Helping Someone You Care for Keep their Pearly Whites

The good news: With advances in fluoridation and dentistry, increasing numbers of older adults are keeping their teeth. And the more teeth you have, the longer you live.

The not-so-good news: Those who have kept their teeth are prime candidates for late-life cavities and gum disease. Both can be painful and lead to system-wide inflammation that plays a significant role in worsening several medical conditions, including diabetes, heart disease and pneumonia.

This new reality means if you care for an older loved one, you need to make sure they are caring for their teeth. And not just so they can keep cavities and gum disease (periodontitis) at bay.

“The mouth plays a major role in people’s self-image and over-all sense of well-being,” says Dr. Kavita P. Ahluwalia, Director, Postdoctoral Program in Dental Public Health Associate Professor of Dental Medicine at Columbia University Medical Center in New York City.

The big 5

“A lot of things are coming together to promote cavities, gum disease and other conditions that lead to tooth loss and poor oral health,” says Dr. Peter DeGolia, Director of the Center for Geriatric Medicine at University Hospitals Case Medical Center in Cleveland, Ohio.

The most important of those “things” are:

  • Dry mouth (xerostomia) Hands-down, the 30 percent drop in saliva production that comes with aging – and the acidic environment it creates in the mouth – is themajor factor contributing to tooth and gum problems.
  • Medications “There are over 400 medications – for high blood pressure, incontinence, depression, neurologic conditions, etc. – that can cause or worsen dry mouth,” says Dr. Marco Rouman, DDS, MFDS, head of Case Western Reserve University Dental School’s new geriatric dentistry program.
  • Plaque The production of oral plaque – a gummy andcorrosive mix of bacteria, food particles and substances found in saliva – explodes as the mouth becomes dryer and more acidic.
  • Receding and inflamed gums Gums recede naturally with age, leaving the roots of teeth exposed to plaque. Plaque build-up leads to gum inflammation which, says Dr. DeGolia, “sets the stage for late-in-life tooth loss.”
  • Bone shrinkage — Age-related shrinkage of jaw bones leads to ill-fitting partial and full dentures; mouth, palate and gum sores; and chewing and nutrition-related problems.

The fact that all these “things” increase as a loved one is dealing with functional decline — due to worsening chronic conditions, such as arthritis or osteoporosis; progression of a neurological disease, such as Parkinson’s; or advancing Alzheimer’s disease or a related dementia – can lead to apathy about dental care or resistance to care.

“Most often resistance to care is due to some form of dementia,” says Dr. Rouman. “For that reason, it’s always recommended that as soon as a person has received a dementia diagnosis, that they get as much of their future dental work done as possible.”

The basics

There’s no getting around the fact that helping a loved one with his or her dental care needs, or providing care, can be challenging. That help (or care) begins with making sure the person is:

  • Using a saliva substitute Sugarless gum and hard candy stimulate saliva, but if they don’t work, there are many commercial products available, says Dr. Degolia. “They don’t just address the dry mouth issue,” he adds; “they make a significant improvement in people’s quality of life, too.”
  • Brushing with the right brushFor everyone, that means a toothbrush that they can hold, which for some people means brushes with modified grips. For some, especially those with functional concerns, it may mean an electric or sonic toothbrush. For those using dentures, it means two brushes: one for the mouth and one for the dentures. “With brushes, and all oral care products, there are a lot of choices, so get the dentist’s assistance in making the right choices,” advises Dr. Rouman.
  • Using an appropriate tooth cleaner Products for sensitive teeth and that include enamel strengtheners are best. For those who have swallowing and/or spitting problems, gels, which don’t create much foam or require constant spitting and rinsing, are probably the best choice.
  • Rinsing: Antibacterial mouthwashes keep plaque at bay and freshen breath. Rinsing with water several times a day helps with bad breath and dry mouth.
  • Seeing a dentistOlder adults should see a dentist twice a year: three times a year after 75. And, advises Dr. Degolia, those with complex oral problems or cognitive decline should probably see a geriatric dentist because “they have the skills and comfort level to work with those individuals.”

Paying for care

Most private insurance plans (including Medicare “advantage” plans) cover only basic dental care. While dental services may be covered through regular Medicare) and some may be available through state Medicaid programs, they are provided only in specifically designated situations. That means dentists’ visits and procedures must be paid out-of-pocket.

To keep those costs manageable, check out local dental and dental hygienist schools, most of which have “clinics” that provide low-cost care. To find a dental school in your area, go to the American Dental Association web site

Federally Qualified Community Health Clinics also provide low-cost basic dental services for those with limited or no dental insurance.

If a loved one is enrolled in Medicaid and resides in a nursing home, he or she may be eligible for the Incurred Medical Expense benefit which can often be used to pay for dental services. To find out if he or she is, consult his or her Medicaid Caseworker.

The not-so-basics

Since dental health and physical health are linked, your loved one (or you) should make sure that what’s going on in the dentist’s office makes it into his/her primary care physician’s, specialist’s and pharmacist’s records. “It’s very important for everyone to be communicating,” said Dr. Rouman.

Independence is a big and constant concern for older adults and, in some cases, the person you are caring for isn’t going to be all that forthcoming if they are having dental or mouth problems. That means you need to be on the look-out for signs that all is not well.

“Pain,” says Dr. Ahluwalia, “is a major indicator that there is a problem and people are usually pretty good about telling you about that…But there are others, too: avoidance of foods they once relished, a hand to a cheek, a bad mouth odor, popping or clacking dentures or wearing them only when they go out.”

“Picking up on those clues,” she adds, “means constant vigilance and recognizing what you are seeing and hearing.”