average age of diagnosis is 62; meaning that vigilance is important.

Elderly patients might also have heart conditions or artificial joints and implants, and so will require antibiotics to reduce their elevated risk of infection during dental work.

Resources

Fortunately the elderly in Canada have numerous resources to assist with dental needs. Community Care Access Centres can provide personal support workers for dental assistance; several agencies and groups can help with liaison with social supports; and nursing care and long term care facilities are familar with the dental needs of elderly people. Sherway Gardens Dental Centre is also well equipped to help; contact us for more information.

Visit our office for a consultation