Poor Oral Health in the Elderly

Poor oral health in the Elderly is something that doesn’t occur overnight. It develops rather gradually, over many years, and isn’t picked up by family members, residential staff, caregivers or professionals until a major issue arises.

As we age, some oral daily living skills become more difficult to maintain due to health issues, infirmity, lack of energy, medications, or depression. The gradual decline in the ability to maintain good oral health practices creates an unhealthy mouth environment. It begins a cycle of lack of care that will not only affect the senior with pain, swelling, and difficulty eating, but also may lead to medical issues – some of which could lead to death.

Mouth infections, while making eating unpleasant, are also dangerous to a person’s health. Mouth infections can be extremely dangerous, especially if a person’s immune system is weakened due to nutritional deficiency. Broken teeth, missing teeth, lack of ability to grind or bite, lack of saliva and lessened jaw strength can all lead to not eating well and, ultimately, malnutrition.

As we age, our sense of smell and taste changes too. Foods that we used to love to eat don’t smell or taste as good. Senior eating behavior also grows more into ‘counter grazing’ which means picking at, usually finger foods that are easy to access. This is important for staff and dietary departments to understand in order to better meet their resident’s dietary needs and how to use these behaviors to actually increase food consumption for optimal diets.

Often, senior adults compensate for this loss of taste by eating sweeter and/or saltier foods. The combination of these types of food, with the regressing of their oral hygiene skills and reduced saliva production, allow residue of these foods to remain in the mouth longer. Food residue in the mouth for longer periods of time may create and environment for an oral health problem.

Dentures play an important role in nutrition for seniors. Many senior adults are not eating correctly. They may forget or don’t bother to wear their dentures, because they are uncomfortable due to improper fit. If a person has lost weight, it may mean his or her dentures need to be adjusted. The senior adult may not know that dentures can be adjusted or they may not have the transportation or funds available to make the change.

Finally, routine preventive dental care is often avoided because dental care is not covered by insurance for a majority of senior adults. Seniors prefer to use their funds for immediate needs and they don’t like spend money to solve a problem until it is a necessity.

Key oral health areas to address are:

  • Health of teeth
  • Condition and fit of dentures
  • Proper care of dentures and gums. (Are they getting brushed and cleaned?)
  • Are there sore spots on the gums?
  • Is there increased sensitivity to heat or cold?
  • Are regularly scheduled dental checkups maintained?
  • Checklist for assessing the oral health skills of seniors:
  • Is he/she brushing teeth a minimum of at least once a day?

Examine brushing routine and how the task is done.

  1. Assess what the senior considers to be “done well” for oral hygiene.
  2. Are the right materials/supplies used?
  3. What products and tools are used and how often are they replaced? I.e. toothbrush, denture cleaner, floss, etc.)
  4. When was the last time the toothbrush was replaced? (Explain how often it should be replaced and what type to use – a free brush is always welcome).
  5. Is he/she wearing the required dental devices? (do not assume that a senior is caring for or using their dental devices properly – ask how and have them demonstrate it to you)
  6. Are any dentures, plates, or other oral devices cleaned daily and properly? (Do not assume that dental devices are being cleaned properly, even if they obviously tell you the right products they are using. Ask for details and even have them show you what they do.)
  7. Are all oral devices, dentures, and teeth in good repair?

Do not assume the senior will tell you if there is problem. Many seniors come from a background of not complaining about things. Also, due to medications or health issues, the senior may not be physically or mentally be able to tell you if there is a problem.

To avoid any lapse in care, schedule the next routine appointment at the end of the visit. Making sure dental visits are part of any regular routine medical care plan is essential.

As more seniors live longer lives, the majority would like to preserve their teeth for as long as possible. But as shown, there are many obstacles that may go undetected that could prevent this.

It takes a collaborative effort of the caretakers, residential staff, seniors, and dental professionals to maintain good oral health. It is important for residential staff to understand how they can help monitor and assist in their resident’s oral health. Seniors need to understand how the aging process can create unforeseen obstacles that would prevent good oral health. Dental professionals need to be more aware of assessing the larger picture, while paying more attention to the details of the patient’s oral health too.

Maintaining good oral health of facility residents is important as it helps keep the resident healthier, happy and it creates a better quality of living. Life expectancy increases too.