Oral Care and the Elderly

Oral cavities in the Elderly are more vulnerable to oral hygiene related problems and require a higher level of care. As people become more frail they are less able and less diligent maintaining their oral hygiene. Problems are exacerbated by these coincident trends.

“Oral diseases and conditions can have social impacts on quality of life, including comfort, eating, pain and appearance and are related to dentate status. Older adults need to eat and talk comfortably, to feel happy in their appearance, stay pain free, maintain self esteem and to maintain standards of hygiene they have had throughout their lives” JM Chalmers – Australian Dental Journal 2003 vol 48.

Why is Oral Health in the Older population so important?

Oral health plays an important role in the health and well-being of elderly people and therefore quality of life.

  • Pain and difficulty with eating can lead to poor levels of nutrition
  • Poor oral appearance, bad breath and dental incapacity can lead to social isolation
  • Oral disease is now implicated in peptic ulcers, respiratory and cardiovascular illness
  • Dental decay is the most costly diet related disease in Australia ahead of coronary disease, hypertension and diabetes
  • Minimise oral sources of infection to other parts of the body (e.g. bacteraemia)
  • Minimise behavioural problems
  • Main oral diseases resulting from poor oral hygiene

  • Dental decay
  • Gum disease
  • Mouth Ulcers
  • Oral thrush
  • Periodontitis
  • Contributing factors

  • Physical and mental difficulties – decreased ability to clean the teeth
  • Diets high in sugar – higher levels of bacterial proliferation
  • Low saliva flow / Dry Mouth – less benefits from saliva (Cleansing, antibacterial, protective barrier)
  • Chronic medical conditions and oral hygiene – some conditions are known to contribute to oral problems and vice versa.
  • Receding gums – bacteria attaches and cavities form – remineralisation required
  • Dentures – denture wearers often times, do not clean their oral cavity. Badly fitting or damaged dentures cause various problems
  • Reduced ability to access dental services
  • Long dental history – fillings, damaged teeth, dental appliances
  • Reduced financial status – less inclined to seek dental treatment
  • Cost/Benefit analysis

    Cost benefit studies in the US have demonstrated the cost of treating medical complications caused by untreated dental conditions was seven times more than the cost of providing the “medically necessary” dental care. (US Institute of Health, Office of the Actuary, 1988)

    Pneumonia is prevalent in the elderly, frequently caused by inhaling pathogenic bacteria from the mouth. Those with strokes and emphysema are at high risk. Nursing home studies in Japan have demonstrated preventive oral care regimes can reduce the incidence of pneumonia.

    click here for more about "The Denta-Med story"

    Common myths

  • 'Tooth loss is an inevitable part of the normal ageing process'
  • 'Most teeth are lost as people become 'long in the tooth' because of advancing gum disease'
  • 'All adults are susceptible to severe gum disease'
  • 'Today's medications do not reduce saliva flow'
  • 'Dental decay is not a common oral disease in the older person and usually occurs in the young'
  • 'Salivary flow decreases in all older people'
  • Oral hygiene for health & happiness

    Denta-Med Whole Mouth Gel has been developed for medically compromised users who have sore, uncomfortable mouths. It soothes and cleans, maintains both hard and soft tissues of the mouth. It has a prolonged effect in the mouth and has proved efficacious assisting with many oral conditions. It restores comfort, dignity and quality of life for the person affected. It reduces bacteria in problem areas of the mouth, remineralises, moisturises and restores oral health providing multiple benefits for the user.

    Important points

    Ideally, teeth should be cleaned, at least, twice daily. Rinse the mouth before applying Gel with a soft toothbrush, disposable oral swab or apply to problem areas with a clean finger. or finger brush. Denta-Med Gel is low foaming. However aim to produce enough foam to cover all parts of the mouth. Spit out the residue. It is not recommended to rinse after application.

  • Brush all surfaces of the teeth and gums
  • Work on two teeth at a time
  • Be aware of any loose teeth and brush with care
  • * Dry Mouth sufferers may wish to apply more often than twice daily. There is no recommended limit to daily application

    Denture Wearers

    Remove (full or partial) dentures. Rinse mouth. Apply Gel by rolling around the mouth with the tongue or use a disposable oral swab. Denta-Med Gel is very effective to clean dentures. For increased adhesion, line the denture with Denta-Med Gel. In addition, apply directly to any tender spots or mouth ulcers that occur under the denture.

    Denture care

  • Handle dentures with care and avoid pressure on the weakest points
  • Food debris and plaque need to be cleaned from all denture surfaces
  • Preferably use a denture brush, toothbrush and water
  • Ideally dentures should be removed at night, cleaned and stored in a container of cold water in a safe place
  • Removal of the dentures allows the mouth to rest and prevents fungal infection
  • Check the mouth for ulceration, ill-fitting dentures and food debris
  • Calculus can be removed by soaking dentures overnight in one part white vinegar and two parts water
  • Clean over a hand-basin half filled with water to prevent breakage if dropped
  • Irony and tragedy - A personal, heartbreaking and preventable true story

    "My mother was admitted to an aged care facility 2 years ago. About the time that my career focus changed to oral hygiene and dental products. My mother had always been meticulous with her oral hygiene but having grown up in post war Queensland had never had the benefits of fluoridated water. She always avoided the luxury of desserts and sweet food.

    She had had few oral problems before being admitted to the aged care facility. She had suffered from asthma and had been on Ventolin and prior technology for a long time. She now had a chronic lung problem that required frequent antibiotic treatments. I have just learned that these treatments quite often result in dry mouth. I had noticed that she was more inclined to rely on sweet meals for nutrition something she had never been interested in, previously. She complained one day that the aged care facility would give her curries despite her request not to provide her with spicy food. She had always been a food lover and I asked why she was being so picky. My new interest in oral care prompted me to ask her to show me her tongue. When she did I was shocked. Her tongue was covered with white lesions and her lower lip was spotted with what appeared to be ulcers. She was reluctant to show me the further reaches of her mouth. I had an oral hygiene product that I knew would address some of the issues but thought I would bring the condition of my mother’s mouth to the attention of the aged care facility’s head nurse.

    She told me that they can’t be expected to know of any oral health problems unless the resident brings it to their attention. My mother was bedridden at the time and needed assistance to brush her teeth. This did not always happen. The nurse did not look at my mother’s mouth but did alert the Doctor. The doctor attended her 3 days later and gave her an anti-fungal solution.

    If the infected lesions were outside the mouth a 3 day delay would have constituted criminal neglect. The next time I visited she reported that the anti-fungal treatment had much improved her mouth and she was eating again for some days but now the infections had returned. I immediately gave her the oral hygiene product I was marketing which gave her some relief. The nurses removed this product because it was not on her drug list. Even though it is regulated as a toothpaste.

    My mother was admitted to a major private hospital for a hip replacement when next I saw her. She had been intubated in the first operation and because of some event to do with this, the staff were not giving her food or water. Her mouth again was massively infected. I know this because I spent my entire two day visit swabbing her mouth with water. My mother was extremely distressed. Not about her many other maladies but about her mouth. She was dehydrated and her mouth was inflamed. She was moved many times to tears because of the lack of moisture in her mouth. The nurses were very sympathetic but appeared to have no tools to assist. Never a heavy person, my mother’s weight, by now, was life threateningly low. At no time were the multiple oral infections diagnosed or identified.

    My mother died in hospital from a lung infection a month later. I suspect because of bacteraemia from the mouth infections they seemed incapable of addressing. Ironically the private hospital involved is the first hospital to order our oral hygiene product. It is not, however, being used in the wards in which my mother was cared for. It is only used in Oncology care."