Dental care just as important for the sick and elderly

Hussein Elastal, Ottawa dental surgeon

Although good dental health is important for everyone, it may not be possible for all residents of nursing homes. A reasonable explanation for this may be that the responsibility of a power of attorney authority, or a caregiver, is usually focused on making up for the basic care that short-staffed homes may not always provide with consistency. And, as several publicly funded health services are delisted to help the province trim its multi-billion dollar deficit, it’s unlikely that Ontarians will see a marked improvement in the care provided to seniors residing in long-term care facilities in the near future.

In addition, if we are all guilty of neglecting our own teeth at one point or another in our busy lives, it’s easy enough for a caregiver to let dental care for a loved one fall by the wayside. Besides, there are few among us who would even think of taking on the job of cleaning an elderly loved one’s teeth or dentures. It’s something we assume everyone does for themselves, or that health care aides in nursing homes would do for a resident without prompting from family.

If at all possible, when caring for an individual who is either physically or mentally incapable of cleaning his or her own teeth or dentures, a caregiver should inquire about the daily dental hygiene provided at a nursing home. It should be part of the comprehensive care package offered by any long-term care facility, but it may not always be implemented on a day-to-day basis. To make sure that it is, a caregiver can always insist that dental hygiene is specified in a loved one’s basic care plan upon admission to a home.

Monitoring dental hygiene for an individual who still has teeth would go a long way to preventing cavities and periodontal disease, while regular dental care for those without teeth could prevent fungal disease and other types of sores caused by ill-fitting dentures. Unwanted diseases can be avoided by simply removing dentures at bedtime and placing these in a container for overnight soaking in a cleaning solution.

The sick and elderly are often on several medications, some of which may cause xerostomia, a condition of dry mouth. This form of salivary gland dysfunction can be improved by avoiding caffeine, tobacco and alcohol and drinking plenty of water (ideally fluoridated). Also helpful are artificial saliva products such as Biotene, Oasis moisturizing mouthwash by Sensodyne, Salese lozenges with Xylitol by Nuvora, as well as the use of USFDA approved secretagogues such as Pilocarpine tablets and Cevimaline for salivary hypofunction. Caregivers responsible for a loved one with a condition of dry mouth should ask a home physician about the possibility of lowering the dose of various medications known to cause the problem. Sometimes just lowering the dose of a medication can make a huge difference in the life of an elderly who suffers from that condition.

Other adults can lower their risk of developing oral infections by chewing a sugarless, medicated gum, as recently reported by a British group of researchers. Poor oral hygiene among elderly adults can lead to debris-covered dentures and tooth decay, which can affect one’s overall health. For example, high levels of dental plaque, combined with an oral infection called “thrush”, can lead to serious illnesses elsewhere in the body, such as pneumonia. Therefore, an easy-to-use method for oral hygiene could help improve the overall health of any elderly person.

People with dementia or other conditions affecting their physical or mental status are most vulnerable to dental problems. In fact, there are several health conditions which can interfere with regular oral hygiene, and possibly become a contributing factor to dental disease. These conditions would include movement disorders such as Parkinson’s, cerebral palsy, atrophy, tremors, dystonia, dyskinesia, chorea and tics; cognitive impairment such as Alzheimer’s and Huntington Disease can be added to this list, as well as musculoskeletal conditions including osteoporosis, Paget’s Disease and arthritis. Other health problems likely to lead to dental problems include diabetes, hypertension, coronary artery disease and stroke, all of which further confirm the importance of monitoring an elder’s dental health.

Lastly, if a resident of a long-term care facility is able to transfer from bed to chair easily, regular visits to a dentist are highly recommended. Depending on the availability of a caregiver, of course, and the mode of transportation required for an elderly person who is wheelchair bound, bi-annual visits to the dentist would be good preventative medicine.