Caregiver Guide: Dental Problems

Understanding the Problem

Dental problems are some of 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.  This means they continue to need a yearly visit to the dentist.
 
There are many reasons why older adults have dental problems.  Older people produce less saliva, which is needed to clean the teeth. Gums shrink with age, which exposes teeth to decay or infection. Additionally, older persons may have difficulty flossing and brushing because of poor vision or problems moving their arms, wrists, and hands.
 
Dental problems can also lead to poor nutrition. Unfortunately, these problems are often not taken care of by older persons, particularly men.
 
There are five dental problems common among older persons.

Dental decay

When people age, their gums begin to shrink. 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 way to prevent this. If the older person does not feel comfortable with the dentist you have chosen, find a dentist with training in treating older adults.

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.

Poorly fitting dentures

Dentures need to be checked and refitted on a regular basis because they can become loose or uncomfortable. Poorly 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. Dry mouth can cause dental decay.  It can be caused by some diseases, cancer therapy, or by certain medicines, alcohol, and other drugs which slow the flow of saliva.  

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 healthcare provider. 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.

Your goals are to:

  • Encourage daily mouth care
  • Be alert to signs of dental problems
  • Keep mouth moist
  • Make sure the older person visits the dentist at least once a year

Click on each of the topics below to read more.

When to Get Professional Help

Call the dentist or healthcare provider 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 of blood, but it really isn't. Severe bleeding, however, should be checked by a dentist or healthcare provider since it can be an early sign of oral cancer.

Severe swelling near the eye, on the upper or lower jaw, or on the neck

This 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 to non-verbally show they are in pain through noticeable changes in behavior (such as slapping of their face) and/or changes in eating habits (such as not eating).

Trauma to the mouth from a bad fall or accident resulting in cuts, scrapes, bleeding, and/or broken bones

If this happens, the older person should be seen by a healthcare provider or oral surgeon immediately.

Call the dentist or healthcare provider 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, although in some cases, they may need to be taken out.

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 the 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

If there is redness or a white film or curd that can be wiped away, these may be signs of a yeast infection. People with dry mouth and who have certain diseases are more likely to get yeast infections in the mouth. A dentist or healthcare provider can treat the infection with an anti-fungal medicine.

Loose dentures

As we get older, our gums tend to shrink and dentures may become loose.  This can lead to rubbing against the gums and irritation. A dentist can examine the area and see if a new set of dentures is appropriate. Dentures are too loose if they drop from the gum line when the person is speaking or eating.

Know the answers to the following questions before calling the dentist

  • 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, such as a fall, describe what happened.

What You Can Do to Help

There are many things that you can do on your own to help an older person with dental problems.

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 collects there on a daily basis. Ask the dental hygienist or dentist to show the older person the proper way to brush teeth. 

Use a toothbrush with soft, rounded bristles. Hard bristles can damage teeth and gums.

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 an electric toothbrush.

  • 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
    • make the handle longer by attaching a piece of wood or another toothbrush handle
    • use a floss holder to make flossing easier

An occupational therapist can provide more tips.

Brush the older adult’s teeth

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 of the mouth, and inside of cheeks (if the older person is bedridden, use cloth or a piece of cotton gauze to do this). You can also ask the dentist, dental hygienist or occupational therapist to show you how to brush someone else’s teeth.

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 and liquid detergents (available at drug stores) are good too.

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 the older person’s 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 the appointments yourself. 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 their needs.

Examine the mouth once a month

Check for early signs of disease. Inspection can reduce the risk of serious problems developing. Look for any abnormal masses or lumps, color changes, or signs of inflammation or infection.

Helping with a Dry Mouth

Ask about artificial saliva

Artificial saliva makes the mouth more comfortable. You can buy artificial saliva products such as Biotene™, Optimoist™, Oralbalance™ gel, Mouthkote™, XyliMelt™ and Salivart™ at the pharmacy. Also, water-soluble gels like K-Y Jelly™ can be used. They last for a longer time in the mouth than artificial saliva.

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

Encourage the older person to eat ice chips, sugar-free Popsicles, frozen juices, or frozen drinks.  These are good ways to take in liquid. Also encourage the older person to try to stop drinking 2 hours before bedtime to reduce night-time urination issues.

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 Your Plan

Problems you might have carrying out your plan

Even when you have excellent plans, there are obstacles or problems that may prevent you from carrying out your plans.  Here are some examples along with responses.

“Well, tooth loss is normal in older people, so don’t worry about mine.”

Losing teeth is not a normal part of aging. It is decay and gum disease that cause teeth to fall out, not aging. Encourage proper brushing and flossing to prevent tooth loss.

"It's normal for gums to bleed when brushing, so when mine bleed, it’s ok.”

Some bleeding happens sometimes, but constant bleeding is not normal. Bleeding is a sign of gingivitis, which is an inflammation of the gums. Brushing and flossing at least daily should get rid of the gingivitis in approximately two weeks. If there is a small amount of bleeding after that time, it should eventually stop if the brushing and flossing are continued.

"A toothbrush with hard bristles cleans better than one with soft bristles."

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.

"Mother does not want me to help her with her teeth."

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 of your helping. Always tell her what you are doing and why.

Think of other problems that could interfere with carrying out your plan

What other problems could get in the way of doing the things suggested in this guide? 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?

You need to make plans for solving these problems.

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 no natural 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. Yeast infections will disappear in just a few days with anti-fungal treatment. However, treatment for more serious gum disease can last up to six months or longer.

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.