Elderly dental problems and solutions
The Dental Problems of the elderly can be divided into four groups. Problems arise with their teeth, gums, dentures and their medical histories.
Older people are more vulnerable to tooth decay, possibly due to a preference for sweeter foods, less care with their oral hygiene and inability or reticence to access dental treatment.Tooth decay is largely preventable by reducing the quantity and frequency that sugar is consumed. If one eats only 5 times a day and brushes with fluoride tooth paste at least twice a day, it is hard to develop tooth decay.Remember, even fresh fruit eaten in excessive amounts causes tooth decay. Food grazing throughout the day is especially bad, as it means that there is sugar and acid against the teeth all day long. In these cases, rinsing with water will help to dilute any sugar or acid ( in the case of fruit ) and then the application of fluoride tooth paste as a tooth “ointment” can reverse, or stop tooth decay.
Heavily filled teeth, or teeth under crowns and bridges may look sound, but the nerves in these teeth may die off. Once this happens, the dead nerve tissue may become infected and toothache can follow. The ideal treatment would be root- canal treatment, or possibly extraction. If it is not possible to get to a dentist, then a combination of pain killers ( ideally Nurofen) and Amoxicillin, the anti-biotic of choice for most dental infections, can be taken under advice. If the person is allergic to the Penicillin group, then Metronidazole would be the second choice. Antibiotics normally take a minimum of twenty four hours to work, so it is important to control any pain with pain killers. Always read the instructions and try and take them regularly and especially before bed, when pain can be particularly severe.
Decayed teeth, worn teeth and old fillings do break, often leaving sharp ends that the tongue plays with. This can result in tongue ulceration, which is very sore. Ideally, one should have a dentist smooth off the sharp piece as soon as possible. However, if this is not possible, usually within a couple of days, the tongue loses interest in the sharp object and the ulcer will heal.
Gum Related and Soft Tissue Problems
Gingivitis (bleeding gums) is present in almost all mouths and is not especially significant. Gum disease that causes bone loss, tooth loosening, or even tooth loss, does require treatment. A dental check-up is the opportunity to assess the level of gum disease. But ninety per cent of gum diseases can be prevented by effective oral hygiene, which should include cleaning in between the teeth with bottle brushes or dental floss. There is no evidence to suggest that mouth rinses make a significant difference but an electric tooth brush might. They are easier to use than a manual brush and have more of a rinsing effect. Food impaction can cause sore gums and bottle brushes or flossing will prevent this.
Soft Tissue Problems
It is not uncommon see a range of lumps, white lines and patches in the mouth. Ulcers are common, but, if they have not healed within two weeks and there is no obvious cause ( sharp tooth or filling), the ulcer should be investigated, first of all by a dentist. Any lump or patch in the mouth should be investigated if it bleeds, changes in size, appearance or ulcerates. Mouth cancers account for over two per cent of all cancers and their incidence is increasing. Smokers are at increased risk and if the person has a history of smoking and heavy drinking, the risk of oral cancer increases by sixteen times.
New dentures should be made as a last resort, only if the person is lucid and able to cope with dental appointments. If the previous dentures have never been successful, then it is highly unlikely that further attempts will be. If the previous dentures have been successful, but no longer fit, perhaps because they have broken or because the person has lost a lot of weight, then copying the original denture is the best way forward. A dentist should be able to offer this service. Denture wearers who develop Dry Mouth ( see below) can struggle with dentures. It is the thin film of saliva between the denture and palate in the upper jaw that creates denture retention.
Dentures must be cleaned properly by scrubbing vigorously with a toothbrush. Dentures should not be worn at night and should be soaked in Steradent overnight, otherwise oral fungal infections will occur. It is common in denture wearers and the elderly in general to lose skin tone especially at the angle of the mouth. These tissues can become cracked due to the pooling of saliva causing fungal and bacterial infections. There are anti –fungal/bacterial creams that can clear this problem but need to be prescribed by a dentist or doctor.
It is important to know that 75% of lower full dentures are never worn. To either fit, or test denture retention, dampen the denture, seat it in the mouth and hold it in place for ten seconds. If this is not immediately effective, denture adhesives can work very well. If the person has dementia, they may lose the ability to control the denture and often the tongue will dislodge it, especially common with a lower denture.
Old age itself can eventually lead to a reduction in saliva gland function, but anti-psychotic drugs, anti-epileptics, anti-depressants, beta-blockers, and diuretics can all cause a reduced saliva production. Poor saliva production makes it much harder for denture wearers and there is a higher risk of tooth decay and gum disease in people with dry mouth due to the lack of cleansing effect from the saliva. Using sugar free gum and regular sips of cold water help and there are saliva substitute sprays that are available. Increased tooth paste use is important to prevent tooth decay. Diabetics are more vulnerable to gum infections.
People with dementia must be individually assessed. Whilst there may be a need to do dental treatment, it may be that a general anaesthetic is required. This facility may only be available in a hospital. In my experience, it is unusual for patients with dementia to suffer toothache. In the care homes I have visited, it has been rare to hear of residents with toothache. This may be due to medication or due to their reduced levels of pain awareness.
Prevention is the easiest cure
Regular dental check -ups, liberal use of fluoride toothpastes and effective oral hygiene twice a day should be encouraged.
Julian Kurer BDS. MSc. FDSRCS. MRD
The Dental Rooms 020 8455 2941