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Special Oral Health Guide for Elders

Introduction :

Dentists, negate the belief that you lose your teeth with age. Facial attractiveness is linked to self- image, social interaction and psychological health. The reasons for dissatisfaction with ones dental appearance may be due to missing teeth, the position, alignment or spacing teeth, colour of the teeth or oral soft tissues, scarring and trauma.

This associations between dento-facial attractiveness and social traits, make dental appearance a substantial concern for many people. You would be surprised to know that simple care can give you a healthy mouth and a healthy life, even as you age.

Geriatric Dentistry

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention and treatment of problems associated with normal aging and age- related diseases as part of an interdisciplinary team with other health care professionals

India is passing through a stage of `demographic transition'. The high birth rate and high death rate situation that marked population growth earlier has turned into one of moderate birth rate and low death rate. Improved health care has resulted in decline in death rate, thereby increasing elderly population. This was 56.7 million in 1991, rose to 77 million in 2001 and is expected to touch 137 million by 2021. Today, India is home to one out of every ten senior citizens of the world. Among the elderly population, those who live in the rural areas constitute 78 percent. It's sad, that in India geriatric dentistry has not received any independent status till now. With ever increasing geriatric population, it is the need of the hour to establish this branch of dentistry as early as possible.

A UN report on the changing age structure of global population has projected that by 2050 the number of elderly people, defined as aged 60 and above would exceed the number of children. A World Health Organisation's (WHO) report also estimates an increase of 300 per cent in the elderly population of Asia by 2025, augmenting the need for geriatric dentistry.

Below is detailed information on the significance of oral care for aging individuals.

Importance of Oral Hygiene

The inter relationship between oral health and general health is particularly pronounced among older people. Poor oral health can increase the risks to general health and with compromised chewing and eating abilities, affect nutritional intake. Similarly, systemic diseases and/or the adverse side effects of their treatments can lead to an increased risk of oral diseases, reduced salivary flow, altered senses of taste and smell, oro-facial pain, gingival overgrowth, alveolar bone resorption and mobility of teeth. The high prevalence of multi-medication therapies in this age group may further complicate the impact on oral health. Other relevant issues include high sugar content diets, inadequate oral hygiene due to poor dexterity, alcohol and tobacco use, risk factors that are detrimental to oral health.

Steps to maintain good oral health
  • Talk to your dentist about oral hygiene products including fluoride and desensitising toothpastes, toothbrushes, floss, interdental cleaners, oral irrigators, and mouth rinses effective for you.
  • Brush your teeth twice a day with a fluoride toothpaste. Choose a toothbrush with soft bristles. Harder bristles can wear away your enamel and damage your teeth and gums. If you have limited ability to move your shoulders, arms and hands you might benefit from using an electric toothbrush. The handle is larger, which makes it easier to hold, and the powered brush does a lot of the fine movement needed to assist with cleaning your teeth.
  • Clean between teeth daily with floss or another inter-dental cleaner. Floss holders are designed to make it easier to use floss between your teeth. Special inter-dental cleaners, such as picks, brushes or sticks may also work effectively for you
  • Mouth wash is important to kill the harmful bacteria of the mouth and offer you protection against periodontal diseases and caries. Chlorhexidine mouth wash is recommended once daily, cause your teeth need some extra care
  • Replace your toothbrush every three or four months, or sooner if the bristles become frayed. A worn toothbrush will not do a good job of cleaning your teeth
  • Regular visit to dentist is must for teeth examinations and professional cleaning
Taking care of your dentures

Dentures are the prosthetic removable replacement of missing teeth and surrounding tissues. They must be made by a certified dentist so that they fit precisely. If they are cared for properly, they do not change shape. They can become loose due to natural changes in the gums and bone supporting them. As the jawbone begins to shrink, so do the gums. When your dentures do not fit properly, see your dentist for adjustments. ill-fitting dentures can irritate the gums, tongue and cheeks. In emergencies, denture adhesives can be used to keep the dentures stable until you see the dentist.

The dentist will examine your mouth to check for any problem with the gums and ridges, the tongue and the joints of the jaw, as well as screen for oral cancer. Many adults are more susceptible to oral diseases, including oral cancer, about 95 percent of all cancers are found in people over age 40. However, many cancers are treatable if detected early. Oral tissues are also checked for signs of other diseases that first manifest themselves in the mouth.

  • Bacteria stick to your teeth and also to full or partial dentures. If you wear dentures, cleaning them on a daily basis is very important.
  • Generally, dentists advise you to remove your full or partial dentures at night. To stay healthy, the lining of your mouth needs to rejuvenate after prolonged contact with dentures. Your dentist will provide you with instructions about how long your dentures may be worn each day.
  • Denture cleaning products like denture cleansers and overnight soaking solutions, help keep dentures fresh and clean.
Diet for elderly

Many elderly people avoid meats, raw vegetables and fresh fruits because they have trouble chewing or swallowing. These problems can be caused by painful teeth, ill- fitting dentures, dry mouth or changes in facial muscles. Hence, their diet lacks calcium, protein and other essential nutrients. Elderly people can lose the inclination to eat as there is change in smell and taste. Several factors like diseases, medications and dentures, besides old age are responsible for this. At your age it is important to keep the following points in mind.

The right choice for food and healthy living can prevent oral problems.

  • Drink plenty of water:

    As your age advances there is a possibility of decrease in the flow of saliva, due to which you may experience dryness of mouth. If the flow of saliva drops considerably then problems like dental caries and periodontal diseases arise. Drinking water is one of the basic remedy.

  • Healthy food:

    Diet rich in natural fibres helps in maintaining the oral hygiene as well as providing nutrients like Vit. C, A, D, etc. necessary to maintain oral tissues. Avoid beverages like coffee, tea, carbonated drinks, which may harm your teeth. If you are suffering from diabetes, then you must follow your dietician's/physician's advise on food.

  • Quit Tobacco:

    There is no age barrier to quit. Research has now proved that quitting at any time has health benefits. Tobacco consumption increases problems with gum disease, tooth decay and tooth loss, affects healing after dental procedures and retention of dental implants.

Common Problems Associated with Elderly:

There will be gradual but prominent facial changes with ageing but on a subtle level there are alterations in lip curve, mucosal lining of the mouth, tongue, teeth, gums and in the bone that supports the teeth. Common problems faced by adults are:

  1. Dry Mouth (Xerostomia)

    The tissue on the inside of cheeks receive less blood supply and with age become thinner and has reduced elasticity. Insufficient supply of saliva may be the cause for this change. Reduced saliva flow results in a dry mouth. It is caused by certain medical disorders and is often a side effect of medications like

    • anti-histaminics, allergy and asthma medications, seizure medications,
    • decongestants,
    • anti- hypertensives, anxiety, depression and most other psychiatric medications,
    • pain killers and diuretics, pain medications, sedatives and muscle relaxants,
    • cholesterol lowering drugs, medications for Parkinson’s and Alzheimer’s disease. Some of the common problems associated with dry mouth include a constant sore throat, burning sensation, problems in speaking, difficulty in swallowing, hoarseness or dry nasal passages. Left untreated, dry mouth can damage your teeth. Extensive cavities, form without adequate saliva to lubricate your mouth, wash away food and neutralise the acids produced by plaque.

      Your dentist can recommend various methods to restore moisture, these can be sugar- free candy or gum, that stimulates saliva flow. Moisture can be replaced by using artificial saliva and also oral rinses.

  2. Infection of the Lips (Angular cheilitis/Candidiasis)

    The most common change observed in lips of the elderly patients is a type of lesion called angular cheilitis. This is the infection of fissures at the corners of the mouth. A fungal infection (candidiasis) it is caused due to lack of vitamin B.

  3. Burning Mouth Syndrome (BMS)

    Smooth and shiny tongue is a sign of Burning Mouth Syndrome (BMS) caused due to deficiency of iron (anaemia) or other minerals. It results in loss of taste or sensation. Proper nutrition and nutritional supplements would help in resolving the condition.

  4. Thinning of enamel (Dental Attrition)

    Most of the teeth turn yellowish with age, this is the result of thinning of the enamel, the outer most covering of the tooth. This is called dental attrition. Thinning is often the result of systemic diseases, improper brushing technique or due to hard bristled toothbrushes. Chipped teeth are also common at this age.

  5. Gum disease (Periodontal disease)

    Gum disease—periodontal disease—often progresses slowly, without pain, over a long period of time. Periodontitis is inflammation of the tissues that surround and support the teeth. Periodontal or gum disease causes gum recession or exposure of the root surfaces. Once this soft tissue below the enamel is exposed it becomes more prone to decay by bacteria and acids in food . The longer the disease goes undetected and uncontrolled, the more damage it causes to gums and other supporting tissues.

    Although periodontal disease is caused by plaque, other factors can increase the risk or severity of the condition. These include food left between the teeth, smoking, smokeless (spit) tobacco use, badly aligned teeth, ill- fitting bridges or partial dentures, poor diets and systemic diseases such as anaemia.

    Although periodontal disease is common, it can be controlled or arrested. In its early stages, it can be reversed. Treatment of advanced cases may require surgery. Look for these warning signs and see your dentist if you notice any of them: bleeding gums when you brush; red, tender or swollen gums; gums that have pulled away from the teeth; pus between your teeth and gums when pressure is applied; loose teeth or teeth that are moving apart; any change in your bite; any change in the fit of your partial dentures; constant bad breath or bad taste.

    It is estimated that 90% of the population have periodontal disease (gum disease) but they remain undiagnosed. Gradually it proceeds beyond gum tissue and attacks the bone.

    Research has established a link between periodontal disease and other chronic diseases like coronary heart disease, stroke, aspiration pneumonia and complications from diabetes.

  6. Dental Caries

    Elderly with increased life expectancy and longer retention of teeth suffer from tooth caries (decay). Tooth caries results when the bacteria in plaque feeds on the carbohydrates (sugar) in the diet to produce acids that cause cavities. Adults are more likely to have decay around older fillings because many adults grew up without the benefits of fluoride. Defects in the tooth surface like uneven surfaces, pits and fissures encourage accumulation of plaque.

    Root caries occur when the gums recede, exposing the softer root surface, which decays more easily than tooth enamel. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch, hot and cold. The majority of people over the age of 50 years have tooth-root decay.

Dentistry for the elderly

Sensitivity of dentists is increasing for the needs of older patients, who are aware of the oral health importance. But at the same time, they are nervous about seeing a dentist. Older patients may be less able to cope with the stress, due to certain physical conditions such as vision or hearing loss. Communication between you and your dentist, is an important aspect of a comfortable dental visit.

You should share your feelings with your dentist and the staff. Let them know that you are anxious, so that they can adjust their treatment and their pace to meet your needs. Advances in pain and anxiety control, including many behavioural therapy techniques borrowed from psychology, have made dental visits relatively anxiety and pain-free.

On a dentist visit carry
  • An up-to-date list of your medications including vitamin supplements whether prescription or over- the- counter products.
  • An up-to-date list of your medical conditions and allergies and related medical reports and records.
  • Information about your health care providers, including your doctors and their phone numbers and your previous dentist (if applicable).
  • Information about your emergency contacts.
  • Your dentures or partial dentures, even if you don’t wear them.

This information will help the dentist to select the most safe and effective method of treatment for you.

Benefits of Cosmetic Surgery

Elderly people are turning to cosmetic dentistry or aesthetic dentistry, as a way of improving their facial attractiveness and quality of life. Your dentist can describe and discuss with you the range of treatments that would be right for you from straightening, lightening, reshaping and repairing your teeth. Cosmetic treatments include veneers, crowns, tooth-coloured fillings and tooth whitening.

In this context, dental treatment of elderly can be a healthy and adaptive way of maintaining dental health and emotional well-being. Our teeth and mouth play a critical role in psychological development and well-being throughout our lives. Modern dentistry has expanded aesthetic options for people of all ages. Coupled with good oral hygiene and regular dental visits, cosmetic techniques can help improve your smile.

Dental Implants

Dental implants offer solutions for patients who cannot function adequately with conventional dentures. However, not every patient is a candidate for implants. The decision can be taken after an examination by your dentist and discussion of the benefits and risks and the procedure involved.

Steps for Good Oral Health
  • Carry the list of all your recently prescribed medications for every dental appointment.
  • Inform the dentist accurately about our overall physical health.
  • Visit the dental professional at regular intervals.
  • In case if diagnosis is required of periodontal disease undergo the recommended treatment at the earliest.
  • Avoid habits such as smoking, sedentary lifestyle, obesity etc. which affect good oral health.
  • Consult your dentist for an oral care regime to control root decay of tooth.
  • Enquire for products to soothe and stimulate salivary flow in case of dry mouth. Also seek advise about appropriate toothpastes
  • Get the bacterial plaque cleaned from a dental professional.
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