6 Important Steps in Caring For the Oral Health of Adults as They Age

It’s quite interesting to see patients mouths throughout the years when things like arthritis settle in, dexterity decreases or heaven forbid a stroke renders them unable to do what used to be the everyday mundane.  Once was what a somewhat simple task becomes quite difficult, and even impossible to do by themselves.For families and caregivers, one of the most frustrating populations to deal with can be the oral health of dementia and Alzheimer’s patients, especially when they are in a care facility. 

Family members of these patients often complain when they are in assisted living facilities, and as health declines, that the care of the mouth is something that goes by the wayside.

Patients with heavy plaque and unhealthy gums are more likely to deal with respiratory infections and are subject to many other illnesses, including blood sugar issues and issues with regulating medications. In reality this would be the only time that dentures would be a good alternative, but that is ONLY if they already have them.

People who have no teeth have fewer infections because the bacteria from the mouth is not going directly into the bloodstream via the gum tissue…..but please, do not rush grandma to the dentist to have her teeth yanked out, the multiple open sores and healing would be far worse, and learning to deal with a denture is not an easy task for many people.  Instead, you may find it helpful to know that there are a few tricks and tips that make dealing with the health of the mouth easier.

Here is a list of 6 things you can do to make oral health care easier for adults as they age.

1. If your time is limited, deal with the areas that build up quickest first. This is usually the insides of the lower teeth, and the gum, line throughout the mouth. Using a smaller and softer toothbrush will allow you to brush the gums without scouring them. When plaque is heavy and tissues are dry, they become very delicate and bleed easily.

2. Good saliva flow is key. When you don’t have enough saliva the chemistry of the mouth goes haywire, and the acids go crazy! Plaque becomes extremely sticky and any carbohydrate that is eaten contributes to plaque buildup, which leads to cavities and gum disease. Furthermore, every time a carbohydrate is taken in, the pH of the mouth increases for 20 minutes.Use products that stimulate salivary flow like xylitol throughout the day and evening to buffer the pH and increase salivary flow.
   
   Xylitol is a sugar replacement that comes from North American Birch, corn, and other vegetables. Our body even produces small amounts of xylitol daily. Xylitol discourages plaque from sticking to more plaque, it helps to deactivate cavity causing bacteria, stimulates salivary flow and remineralizes teeth. It does not cause blood sugar spikes (xylitol has a glycemic index of 7 where as table sugar is 68) and is diabetic safe.Please note that we recommend 100% North American Birch because the corn has a GMO issue, and is likely manufactured in China. 100% North American Birch is more expensive but is made in the USA and has no GMO issue. To read more about xylitol, click here.
   
   In order to be effective it is recommended that you have 6-10 grams a day of xylitol, and dividing it up into at least 5 doses. Effectively after each meal and a few during the day will get you to the recommended amount, but if the mouth is really dry, you may need more. Xylitol comes in the form of mints, candies, lollipops, gum, granular (similar to table sugar), coffee sweetener, mouth rinse and “ice chips”.

3. Rinse with water throughout the day. A good swish with water is nearly as effective as any of the brand name stuff. If you want to use a mouth rinse, make sure it is alcohol free. Again, xylitol rinses are helpful in relieving dry mouth and decreasing the likelihood of cavities and gum disease. You could always just dissolve a teaspoon of xylitol in water to sip throughout the day.

4. Use a tooth paste that has a mild flavor. Try to avoid mint flavoring, Sodium Lauryl Sulfate (SLS) and Triclosan. Mint can be harsh, and fruit flavors tend to help with saliva flow. If you choose a tooth paste that has fluoride in it, make sure it is Sodium Fluoride, and not Stannous fluoride which can stain teeth or even turn them black.
   
   SLS (Sodium Lauryl Sulfate) rids the mouth of all of the oils both good and bad and is known to cause canker sores. Triclosan, although it isn’t a fluoride it should be avoided as it is an antibacterial agent found in anything from toothpaste to hand soap to deodorant. Many people find Triclosan harsh on the “skin” of their mouths.
   
   Squigle toothpaste is designed for dry mouth suffers and the aging population. It has the highest concentration of xylitol (36%) and is available in both fluoride and fluoride free formulas. The benefit to using the non fluoride formula is that it can be left in the mouth vs. needing to rinse it away. Leaving toothpaste in the mouth that contains xylitol helps to remineralize the teeth and protect the mouth from acids.

5. If you can use an electric toothbrush, use one that makes a difference. Using a rotary toothbrush is the most effective toothbrush for this situation. A rotary toothbrush is one that spins in a full 360 circle and is mimicked after the polishing tool you get at the dentist. The pointed heads make it easy to get under the gums and in between the teeth. To date there are 2 of these on the market. One is a Rotadent, and the other is a Revolation. The Revolation is the newer version and has a UV sanitizer in the charging base which helps keep the bristles clean.

6. Use Xylimelts to help control moisture and stimulate saliva flow. Xylimelts are little disks of xylitol that stick to the gum just above the upper back teeth (molar teeth). As the xylitol dissolves saliva is stimulated, plaque is controlled and the acids from the mouth are decreased. Xylimelts can be used for overnight use, but can also be used throughout the day as well.

I’ve always enjoyed seeing elderly patients. To me, there is something beautiful and tragic about life and how you go from complete dependency as an infant, to the independence of an adult, and then you are faced with the possibility of returning back to a dependent or somewhat dependent state as you grow old. I’ve seen it first hand with my grandparents, and I’ve watched it with the patients I see.

As an Oral Health Coach I am happy to work with anyone that is experiencing frustration with this difficult time. A few good lessons with an oral health coach can help both families and caregivers work together in this situation that is often left untreated. Oral Health Coaching sessions are easy to do online via Skype (and many other telecommuting channels), or if you are in the Orange County area we can meet in person. 

Click here for contact information.What do you find is the most frustrating thing in caring for the health of a loved ones oral health?  Leave a comment below, and let's see if we can figure out a way to make it easier.

References:http://www.ncbi.nlm.nih.gov/pubmed/7488359http://xylitol.org/about-xylitolhttp://www.beyondpesticides.org/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946730/