In a review article by dental and medical experts from UConn Health, recently published in the Journal of the American Geriatrics Society, the authors outline the potential complications that can arise from poor oral hygiene in older adults and cite the role of all health care professionals in working to promote good oral hygiene in this population.
The authors concluded that all health care professionals should work to promote good oral hygiene for their older patients. Specifically, medical doctors should consider an oral examination during an annual wellness visit, especially for those patients who are not receiving regular dental care.
The need is evident. Data from the National Center for Health Statistics indicates that the prevalence of cavities is more than twice as high in older adults than younger adults. The prevalence of periodontitis -- a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth -- also increases with age. As many as 64% of older adults in the U.S. have periodontitis.
Periodontitis is associated with a variety of medical conditions including cardiovascular disease and diabetes. Patients with replacement heart valves and prosthetic joints should be particularly careful regarding their oral hygiene.
This is primarily because it is well recognized that manipulation of teeth and their support structures can result in bacteria present in the oral cavity being released into the bloodstream, which may lead to infections in parts of the body far removed from the oral cavity. Even tooth brushing for those who have poor oral hygiene can cause bacteria to be released into the blood stream and these bacteria can potentially cause joint infections and heart valve infections.
Without good oral hygiene, the use of fluoride, and regular dental care, older adults are more prone to damage to the oral cavity and the extension of infection into surrounding tissues. Tooth loss, for instance, can affect a person's ability to chew, which can lead to malnutrition. Chronic oral infection is a recognized risk factor for heart disease, and can also lead to the spread of infection to artificial joints and endocardial implants.
Researchers noted several populations of older adults who are at increased risk for oral health problems, including patients with diabetes, patients with dementia, and those in long-term care settings. Patients with dementia -- particularly those with advanced dementia -- may neglect their oral health and may be reluctant to see a dental hygienist. And, many residents in nursing homes also do not receive adequate dental care, despite federal requirements for nursing homes to provide both routine and emergency dental care. Nursing home facilities, the experts say, should adopt risk assessment tools to identify patients at high risk for poor oral hygiene and educate staff on the importance of good oral hygiene and how to provide it.
The article recommended that all older adults should have biannual dental cleaning performed by a hygientist and a biannual oral health assessment by their dentist. But keeping ahead of problems in seniors is a very complex situation involving a lot of players -- the insurers, Medicare, the medical profession, the dental profession, and the families and caretakers of seniors. I know from my own experience that as they age, many people need help from their adult children or caretakers in making health care decisions, or even getting to the office of a practitioner.
Anecdotally, I’ve had many patients who had come to me for years, but as they aged and became more frail, I would see them less because their children didn’t think they’d need to see the dentist unless they had a complaint. They simply don’t realize that this can have traumatic impact on the dental health of their parent, who may have a spiraling of oral disease and other systemic disease, which can feed off each the inflammatory bacteria present in both.
Moreover, older adults are usually on many medications, a lot of which can have the side effect of drying the mouth, which makes the prospect of oral disease increase dramatically.
If you’re the child or caretaker of an older person who hasn’t had a dental appointment in the past six months, you should remind them to make one, help them make one and/or drive them to one. It’s important for their good health, their appearance, their confidence, and quality of life.
Both our West Hartford Center office and our New Britain office is fully ADA compliant, with free off-street handicapped parking, an elevator in West Hartford, a ramp in New Britain, and they are easy in and out of. Contact us to set up an appointment, or give us a call at 860-561-2121 today!
Keep smiling,
Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut. She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121
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