Approximately eighteen percent of the U.S. population is sixty-five or older. Thanks to longer life expectancies and lower birth rates that trend is increasing and this group is projected to represent nearly a quarter of the population by 2050. As our populations ages, it is important to focus on maintaining quality of life.
Although the oral cavity plays an essential role in our physical, psychological, and overall health, the mouth is often not included as part of the daily basic healthcare routine in nursing homes, hospitals, and other healthcare facilities. Daily oral care for many of the 1.2 million residents in American nursing homes is inconsistent, inadequate, or completely ignored. Even when caregivers understand the consequences of poor oral health on overall health, chronic understaffing leaves nursing home and hospital staff without enough time for effective routine oral care. In addition, many staff members lack proper training in dental hygiene and may not know how to assist residents with cognitive impairment or physical limitations.
Patients in hospitals and nursing home residents may be too weak or lack the dexterity and vision to perform oral hygiene measures adequately without assistance. Many people are reluctant to voice their need for assistance with their daily oral care. Still others may no longer have the ability to recognize and/or voice their needs.
The need to improve oral health care for our loved ones in hospitals and nursing homes is evident when we consider that many of our elderly have multiple chronic health conditions that increase their vulnerability to infections. Allowing bacteria to proliferate in the oral cavity puts patients at risk of aspirating or inhaling it into the lungs causing pneumonia or other infections. Neglecting daily oral care results in rampant tooth decay, periodontal disease, broken teeth, oral infections, mouth sores, and pain. Pain can lead to malnutrition, which makes them even more vulnerable to infection.
The oral cavity plays an essential role in many of our fundamental social activities that contribute to quality of life. Maintaining oral health helps our loved ones to speak, smile, taste, chew, swallow, communicate, and connect socially with others with confidence and without pain. Neglecting daily oral hygiene may lead to family and friends avoiding close contact with their loved ones due to halitosis (bad breath). This only adds to feelings of low self-esteem, isolation, depression, and abandonment that patients often experience in care facilities. Since oral health promotes psychological and overall health, this is a critical responsibility that is being increasingly neglected.
Whether you are a lay person taking care of an elderly parent at home or a healthcare worker, providing dental care for another can feel daunting.
When faced with a diagnosis of Parkinson’s, Alzheimer’s or any other condition associated with dementia, we know that it will become increasingly difficult to perform dental treatments as the disease progresses. It is important to be proactive and make an appointment with your dentist for a complete oral exam. This allows early detection and treatment of disease and assistance from the dental team in providing both the patient and caregiver the education, including demonstrations of routine oral care, adaptive toothbrushes, and/or flossers to meet their physical limitations and establish an effective preventative oral care routine at home.
To preserve oral health, toothbrushing and flossing must be performed meticulously twice a day for two minutes. Whether you are a caregiver at home or a staff member at a healthcare facility, the following will help you to provide effective, preventative oral care for those who may need partial or full assistance in maintaining their oral health:
- Every person’s needs are unique, so you will need to start where they are at. As their needs change, (whether they are improving as they recuperate from their injuries/illness or lessening as their physical and mental capabilities decline), Your loved one or patient may initially require nothing more than guidance. or require total care with choking precautions.
- Whatever the case, all will benefit from an established routine where oral care takes place at the same time (after breakfast and before bed), in the same place and in the same order. This has been shown to decrease anxiety and increase compliance, especially in those with dementia. You may want to play music or use some other visual or auditory cue to establish that it’s time to clean their teeth to stay healthy.
- Make it easy on yourself by gathering everything you need prior to the cue to start. Keep in mind that oral care can be provided bedside, in a wheelchair or wherever your particular situation warrants, but keep the location consistent. You will need an oversized towel to cover the chest, a glass of water with bendable straw, a rinse basin, fluoride toothpaste, floss in a floss holder, and a toothbrush with a small head and soft bristles(or the adaptive toothbrush/floss holder, electric toothbrush, and any fluoride gel or rinse your dentist has prescribed).
- Maintain eye contact, give short, simple instructions, give visual cues, hand gestures, and demonstrations rather than talking, listen, and give positive, encouraging feedback. As dementia, fear and confusion increase, remind them they are safe, maintain calm(sensing your stress can make their agitation worse), use a gentle touch for reassurance, assess their body language and document what seems to trigger their anxiety. Offering two options, such as would you like to floss or brush first, can provide your patient with a sense of control. The hand-under-hand technique, where you stand behind the patient and hold your hand over the patient’s hand to help them brush also promotes a sense of control, increasing cooperation and reducing resistance. You can also use distraction, such as talking about an activity /snack/show they enjoy to restore calm.
- Don’t forget their dentures or partial dentures. These need to be rinsed off at every meal and cleaned and stored every night. Never leave partials or dentures in the mouth overnight as this can cause bacteria to build up and cause mouth infections and/or sores, increases the risk of aspiration pneumonia, choking and blocking the airway, and accelerates bone loss leading to ill-fitting, dried out, damaged or painful dentures. Removing them gives oral tissues a break from the pressure. Dentures and partials should be soaked overnight in water or recommended denture cleaning solution. After the denture is removed for the night, brush the gums and tongue with a soft bristled toothbrush. Then have them rinse with water or their prescribed rinse.Maintaining oral health is essential to quality of life, allowing our senior citizens to maintain their dignity, social connections, and overall health.
Dr. Stephen Petras
An Illinois Licensed General Dentist