The challenge of treating elderly patients might be broader than you thinkNews
Posted by: The Probe 10th September 2020
Elderly patients must be supported to maintain optimal oral health. At any age, oral health cannot be separated from general health, but older people also deserve to enjoy the great feeling of a clean, healthy mouth.
Your oldest patients will be some of your most vulnerable, exhibiting some, if not all the physical and psychological consequences of the ageing process, to varying degrees. For example, elderly people often see decline in their manual dexterity. If holding a toothbrush is difficult, plaque removal will be compromised. Arthritis, sight problems and conditions that impair movement which are commonly seen among (although not exclusive to) elderly people – who have an increased risk of stroke and Parkinson’s disease – will make cleaning hard too. They may also find attending the practice for routine preventive-maintenance appointments difficult, or struggle to shop for, prepare and cook healthy meals.
But not every “elderly” person will have the same physical struggles. Although it is true that a longer life does not guarantee a healthier life, many people can feel dismissed by stereotypical attitudes about old age. You will have patients over 65 who still care deeply about their physical appearance, for example, and will be highly motivated in all aspects of self-care. They will try to maintain sensible levels of physical activity and be interested in eating healthily, to get the maximum enjoyment out of life. Many will still be working – out of choice – with no plans to slow down just yet.[i] They will want to keep their own teeth for as long as possible too and therefore be receptive to learning how to avoid invasive dental procedures, if they can. They will understand their own role in keeping orally healthy and be willing to adapt to advice. This is another key point – not all your older patients will have impaired cognitive function, or struggle to adopt new routines.
This is a complex issue and practitioners must take a pragmatic approach, to treat older patients with dignity and respect and offer tailored treatment plans. It is a delicate balance, because although someone might be proud to tell you how they do not look their age, they will still need to work that bit harder to maintain optimal oral health. There will be consequences to a lifetime of “normal” function. Older patients statistically present with more restorations, or failed restorations, often a legacy of different patterns of dental care (“drill and fill”) over the todays’ preventive approach.[ii]
As people get older, it is also more common to experience a dry mouth, which may be attributed to certain medications, diminished function of the salivary gland, cancer treatments, or other systemic conditions.[iii] This has many consequences for oral health maintenance. Without this natural lubrication, the mouth is prone to caries. Plus, “the presence of saliva protects the oral cavity, the upper airway and digestive tract and facilitates numerous sensorimotor phenomena”.[iv] A dry, uncomfortable mouth will also be more difficult to clean and may contribute to embarrassing bad breath.
Other reports have suggested that the oral mucosa becomes “increasingly thin and smooth with age”, with a linked “tendency for development of sublingual varices and an increasing susceptibility to various pathological conditions (and) a decreased rate of wound healing”.[v] Studies have also found that the “prevalence and severity of periodontal diseases increase with age”.[vi] A “basic” routine, that has kept them in good oral health for years, might no longer be enough.
The link between oral disease/infection and various serious systemic diseases is well-documented – good dental hygiene is essential for a long, healthy life.[vii] A clean mouth will have enormous benefits to mental wellbeing too. The social impact of toothache on someone who already feels lonely can be devastating. But even if a patient has not felt inhibited by their age, pain, particularly if it affects their ability to communicate, can be distressing and isolating.
A careful programme of care that is within each patient’s capability must be recommended, alongside lifestyle advice to support oral health, for example, drinking more water to combat dry mouth. Gentle, daily cleaning is essential, enhanced by tools to elevate preventive care further. The Waterpik® Sonic-Fusion® combines a Water Flosser and toothbrush that can be grasped comfortably by patients with limited dexterity to give a deep clean and improve gum health. Accredited by the Oral Health Foundation, it is clinically proven to be twice as effective as traditional brushing and flossing.[viii]
The aging issue is complex. Take levels of motivation/understanding into account, also the impact that the ageing process can naturally have on the oral cavity and you will keep more of your older patients in good health and wellbeing for longer.
For more information on Waterpik® products please visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Asda, Costco UK, Boots.com and
in-store, Superdrug online and in stores across the UK and Ireland.
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[i] Living Longer: is age 70 the new age 65? Office for National Statistics, 19 November 2019. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerisage70thenewage65/2019-11-19
[ii] The Health and Social Care Information Centre. Executive Summary: Adult Dental Health Survey 2009, 24 March 2011. Found at: http://www.hscic.gov.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf (accessed April 2020).
[iii] Navazesh M. Dry mouth: aging and oral health. Compendium of Continuing Education in Dentistry (Jamesburg, NJ: 1995). 2002 Oct;23 (10 Suppl): 41-8.
[iv] Razak PA, Richard KJ, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: a review article. Journal of International Oral Health: JIOH. 2014 Nov;6 (6): 110.
[v] Journal of International Oral Health: JIOH. 2014 Nov;6 (6): 110.
[vi] Journal of International Oral Health: JIOH. 2014 Nov;6 (6): 110.
[vii] Kane SF. The effects of oral health on systemic health. Gen Dent. 2017 Nov 1; 65(6): 30-4.
[viii] Goyal C.R et al. Comparison of a novel sonic toothbrush to a traditional sonic toothbrush and manual brushing and flossing on plaque, gingival bleeding and inflammation: a randomized controlled clinical trial. Compend Contin Edu Dent 2018; x (Special Iss. 1): pp. https://www.aegisdentalnetwork.com/cced/special-issues/2018/06/comparison-of-a-novel-sonic-toothbrush-to-a-traditional-sonic-toothbrush-and-manual-brushing-and-flossing-on-plaque-ginigval-bleeding-and-inflammation (accessed April 2020).
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