The current level of knowledge allows us to assess the dental health of geriatric patients as unstable. Elderly and senile people, as well as people with disabilities, have an increased risk of developing oral diseases. In world practice, there has been an increase in interest in the quality of hygienic oral care for this category of patients.
Dental and oral health greatly impacts your quality of life—from your daily ability to eat, speak, and communicate to the prevention of pain and discomfort.
According to research, there is a link between oral health and various diseases such as heart disease, stroke and diabetes.
Treating and preventing oral disease in older adults is also important for improving well-being and health status. Good habits, a smart diet and regular visits to your doctor can help you maintain a lifetime of oral health, including natural teeth, implants and dentures.
Common dental problems in older people
Poor oral hygiene – as a result of poor health and limited mobility or mental limitations, it may be difficult to perform activities necessary for good oral hygiene, such as brushing teeth.
Gum disease is an infectious disease of the tissues that support the teeth. These diseases can cause bleeding gums, bad breath, receding gums and loose teeth, including tooth loss. In addition, gum disease affects other diseases such as heart disease, stroke and diabetes.
Tooth decay – The risk of tooth decay increases in old age due to exposure of tooth roots due to gum recession, multiple previous restorations, sometimes incorrect, and dry mouth as a result of taking medications or after chemotherapy and radiotherapy.
Fungal diseases – Oral fungal diseases can occur at any age, but especially in people who wear partial or full dentures. Long-term use of antibiotics or steroids, diabetes, a suppressed immune system, dry mouth and poor diet increase the risk of oral fungal infection.
Denture-Related Soft Tissue Wounds – People who wear full or partial dentures may suffer from wounds developing under their dentures. In most cases, we are talking about a traumatic wound formed due to friction of an unstable prosthesis.
Oral cancer – Older adults (over 60 years of age) are at increased risk for cancer of the mouth and lips. This risk is higher in people who smoke, drink alcohol or spend a lot of time in the sun.
Elderly and senile patients have an increased risk of developing oral diseases compared to younger patients. In geriatric patients with a pronounced need for outside help, dental caries, periodontal diseases and oral mucosa are more common compared to patients of the same age category, but capable of independent hygienic care (or their need for outside care is extremely low).
Factors that increase the risk of developing dental diseases in elderly and senile patients include:
- a decrease in the secretion of saliva, associated with age-related atrophy of the salivary glands, and a change in the rheological properties of saliva (increase in its viscosity, change in qualitative composition), caused by involutive changes in metabolic processes and regulation of the activity of the exocrine and endocrine secretion gland system. Taken together, this determines the salivation causes of the accelerated rate of formation of dental plaque, soft plaque, supragingival and subgingival deposits of tartar;
- unsatisfactory hygienic care of the oral cavity, leading to the formation of a dense formation from dental plaque (within just a few hours) and retention of food debris in the mouth, which, transforming into products of putrefactive decay, are an excellent habitat for a number of pathogenic microorganisms. Plaque microorganisms colonize the tooth surface and gingival sulcus areas, contributing to the onset and progression of periodontal inflammation; the toxins released in this case (especially endotoxin) disrupt tissue nutrition, cellular metabolism and promote cell death, violating the integrity of the cellular cover of the periodontium. The surrounding tissues become permeable to the destructive action of endotoxin and its distribution throughout the body. In addition to the direct effect on tissue, the microbial flora of the oral cavity causes the formation of specific antibodies in the blood, which change the reactions of the body and periodontal tissues, in particular, increasing inflammation. Oral pathogenic microflora can cause allergic reactions in periodontal tissues and immunological disorders in the body. Elderly and senile patients, whose hygienic oral care is well established, regardless of their need for outside help, have a significantly lower number of pathological conditions and diseases of the oral cavity compared to patients of the same age, in whom hygienic oral care is carried out irregularly, from case by case. Quite often, older people with moderate needs for third-party care are able to independently carry out systematic hygienic care of their oral cavity, which indicates the justification and need for them to teach the correct skills for adequate oral care.
Recommendations for maintaining oral and dental health in old age
In order to preserve your teeth and prevent, as far as possible, oral diseases, it is important to take care of your oral and dental health.
Oral hygiene – brushing teeth and using devices to clean the space between teeth is important even in old age. It is necessary to brush your teeth twice a day with a soft toothbrush and toothpaste containing fluoride. If you have limited mobility, you can use an electric toothbrush.
Caring for Dentures – Bacteria are found on dentures just like they are on teeth. Dentures should be cleaned every day and removed from the mouth at night. To keep dentures clean, you need to clean them with a special brush. If your denture is not in your mouth, soak it in a denture disinfectant solution.
Quitting Smoking – In addition to causing other types of health damage, smoking can make gum problems worse. It has a negative impact on recovery after dental procedures and on the placement of implants. In addition, smoking increases the risk of oral cancer.
Alcohol use – In addition to causing other types of health harm, drinking alcohol increases the risk of oral cancer.
Healthy diet – a diet rich in fresh vegetables and fruits is a protective factor against oral cancer.
Monitoring and Prevention – If you experience a sore in your mouth that does not go away within two weeks, have it checked by your dentist. Oral cancer does not cause pain in the early stages, so it is important to have routine checkups with your dentist even if there are no changes in your mouth.
Treating Dry Mouth – In some cases where dry mouth is caused by medication, your doctor may be able to prescribe an alternative medication to resolve the problem. To reduce dry mouth, it is recommended to drink plenty throughout the day. You can use chewing gum or sugar-free candy, or, in certain cases, even saliva substitutes.
Prevention and treatment of fungal diseases - daily measures to maintain oral hygiene and dentures are very helpful in preventing fungal diseases. If you have a fungal infection in your mouth, you should check with your dentist. Treatment for fungal infection can be local or systemic.
Periodic dental checkups – It is recommended to have routine checkups at least once a year with your dentist. It is important to inform your dentist of any changes in your health, including changes in medications, as these changes can have a decisive impact on your dental treatment.
List of necessary daily caring actions
The choice of complex and frequency of hygiene procedures depends on the condition of the seriously ill patient. It is very important to understand what actions the patient is able to perform independently, so as not to lose the skills that are still available. Every morning, the caregiver should:
- wake up the patient;
- help relieve natural need;
- wash the genitals, change the diaper if necessary;
- carry out hygiene procedures - toilet the eyes, nose, mouth, ears;
- wipe the armpits, areas under the breasts in women;
- comb hair;
- straighten the bed, pajamas;
- prevent bedsores;
- measure physiological indicators;
- feed the patient;
- help take medications;
- follow the doctor’s individual recommendations.
Careful hygienic care ensures the comfort and well-being of a bedridden patient.
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How does oral hygiene change with age?
Age is not kind to teeth. Just like the musculoskeletal system, teeth and gums wear and change with age. Diseases, one-sided nutrition and medications, unfortunately, leave their mark: they lead to dry mouth and reduce salivation. And the latter is very important due to its antibacterial properties, which inhibit the growth of bacteria that cause caries and periodontal disease. In addition, saliva regulates the acid-base balance in the mouth and helps reduce the effects of acids responsible for disrupting the mineralization of tooth enamel and the occurrence of caries.
Proper dental care in old age
In principle, dental care in old age and young age consists of many similar stages. The difference lies in the aids and products. To make life easier for older people, special toothbrushes with large, strong handles have been created, as well as modern electric toothbrushes that make daily oral hygiene easier. As you get older, brushing your teeth thoroughly is very important. As you age, your risk of severe periodontitis and aggressive root caries, a common cause of tooth loss, increases. Unfortunately, gums recede as we age, and exposed tooth necks become a problem. In addition, the distance between the teeth increases. It is necessary to brush your teeth more carefully, for example, with brushes with rounded bristles or suitable brushes for interdental spaces. Mouthwashes and special tongue cleaners can help combat tooth decay and bad breath. They penetrate into corners that remain virtually inaccessible to electric brushes.
To eliminate conditions conducive to the development of infection in the oral cavity of geriatric patients, rinsing with weak aqueous solutions of antiseptics, for example: 2% boric acid solution, is recommended after each meal and additionally several times a day; 0.05% solution of chlorhexidine bigluconate.
Algorithm for brushing teeth at home:
It is necessary to brush your teeth thoroughly at least 2 times a day. Best of all, 3 times, each time about half an hour after eating.
Interdental spaces and hard-to-reach areas can be cleaned well with interdental brushes, which are available in different sizes.
Fluoride toothpaste helps restore the balance of minerals in teeth and reduces the risk of tooth decay.
Flossing is easier if the floss is taut on holders shaped like a toothbrush.
A tongue cleaner removes bacterial plaque from the tongue.
A specific and not too spicy mouthwash that freshens breath and kills bacteria.
How to properly clean removable dentures.
Hygienic care is necessary not only for teeth, but also for removable dentures. Contamination of dentures causes bad breath and can lead to the development of pathological changes in the mucous membrane adjacent to the denture, and also reduces the service life of dentures. After each meal, dentures must be removed from the mouth, removed from them with a manual toothbrush and toothpaste, remaining food and plaque, and rinsed thoroughly with water. It must be remembered that dentures require careful care. If done incorrectly, it can be damaged with a regular toothbrush; In addition, a toothbrush is not able to completely remove bacterial plaque and reach hard-to-reach areas of the denture. When cleaning your denture, use your toothbrush carefully. The brush must have soft bristles. When processing dentures, special attention should be paid to the following areas of removable dentures: - the inner surface of the dentures, adjacent directly to the mucous membrane of the oral cavity and exactly repeating its relief; - areas of dentures located near the openings of the excretory ducts of the salivary glands (the outer surface of the lateral sections of dentures for the upper jaw and the inner surface of the anterior sections of dentures for the lower jaw), since this is where the greatest formation of dental plaque is observed. In addition to the usual hygienic care of removable dentures, it is advisable to use cleaning tablets and powders specially designed for this purpose (for example, FittiDent tablets; Corregatabs; Protefix, etc.). The use of these water-soluble products allows you to remove types of contaminants that are difficult to clean using conventional hygiene products. Cleaning tablets can simultaneously clean and disinfect the denture. It is advisable to use them once a week. The dentures are placed in the solution for several hours, then thoroughly washed again with water. The components of the tablet penetrate into hard-to-reach areas of the prosthesis. The solution removes plaque without causing harm to the materials from which the prosthesis is made. Currently, tablets are offered not only with a cleansing effect, but also with a whitening effect. For patients with complete removable dentures, it is recommended to clean and massage all surfaces of the gums with a soft brush. Reason: Full dentures permanently cover the oral mucosa and thus prevent natural cleaning by saliva and the tongue. In some cases, this can provoke an increased tendency of the oral mucosa to become inflamed.
Flexible prostheses.
Removable dentures made of nylon or polyurethane are easy to remove from the mouth and clean by hand. The first thing to do is to rinse them with water (it is best to use boiled water), as this is the fastest, easiest and most effective way to remove food debris from dentures of this type; however, it is not sufficient for its complete comprehensive cleaning. The mechanical action of a soft toothbrush can achieve better cleaning of the denture, but it is necessary to use a special paste (flexible dentures are cleaned with a brush simultaneously with rinsing with water). Therefore, there are special solutions for flexible dentures. For some time (from 15–20 minutes to several hours), the prosthesis is immersed in a special antiseptic liquid. Solutions are sold ready-made or prepared by simply dissolving an antiseptic concentrate in water.
What to do if your prosthesis breaks?
During the use of removable dentures, a fracture of the prosthesis or its individual parts (tooth, clasp) may occur. In this case, you need to consult a dentist. If a tooth(s) on which partial removable dentures are held or supported are lost, it is possible to weld an artificial tooth to the denture in place of the lost one. Repairing a removable denture takes 2-3 days. Repairs are made without warranty.
In case of cracks, fractures, etc. Do not try to fix the denture yourself, even if urgently. Only specialists can repair the prosthesis.
Making new removable dentures takes about 1 week. The warranty period for plastic removable and clasp dentures is usually up to 1 year. During the warranty period, the prosthesis is repaired or altered free of charge. After the warranty period expires, the work is paid in full.
Halitosis.
Bad breath (halitosis) in geriatric patients occurs due to insufficiently thorough oral hygiene. Colonies of about 300 species of bacteria live in the human oral cavity. The decay process produced by bacteria of these strains intensifies during sleep, when the human oral cavity is not sufficiently washed with saliva, designed to prevent the proliferation of putrefactive bacteria. This is one of the reasons for the appearance or intensification of unpleasant morning breath. There are situations when patients produce little saliva even during wakefulness: dryness of the mucous membranes of the mouth occurs in patients after radiation therapy, against the background of long-term use of steroid drugs, hormones, antibiotics and chemotherapy; and also as a reaction to stress or to other (both somatic and dental) diseases. Dry mouth (xerostomia) accompanies diseases such as diabetes, renal failure, bronchitis, hiatal hernia, some types of cancer, sinusitis, tuberculosis, chronic gastritis, liver disease, gum disease (gingivitis; necrotizing ulcerative stomatitis, chronic periodontitis ), infected wounds in the mouth and a number of other diseases. This condition can be avoided using an integrated approach: proper hygienic oral care, dietary nutrition and, of course, treatment of the underlying disease.
Rational oral hygiene can prevent the formation of plaque and tartar, but if they have already formed, dental plaque can only be removed in a professional setting, and this should be done routinely by a dentist, repeating the professional hygiene procedure every six months. It should be understood that even competent oral care cannot replace the professional hygiene procedure indicated to the patient, aimed at the complete removal of dental plaque, controlled tooth brushing, and the use of antimicrobial agents. A professional hygienic procedure should be carried out in elderly and senile patients once every six months, and in some cases, for medical reasons, more often (the schedule is set individually by a dental specialist). Regular visits to the dental office allow the dentist to carry out in a timely manner all the preventive and therapeutic dental measures necessary for the patient, anticipating a possible deterioration in the dental (and in some cases indirect somatic) health of the geriatric patient, and also to monitor the correctness of the implementation of his recommendations. Only a specialist can correctly select individual products (toothpastes, rinses, elixirs) and hygienic care tools (toothbrushes, special toothbrushes and brushes, toothpicks, floss) and recommend a teeth cleaning method that best suits the conditions of the oral cavity. Depending on the condition of the hard tissues of the teeth, gums, oral mucosa as a whole, the presence of dentures, their type (removable/non-removable orthopedic structure), one or another cleaning method is chosen, the necessary hardness of the toothbrush, and means for cleaning the teeth of a particular patient are determined. The dentist also selects an individual hygienic regime, outlines a program of hygienic measures for a geriatric patient and must monitor the correctness of its implementation.
Professional cleaning
This option is carried out to remove accumulated soft plaque, which over time can turn into tartar, which is why the smile will no longer be so attractive.
To prevent this situation, the dentist performs procedures using special tools and products.
Before performing a professional cleaning, your dentist must conduct a thorough examination. After this, the doctor must set the patient up for the procedure. To successfully carry out the reading, rinse the nasopharynx with an antibacterial agent.
For complex operations, painkillers are used in the form of sprays and injections.
Professional cleaning is carried out in several stages:
- Removing plaque and tartar. This happens using an ultrasonic device. Additionally, manual means may be used.
- Elimination of pigmented plaque. It is also carried out using a special dental apparatus. Under its influence, the enamel brightens by 1-2 tones.
- Teeth polishing. Special products are used that contain zirconium microparticles.
- Fluoridation. At this stage, the enamel is strengthened using special drops. The process takes about 2 minutes, but during this time the enamel becomes much stronger.
- Sealing. This method involves filling the grooves of the teeth.
Most people neglect the rules of oral hygiene and rarely visit the dentist. But it's not right.
A timely visit to the dentist will prevent future oral diseases and will also help maintain an attractive appearance and a beautiful smile.
