Eldercare at Home: Dental Problems
Caregiving How Tos
Understanding the Problem
Dental problems are among the most common health problems experienced by older adults. In fact, people over 65 with natural teeth have more tooth decay than any other age group and thus continue to need a yearly visit to the dentist.
Older people produce less saliva which is needed to clean the teeth. Gums shrink with age, exposing the tooth to decay or infection. Furthermore, older persons may have difficulty flossing and brushing because of poor vision or problems moving their arms, wrists, and hands.
Dental problems can lead to poor nutrition. Unfortunately, these problems are often not attended to by older persons, particularly men.
There are five dental problems common among older persons:
Dental Decay
When people age, their gums begin to recede. The roots of the tooth are exposed and it is very easy for cavities to develop in this area. Cavities can lead to infection and teeth breaking off. A yearly visit to the dentist is a good preventive measure. If the older person does not feel comfortable with the dentist you have chosen, find a dentist with training in treating older patients.
Gum Disease
Plaque grows on the surface of the teeth. The bacteria found in plaque give off acids that cause gum disease. To prevent gum disease and decay, make sure the person you are caring for removes plaque daily by brushing and flossing the teeth. An electric toothbrush may be easier for the person to use, but ask the dentist or dental hygienist to demonstrate how to use it.
Poor Fitting Dentures
Dentures need to be checked and refitted on a regular basis because they can become loose or uncomfortable. Poor fitting dentures may drop when a person speaks, and they can cause chewing problems that can lead to poor nutrition.
Dry Mouth
Older people sometimes produce less saliva. Saliva is a natural mouth protector which limits the growth of bacteria, cleanses the mouth of food, and bathes the teeth with protective minerals; thus a reduction in saliva (resulting in a dry mouth) can cause dental decay. Dry mouth also can be caused by some diseases, cancer therapy, or by medicines such as diuretics, antihistamines, anti-anxiety drugs, antidepressants, alcohol, certain bladder medications and other drugs that slow the flow of saliva. Ask your doctor or pharmacist if the dose can be lowered or the prescription changed. (See the "Moisten a Dry Mouth" section in this section.)
Oral Cancer
Oral cancer includes cancers of the mouth, throat, tongue, and lips. If you notice red or white spots, sores in the mouth or bleeding which does not disappear within two weeks, make an appointment with the dentist or physician. These could be early signs of oral cancer.
Prevention is the best medicine. Many dental problems are preventable with good daily mouth care. If problems are caught early they are usually inexpensive and easy to fix.
For more information about dental problems, visit the American Dental Association’s website.
Your goals are to:
- Encourage daily mouth care
- Be alert to signs of dental problems
- Keep mouth moist
- See the dentist at least once a year
When To Get Professional Help:
Call the doctor or nurse immediately or go to the emergency room if any of the following symptoms occur
- Large amounts of bleeding from the mouth or gums
Everyone's gums bleed a little. Sometimes blood gets mixed with saliva and looks like a lot, but it really isn't. Severe bleeding, should be checked by a doctor or dentist since it can be an early sign of oral cancer.
- Severe swelling
A swelling the size of a golf ball near the eye, on the upper or lower jaw, or on the neck, may be a sign of a serious infection especially if accompanied by a fever. Serious infections can spread to other areas of the body and can become life threatening.
- Severe pain in the mouth
Severe pain may be caused by a decayed tooth or gum ulcer. If the older person is unable to tell you about pain, there are several ways that a person can non-verbally show they are in pain: noticeable changes in behavior (such as slapping of the face) and/or changes in eating habits (going off food).
- Trauma to the mouth from a bad fall leaving cuts, abrasions, bleeding, and/or fractured bones
The older person should be seen by a doctor or oral surgeon immediately.
Call the doctor or nurse during office hours to discuss the following problems
- A broken denture, tooth, or filling
Dentures can be repaired within a day or two. Broken teeth usually can be repaired, though, in some cases, they may need to be pulled.
- Trouble chewing
This may happen if the older person has lost some teeth. A denture or partial denture may be the answer.
- Loose teeth
Loose teeth are a sign of advanced gum disease. Loose teeth can usually be saved with treatment, even if there is a lot of bone loss around the teeth.
- Sore mouth
This can be caused by certain medicines, lack of saliva, or a cut from a sharp tooth or denture.
- Bad breath
Gum disease or plaque and tartar on the teeth can cause bad breath. Bad breath should go away if the older person: brushes daily, flosses, and makes regular checkups with the dentist. If the problem does not go away, contact your dentist or doctor.
- Bleeding gums
Plaque can cause bleeding gums. By performing daily mouth care, plaque disappears and gums stay healthy.
- Redness or white film or "curd" in the mouth
People with dry mouth and who have certain diseases are more likely to get yeast infections in the mouth. If there is redness or a white curd that can be wiped away, these are signs of a yeast infection. A doctor or dentist can treat the infection with an anti-fungal medicine.
- If dentures are loose, or if the older person is using denture adhesives
If someone has to use an adhesive, it is a sign that the dentures do not fit well. Make an appointment with the dentist. A new set of dentures or relining of the dentures will make dentures more comfortable and may make adhesives unnecessary.
Know the answers to the following questions before calling the doctor
- Where is the problem? Is it a particular tooth or area of the mouth?
- How long has the problem lasted?
- Is there pain?
- Is there bleeding?
- Is there swelling?
- If the problem was caused by trauma, like a fall, describe what happened.
Here is an example of what you might say when calling for help
"This is Sara Edmunds. I am calling for my mother, Jean Moore. The tooth on the upper right side of her mouth broke off last night when she was eating dinner. She says the tooth is not painful, but it has a sharp edge and is irritating her gum and cheek."
What You Can Do To Help:
Brushing teeth
- Be sure proper brushing techniques are used
Plaque should be removed from the front, back, and chewing surfaces of the teeth by brushing in small back and forth (side to side) or circular motions. Be sure to pay close attention to the area where the teeth meet the gum line. The goal is to remove all the plaque that accumulates there on a daily basis. Ask your dental hygienist or dentist to show the older person the proper way to brush teeth.
If the older person is having problems using a regular toothbrush, an electric toothbrush may be easier to use. Ask the dentist to show you or the older person how to use it. Other ways to make brushing easier include the following: make a larger grip for the brush handle by wrapping it with aluminum foil or masking tape, buy a toothbrush with a larger handle, or make the handle longer by attaching a piece of wood or another toothbrush handle. Use a floss holder to make flossing easier.
If you are going to brush the older person's teeth, stand behind and to the right of the person (if you are right-handed). Always start with the same tooth. Clean the surface of every tooth, moving from one tooth to the next. Move the brush in a soft circular motion. Brush the tongue, roof, and inside of cheeks (if the older person is bedridden, use cloth or a piece of cotton gauze to do this). Ask the dentist or dental hygienist to show you how to brush someone else's teeth.
- Use a toothbrush with soft, rounded bristles
Hard bristles can damage teeth and gums.
Denture Care
- Remove dentures at least 6 hours every day
Dentures should be taken out before bedtime. This relieves the gums from the pressure of the dentures. Dentures should be stored in water when not in use so they do not warp. Use fresh water each time you store the dentures.
- Scrub dentures daily
Fizzy tablets will not do the job. Dentures should be scrubbed with a denture brush every night or after every meal. Denture creams (available at drug stores) and liquid detergents are good.
- Learn how to handle dentures
If you feel uncomfortable about removing dentures, talk to your dentist or dental hygienist. They can teach you how to handle and remove dentures.
Prevent dental problems from happening or getting worse
- Replace toothbrushes
Get a new toothbrush every three months or after a major illness.
- Encourage stopping smoking
Smoking causes gum disease, dry mouth, and has been linked to oral cancer.
- Take an active role with dental appointments
Encourage the older person to make dental appointments or, if necessary, make appointments for him or her. At the dentist's office, be available to explain problems and write down the answers. Have the dental hygienist explain things to both you and the older person. If the dentist suggests a special kind of toothbrush or cleaning aid, offer to help the older person choose the one that is best suited to his or her needs.
- Examine the mouth once a month
Check for early signs of disease. Inspection can reduce the risk of serious problems developing.
Helping with a Dry Mouth
- Ask about artificial saliva
Artificial saliva makes the mouth more comfortable. You can buy artificial saliva such as Optimoist, Oralbalance gel, Mouthkote, and Salivart at the pharmacy. Also, water soluble gels like K-Y Jelly can be used. It lasts for a longer time in the mouth than artificial saliva products.
- Rinse the mouth before meals and throughout the day
Rinse with water or a salt solution, using one teaspoon of salt in one quart of water. Do not use mouthwashes with alcohol because they dry out the mouth.
- Use a lip moisturizer before eating
Use petroleum jelly, lip salve, or cocoa butter on the lips. If lips are moist, food is easier to chew.
- Encourage sipping 1 to 2 quarts of liquid a day
Eating ice chips, sugar-free popsicles, frozen juices, or frozen drinks are good ways to take in liquid.
- Encourage dunking bread, crackers, and baked foods in coffee, tea, milk or soup to make them moist
Moistening food is another way to fight dry mouth. Dip bread in soup, shredded meat in marinade, or toast in coffee. Use sauces and gravies to moisten food, making it easier to chew and swallow.
Carrying Out and Adjusting Your Plan:
Problems You Might Have Carrying Out Your Plan
Problem
"Tooth loss is normal in older people"
Response
Losing teeth is not a normal part of aging. Decay and gum disease cause teeth to fall out, not aging. Encourage proper brushing and flossing to prevent tooth loss.
Problem
"It's normal for gums to bleed when brushing.”
Response
It happens but it is not normal. Bleeding is a sign of gingivitis, which is an inflammation of the gums. Brushing and flossing at least daily, will make gingivitis go away in roughly 2 weeks. If there is a little bleeding after that time, don't worry, it will eventually stop.
Problem
"A toothbrush with hard bristles cleans better than one with soft bristles."
Response
Using a hard bristle toothbrush wears away the tooth's surface. The bristles damage the tissues and cause the gums to recede. It is better to use a soft bristle toothbrush.
Problem
"Mother does not want me to help her with her teeth."
Response
Choose a time when she is feeling happy and make tooth brushing pleasant by talking about things that interest her. Just do a little at first until she gets used to the idea. Always tell her what you are doing and why.
Think of other obstacles that could interfere with carrying out your plan
What additional roadblocks could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
Checking on Progress:
- Be on the lookout for dental problems and make appointments with the dentist as soon as they are noticed. Make sure the older person brushes and flosses on a daily basis. Make an appointment with the dentist at least once a year, even if the person has few or none of his or her own teeth and wears dentures.
- Remember to examine the mouth regularly and ask the older person if there are teeth or mouth problems. Examine dentures. Check that they fit comfortably. They should not drop from the gum line when speaking or eating.
- Some problems will improve quickly while others will take more time. For example, gingivitis should clear up after two weeks of good daily mouth care. Treatment for more serious gum disease can last up to six months or longer. Yeast infections will disappear in just a few days with anti-fungal treatment.
What to Do If Your Plan Isn't Working
If dental problems are not improving, discuss with a dentist or hygienist what you have done and what the results have been. Ask for further suggestions.
