Updated November 13, 2021 – Good oral health is important for older adults to help prevent oral infections and tooth loss. Oral health problems and gum disease can contribute to heart disease, dementia, strokes, pneumonia, and high blood pressure, as well as insulin regulation problems in diabetics. Infections could damage heart tissue. Missing teeth and ill-fitting dentures make eating difficult, leading to inadequate nutrition.
As a dental hygienist, elderly patients ask me all the time if they will lose their teeth with old age, then go on to tell me it won’t matter if they do. Many people think that dental problems in the elderly won’t affect their general health, but they are wrong.
Why Is Oral Health Important In The Elderly?
People often don’t realize how important the care of your teeth is to your body’s overall health. This can be especially true for seniors.
Elderly Dental Problems Contribute To Health Problems
The Centers for Disease Control and Prevention (CDC) reports that, “Chronic diseases that may impact oral health and the need for care, such as diabetes and osteoporosis, are common among the older population, and poor oral health may contribute to the risk of certain conditions.”
Seniors 65 and older have an average of 9.24 decayed or missing permanent teeth and 43.02 decayed and missing permanent surfaces.
National Institute of Dental and Craniofacial Health
Today’s elderly individuals have lived their whole lives with the idea that tooth loss is inevitable, but here’s the thing – it’s not. Teeth don’t fall out just because you age. In fact, I’ve treated many senior citizens in their late 90s and early 100s who have kept all of their natural teeth.
However, that wasn’t always the case. When I started in dentistry in 1983, many of the patients in our practice had lost some, if not most of their teeth due to decay or the belief that you were going to lose your teeth, so why not just pull them instead of fixing them?
I’m happy to report that thinking has shifted and now, “Edentulism [the loss of all teeth in the mouth] prevalence declined from 18.9% in 1957-1958 to 4.9% in 2009-2012, a relative reduction of 78%,” according to a study by Slade, Akinkugbe, and Sanders of the Department of Dental Ecology at the University of North Carolina at Chapel Hill.
Elderly Oral Health And Systemic Diseases
Many people don’t realize that poor dental health can contribute to serious problems throughout the body.
A lot of research over the last two decades has focused on at oral health and systemic diseases. The National Center for Biotechnology Information (NCBI) noted that several studies have looked at the relationship between poor dental hygiene and chronic diseases in older Americans in the age group from 65 to 84.
They report that “…there is some scientific evidence to support the proposition that local periodontal infection may be an independent risk factor for certain diseases, including diabetes, cardiovascular disease, dementia, pulmonary infections, some types of cancer, kidney disease, erectile dysfunction, and preterm low-weight birth.”
So – aside from making day to day life more miserable, tooth loss and cavities can severely and adversely impact physical health, particularly for frail seniors.
- Periodontal (gum) disease carries a higher risk of heart disease and stroke, says the American Academy of Periodontology (AAP).
- The AAP also reports that recently, scientists “uncovered a potential link between P. gingivalis, the bacteria associated with periodontal disease (commonly known as gum disease) and Alzheimer’s.”
- We’ve known for decades that coronary artery disease and heart conditions can be worse in people who don’t take care of their oral health. Over my thirty-plus years in dentistry, I have seen many patients who came in to the office because their cardiologist “made me”. In fact, the American Dental Association (ADA) reports that, “Several studies link chronic inflammation from periodontitis with the development of cardiovascular problems. Some evidence suggests that oral bacteria may be linked to heart disease, arterial blockages and stroke.”
- “There is a strong link between tooth loss and malnutrition,” says AARP. “Among older patients who received treatment at the Rutgers School of Dental Medicine clinic, more than 25 percent showed signs of malnutrition or were at risk for malnutrition.“
- Some studies suggest that periodontitis can inhibit the body’s ability to control blood sugar levels in those with diabetes, according to the American Dental Association (ADA).
- The Mayo Clinic reports that, “Certain bacteria in your mouth can be pulled into your lungs, causing pneumonia and other respiratory diseases.” This is often seen in seniors who are in nursing homes or who have caregivers who aren’t aware of the need for good oral hygiene.
What does all of this mean for seniors? Changing our behavior can have a huge impact on oral health, but many seniors don’t take care of their teeth, either because they don’t see the need to do so or because they physically can’t.
Reducing Cavities and Tooth Infection In Elderly
Cavities (the technical term is “caries”) and tooth infection are the result for anyone who doesn’t (or can’t) take care of their teeth and oral health. For seniors, these conditions can also come from:
- medications that cause dry mouth (there are more than 400 types that can cause it, according to Dr. Pyle)
- arthritis or other impairments to dexterity or holding small objects, making them physically unable to brush or floss their teeth
- depression
- cognitive issues like dementia or Alzheimer’s
- inability to stand at the sink long enough to clean their teeth
- physiologic changes in the body, such as gastric disturbances (causing acid reflux) or vision changes (can’t see well enough to be sure they’ve properly brushed their teeth).
While some physical issues can’t be changed, there are products on the market that can help the elderly take steps to better oral health (and better physical health).
Products That Help Dry Mouth (Xerostomia)
Aging can cause xerostomia (dry mouth) because – let’s face it – everything dries up as we age. Eyes feel grittier, skin gets drier, and natural saliva flow decreases.
Medications can cause such a dry mouth that I have seen patients who lick their lips almost constantly while talking to keep their lips and tongue from sticking to their teeth. Even common medication like those for hypertension or antihistamines can cause a dry mouth.
Medications also can have a cumulative effect – and taking more than one can make an elder’s mouth even drier.
The problem with impaired saliva flow or dry mouth is that the plaque and bacteria that would normally be rinsed off the teeth is sticking to them instead. When oral bacteria and plaque stays on the teeth, it releases acids that break down the tooth structure.
This leads to cavities and seniors are particularly prone to getting them on the softer root surfaces of teeth. When a cavity forms on this soft tooth structure (called “dentin”), they can spread fast, especially in someone with a dry mouth. I’ve seen people who had a tiny pinhole-sized cavity come back six months later with the tooth half eaten away.
To combat dry mouth, we recommend:
- drinking and swishing lots of water throughout the day
- avoiding sugary and acidic drinks like soda, lemonade, sweet tea, or energy drinks
- sucking on only sugar-free hard candies. The kind that contain sugar will worsen tooth decay
- using an alcohol-free mouthwash (alcohol further dries out the mouth)
- staying away from salty foods and dry foods like crackers and pretzels (salt will dry out oral tissues even more and dry foods stick to teeth, which can cause or hasten cavities)
- avoiding eating or drinking close to bedtime. I know of one couple in our dental practice who liked to indulge in “just one piece” of dark chocolate right before bedtime. They both lost a tooth and had several cavities in the space of two years before figuring out what was causing the problem.
Products that can help ease dry mouth are saliva stimulants (such as sugar-free gum) or saliva replacements. Dry mouth lozenges that contain xylitol are a great option, as well.
Dry Mouth Lozenges:
I like that they use xylitol as a sugar-free sweetener. Xylitol has been shown to actually kill cavity causing bacteria. In certain amounts, it helps reduce dental caries (cavities), although this product doesn’t contain enough xylitol to do that.
One thing to be aware of – too much xylitol can cause diarrhea. I think someone would have to be sucking on these constantly to get enough to cause that side effect, though.
Dry Mouth Spray:
In my office, we recommend Biotene Moisturizing Mouth Spray as a saliva replacement. The spray instantly relives dry mouth. It’s good for carrying in a purse if the senior goes out or for keeping it on the nightstand by the bed for relief at night.
In a 28-day study, Biotene provided relief from dry mouth symptoms for up to 4 hours after application.
Oral Hygiene Products For The Elderly
There are certain products that I always recommend to my senior patients in order to help them maintain their dental health. These include toothpastes and mouthwashes that contain fluoride to keep soft root surfaces hard, therefore less likely to get cavities.
Power (electric) toothbrushes aid in removing plaque from hard to reach places and make it easier to do so for seniors who have weak hands or arthritic fingers.
Water flossers are an easy way to remove plaque between teeth and under bridges, especially for elders who don’t have the finger dexterity the formerly had.
Toothpaste And Mouthwashes
Toothpastes and mouthwashes that contain fluoride are a must for senior patients – especially for an elder in a nursing home or memory care setting. Often, they aren’t given as much one-to-one care as their loved ones hope for and oral care tends to be mostly neglected.
Fluoride is a naturally occurring substance. Our bodies need some fluoride.
Seniors who have dental restorations like crowns (caps), implants or bridges often can’t clean around them very well. This leads to cavities on vulnerable root surfaces. Fluoride helps harden these tooth surfaces to reduce the chance of decay.
Electric Toothbrushes
At minimum, I always recommend an electric toothbrush for everyone (not just seniors). I use a Sonicare myself, as does everyone (staff) in my dental office. I’m one of those people who builds up a lot of plaque and tartar, so I can vouch for how well these toothbrushes can clean.
The basic Sonicare model provides up to 31,000 brush strokes per minute. This means that it removes up to 7 times the plaque that a manual toothbrush can. Try doing that with a manual brush!
With an electric toothbrush like this, a senior with dexterity issues only has to hold the Sonicare in place – they don’t have to actually brush with it. Because the brush moves by itself, the user doesn’t have to try to manipulate it if they are trying to brush a hard to reach area.
The Sonicare brushes also have soft bristles and built-in pressure sensors, so they are gentle yet effective. Plus, they are rechargeable, so seniors don’t have to worry about trying to keep batteries on hand.
Even if they don’t use a Sonicare, get your senior loved one an electric toothbrush with a timer. People only brush for roughly 30 seconds, but you need to brush for two minutes to effectively remove plaque and bacteria. The Sonicare has a built-in timer that alerts you to change to a new side of the mouth every 30 seconds.
Water Flossers
Okay, us dental professional always tell people to floss, right? Well, for seniors with crowns and bridges, I don’t.
Wait, what?
Here’s why: bridges can be impossible for a dental professional to clean, much less for a senior who may not have as much dexterity. If they can’t see well enough to get those tiny floss threaders under a bridge on the back teeth, people will stop trying to floss it. Ever.
That’s not good because food particles get caught under bridges and then the bacteria just sits there, eating away at the soft tooth roots underneath. Water flossers have enough power to flush that trapped food out.
Also, many water flossers have special tips that can be used to clean out the deep pockets that form around teeth when someone has gum disease.
These oral irrigators are easy to use – just fill the reservoir with water, hold it close to the teeth, and aim it so the water jet goes between the teeth. Because they need to be big enough to have a reservoir, water flossers are usually easy for arthritic fingers to hold, too.
I usually tell people to get the cordless, waterproof model that can be used in the shower or bath. Water flossers can be a little messy until you get the hang of them. One slight drawback to these “travel” models is that the smaller reservoir might need to be filled more than once while an elder is using it.
There are also water flosser countertop models that hold more water and don’t need to be refilled as often. The disadvantage to these is that they can take up a lot of space if you have a small bathroom. Also, the device is just sitting out on the counter all the time.
Note: seniors can also find electric toothbrush/water flosser combos. These are electric toothbrushes that shoot water from between the bristles as the user brushes – sort of one stop shopping! These are countertop-only, there isn’t a cordless option that I know of.
Adaptive Oral Hygiene Products For Seniors
Grip Aids: For a senior who has arthritis and can’t grip a toothbrush, try a NuMuv Multi Use Grip Aid. They are soft, silicone grips that can be used with not only toothbrushes, but also eating utensils, pens and pencils, etc.
A similar product is a grip strap. These are silicone strips that have holes on both ends. Sliding it over a toothbrush creates sort of a handle that the elder can slip over their hand.
For caregivers who are brushing a senior loved one’s teeth, look for something like the Super Dental Mouth Prop. It’s a soft, reusable device that fits between the person’s teeth and helps them keep their mouth open without strain. This reduces jaw pain.
Disposable Toothbrushes: A good choice for brushing the teeth of a dementia or Alzheimer’s patient could be disposable toothbrushes. These are usually soft foam swabs that won’t hurt sensitive gums.
These would be good for someone who has swallowing difficulties because they won’t have to rinse and spit. They can simply swallow normally. You can get them with or without flavoring and can also use them with toothpaste if spitting isn’t an issue.
Keep Up With Dental Hygiene, No Matter What Age
Hopefully I’ve given you enough information and ideas to keep yourself or your senior loved one from having to worry about cavities and tooth loss.
To be sure an elder has the best chance of having a healthy mouth, make sure they brush twice a day (preferably with an electric toothbrush). And, it’s especially important to brush right before bedtime.
They should also floss daily or use a water flosser.
And, it goes without saying that they should see their dentist at least twice a year for a professional teeth cleaning and exam (even if they have no teeth left!). Seniors often have high decay rates, so you want to be sure any cavities are caught in the early stages, to prevent infections and tooth loss.
Even if your senior loved one is in a nursing home or assisted living facility – if possible – make sure that they keep up with their dental care and that they make and keep regular dental appointments. “Thousands of people a day who are in nursing homes often go without their teeth being brushed. The bacteria that arise as a result of the poor care often are resistant to antibiotics, and contribute to infections that are commonly found in these places,” says Frank Scannapieco , Professor and chair for the Department of Oral Biology at the University of Buffalo.
If you are a caregiver who helps seniors with personal care, we have an article on How To Help Elderly Brush Their Teeth.
