Dental Care for Older Adults

Dental care for older adults shouldn’t be a concern just when they have a toothache. Daily brushing and flossing, as well as regular dental visits, can protect not only your loved one’s teeth but also their overall health.

Poor oral health affects more than our ability to chew – speaking, tasting, swallowing, touching, smelling, smiling, and making facial expressions are also affected. Even a few months of neglect can cause oral health to deteriorate and lead to serious health issues, including coronary heart disease and aneurysms.

You can better help your older loved ones with their dental care by:

  • Understanding obstacles to dental care
  • Becoming familiar with signs, symptoms, and causes of oral health issues
  • Learning techniques to assist in caring for their teeth and mouth 

Obstacles to Oral Care in Older Adults

As we age, our teeth darken in color. Changes to the bone-like tissue that is underneath the tooth enamel called, thinning of tooth enamel, and a lifetime of drinking coffee, tea, and other beverages and foods can stain our teeth.

We also become more prone to cavities and periodontal (gum) disease. Most older adults didn’t grow up with the cavity-fighting benefit of fluoridated drinking water, which didn’t become prevalent until the 1950s.

Among older adults (people 65 and older):

  • 95% have had at least one cavity
  • 2 in 3 (68%) have gum disease
  • 1 in 5 (20%) have untreated tooth decay

Dental care also comes with a financial cost that many older adults find challenging to budget for. Routine dental care is not covered by Medicare Part A and Part B, although some supplemental plans may. For people on Medicaid, the federal government doesn’t require states to cover dental care for adults, so few do.

When chronic conditions or stroke affect the ability to control hand movements, it becomes more difficult to brush and floss. People experiencing cognitive decline, including dementia, may have forgotten how to take care of their teeth.

Signs, Symptoms, and Causes of Oral Health Issues in Older Adults

Dry Mouth.  Dry mouth (xerostomia), the result of reduced saliva flow, is typical in older adults. Saliva washes away food particles and acids in the mouth and contains minerals that keep our teeth strong.  Prolonged dry mouth may lead to tooth damage that affects the ability to chew and taste. Dry mouth may also make teeth more sensitive to temperature (cold or hot), sugar, or acids. Dry mouth can be caused by:

  • Medications, including those used to treat asthma, high blood pressure, high cholesterol, pain, depression, and Alzheimer’s disease
  • Cancer treatments
  • Certain diseases

Tips to combat dry mouth:

  • Sip tap water often
  • Use a humidifier to add moisture to the air
  • Drink less coffee, tea, carbonated soft drinks, high-acidity juices, and alcohol
  • Chew sugarless gum or suck on sugarless candy
  • Try over-the-counter oral lubricants (sprays or mouthwashes) 

Periodontal (gum) disease.  Periodontal disease, which can cause receding gums, loose teeth, and bad breath, is the leading cause of tooth loss. Periodontal disease is also linked to heart disease, stroke, and respiratory disorders. People with diabetes are even more likely to lose teeth when gum disease isn’t controlled.

Gum disease is caused by the bacteria in plaque. The American Dental Association (ADA) describes plaque as the sticky film that covers teeth. Think about how your teeth feel when you haven’t brushed your teeth all day: that film contains plaque. Plaque that isn’t removed through brushing and flossing hardens into tartar. When tartar collects above the gum line, gum tissues become swollen and bleed more easily. This is the gingivitis or early-stage gum disease.  

Periodontal disease can be caused or made worse by:

  • Sugar in foods and beverages that cause bacteria to release acids that attack tooth enamel
  • Tobacco products
  • Ill-fitting bridges and dentures
  • Poor diet
  • Certain diseases, including anemia, cancer, and diabetes

Because early periodontal disease is often painless, it may go undetected. In advanced stages, gums, bone, and ligaments that support the teeth are destroyed, resulting in tooth loss. 

Tips to prevent periodontal disease:

  • Brush and floss twice a day, cleaning between the teeth and at the gum line
  • Schedule regular dental visits for the removal of plaque and tartar
  • Tell the dentist about bleeding gums and sensitive teeth

 Oral Cancers.  The risk of oral cancer increases with age. More than 53,000 cases of mouth, throat, and tongue cancers are diagnosed annually, according to the Oral Cancer Foundation.

Most oral cancers can be treated if caught early. However, early-stage oral cancers may not cause any pain or symptoms. That’s why dentists check the lips, tongue, gums, inside cheeks, the floor of the mouth, etc., during regular checkups. Signs of oral cancers that dentists look for include:

  • Red or white patches
  • Sores that don’t heal after a few days
  • Swelling

Tips to discover oral cancers:

  • Schedule regular dental visits that include oral cancer screenings
  • Ask your loved one about signs of oral cancers listed above

 Other Oral Health Issues

  • Respiratory disease caused by bacteria in plaque that travels from the mouth to the lungs
  • Root decay caused by exposure of a tooth’s root to acids that cause decay
  • Uneven jawbone caused by not replacing missing teeth
  • Denture-induced inflammation of the tissue under dentures when dentures don’t fit and aren’t kept clean

Tips for Dental Care of Older Adults

It can be embarrassing to have discolored teeth, dentures or loose teeth that make it difficult to eat or speak properly, or bad breath. Tell your loved one that you’re concerned about their overall health and are willing to help with their dental care. 

What you can do:

  • Schedule twice-a-year dental visits and take them to their appointments, even if they don’t have any natural teeth
  • Tell the dentist about all medications taken 
  • Ask about the application a fluoride gel or varnish to protect from cavities
  • Replace toothbrushes every three to six months
  • Try a toothbrush with a wider handle that is easier to grip or use an elastic band to attach the toothbrush to the hand
  • Replace floss with floss picks
  • Provide fluoridated rinses

If the person is unable to take care of their teeth, learn to do it for them.

  • Brush gently with a soft-bristled toothbrush (electric or manual)
  • If the person is particularly sensitive to brushing, try a foam brush
  • Start with a little bit of fluoridated toothpaste and reapply as needed
  • If they resist because they don’t like the taste, try different flavors of toothpaste
  • Don’t push down on gums when flossing
  • Clean dentures out of the mouth every day
  • Never let dentures dry out
  • Clean the mouth while dentures are soaking
  • See a professional for dentures that don’t fit well
  • Finish by moisturizing the lips
  • Seek care for mouth sores that don’t go away, excess plaque buildup, and pain caused by brushing

Two sources of additional information about dental care for caregivers:

The National Institutes of Health provides free booklets for caregivers on brushing, flossing, dry mouth, and finding low-cost dental care at https://catalog.nidcr.nih.gov/OrderPublications/

American Dental Association, “Aging and Dental Health” at https://www.mouthhealthy.org/en/az-topics/a/aging-and-dental-health or “Aging and Dental Health (Geriatrics)” at https://www.ada.org/en/member-center/oral-health-topics/aging-and-dental-health 

If your loved one is not mobile enough to visit a dentist office, and a few dentists make home visits.  District Mobile Dental is a concierge oral healthcare company providing house call (mobile) dental services in Maryland (Montgomery County) and the District of Columbia.

SmithLife Homecare is available 24/7 to help with the needs of your loved one, including regular brushing and flossing.  Contact us today to discuss your needs. 

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