Seniors Matters(s): Oral health

I just finished my six-month check-up with my good dentist who retired Friday after 43 years in Kincardine. Having taken care of me for so many years, I thanked him for his diligence on my behalf.

We reminisced about the old-style drill that shook the body and the building, and how far dentistry has developed over the past half-century.

At one time, dentists were a profession at risk because of the stress of dealing with traumatized patients who dreaded such visits. The weight of healing was carried hard on the professional.

Dentistry is clearly so much better now and can often focus on preventive plans and large restorative proceedings.

We joked that 50 years ago, seniors’ dentistry hygiene focused on the glass sitting by the bed with the dentures. The procedure was no doubt painful, but after the gums healed, with no teeth, oral hygiene was rather straight forward.

These advances in oral health care, prevention and disease treatment, mean that many seniors still have some or all of their natural teeth.

As we age, not only do our body, metabolism, cognitive abilities, and teeth undergo changes, sometimes these changes are affected by chronic diseases and the use of medications. Some changes may include sensitive teeth - teeth can be sensitive to hot or cold foods and/or touch; gums may start to pull away from our teeth; roots are exposed to bacteria that can cause cavities.

Maintaining good oral health is important throughout life for overall health and well-being.

I once read that your mouth is an important indicator of your body. It can either enhance or hinder your overall health. Good oral hygiene can help prevent the development of lung infections, such as pneumonia, especially for seniors who have a hard time swallowing. Pneumonia may be caused by the inhalation of harmful types of mouth bacteria, which accumulate when the mouth is not cleaned properly and regularly. Good oral hygiene can reduce the risk of such bacteria going into the lungs.

Since studying up on my diabetes, I have learned that I am more at risk for mouth infections, especially gum (periodontal) disease. Gum disease can damage the gum and bone that hold your teeth in place and may lead to painful chewing problems. In cases of severe gum disease, some people may lose their teeth. Gum disease may also make it harder for people with diabetes to control their blood sugar levels, and may increase the risk of heart attack and stroke.

Poor oral health may increase the number of harmful bacteria found in the mouth, which may release toxins into the blood that can damage heart tissue. I have found that my electric toothbrush has improved my plaque removal for older adults with reduced dexterity.

There are also modifications available to the handle of the toothbrush that may help improve toothbrushing ability. The handle can be modified by making it longer and/or wider or adding acrylic to mould to an older adult's grip.

Although caring for dentures and implants is easier than a mouth full of teeth, it is important to care for the natural teeth since redness or swelling of the gums is common among older adults wearing dentures that no longer fit well.

Dry mouth is very common among older adults and increases the risk of cavities and other types of infections in the mouth that can lead to pain. Dry mouth can be caused by:
 

• Medications (the most common cause)
• Dehydration (as most older adults do not drink the recommended daily amount of water)
• Radiation therapy to the head and neck for cancer treatment
• Diseases such as Sjogren's syndrome
• Smoking (such as tobacco or cannabis)
• Alcohol use (including the use of mouthwashes containing alcohol)

Healthy gums are important for the overall health of your teeth and mouth. Gum disease, which includes both gingivitis and periodontal disease, affects the majority of Canadian adults.

Healthy teeth should be free from cavities, clean, firm and intact and free from pain.

A healthy tongue should be pink, smooth, moist, and free from pain.

Research suggests that there appears to be a link between poor oral health and dementia, but the exact nature of the relationship is still unknown. However, evidence shows that older adults living with dementia may:
 

• Have more cavities than older adults without dementia
• Be less likely to visit an oral health professional compared to older adults without dementia
• Have difficulty chewing their food
• Experience pain in the mouth and they may not be able to communicate this issue to others
• Need assistance cleaning their dentures and dental implants
• Have generally poor denture hygiene

As we age, especially if we require the help of someone else, we may be facing barriers in getting oral care.

Older adults may feel uncomfortable with the caregivers' technique of physical closeness. They may feel some anxiety or fear, either because of past negative dental experiences or attitudes toward oral care. They may not be able to afford dental treatment or to physically attend those appointments because of transportation issues.

The old saying goes that it’s difficult to remember your job is to empty the swamp when you’re up to your butt in alligators. Therefore, the struggles of everyday living may override one’s ability to focus on an important but immediate health aid.

Tooth decay occurs when the hard enamel covering the teeth is affected by the bacteria (plaque) that builds up on it. Holes known as cavities can develop, and when this happens, dental treatment will be needed.

Two types of decay or cavities are prevalent in adults: root decay and decay at the edges of fillings. Cavities in older adults appear most frequently on the roots of the teeth at the gum line. Years of brushing too hard and the natural effects of aging can cause gums to recede, exposing the roots of the teeth, which are more susceptible to decay because they are not protected by enamel. Tooth or root decay is caused by bacteria (plaque), which should be removed thoroughly on a daily basis. Decreasing food and beverages high in sugar will also help to reduce cavities.

Periodontal disease is one of the most common diseases in humans. Over time, a build-up of bacteria or plaque on the teeth can cause inflammation of the gums that can spread to the underlying bone and lead to tooth loss. Swollen, bleeding gums, loose or shifted teeth, bad breath and gum recession, are signs of periodontal disease. It is important to keep teeth and gums as plaque-free as possible with professional cleanings and daily brushing and flossing.

Gum disease happens when plaque builds up where the gums meet the teeth. This can cause an infection that damages the gums and also the tissue and underlying bone. Symptoms of gum disease include red, tender or bleeding gums.

Dentures must be adequately looked after to ensure that they last. It is crucial that dentures fit well and are comfortable. They should be brushed daily with a denture care product that is non-abrasive and left in water or a denture cleansing solution overnight or for a minimum of four hours each day.

Keeping dentures clean avoids stains, swollen gums and bad breath. Full and partial dentures should be treated in the same way.

After removing dentures, the tongue, gums and palate should be gently brushed with a soft toothbrush.

Flossers are available for those who have difficulty with traditional flossing. A dental hygienist may recommend other products to clean larger spaces between the teeth or to massage gums, such as a rubber tip stimulator, wooden dental picks or small brushes (proxy or sulcus brush). Rinsing with fluoridated mouth rinse decreases cavity susceptibility.

Dental hygiene visits increase dental oral health with regular teeth cleaning.

Dentures, full and partial, accumulate food and plaque and need to be cleaned. Dentures should be brushed thoroughly to loosen food debris and reduce odours. Commercial denture-cleaning solutions do not replace the need to brush. Dentures should be brushed thoroughly twice a day using warm water and mild soap or denture paste.

I have had the good fortune of a good friend and a strong dental plan throughout the past 42 years and have enjoyed strong oral hygiene routines.

By the way, I passed my review and got the usual toothbrush and floss. (How many have I have collected over 43 years?) I’ll see him more regularly on the golf course now as he begins a well-deserved retirement.

Thanks for your help, Lee.

If it is to be it is up to me.

Stay safe, stay calm!

‘Till next time.