|Dental health of residents in aged care facilities|
|Wednesday, 11 March 2009 18:41 | Print page:|
This article is a brief summary of issues that were identified by the Mobile Dental Clinic and others, as important for the general dental health of residents of RACF, and the ageing in general.
It is well documented that the population is ageing (including the current practising dentists). More people are retaining their natural teeth longer, more people are residing in their own homes for longer, the next few years will see a lot of the "baby-boomer" dentists retiring also, and the polypharmacy for patients living longer is getting much more complicated.
Many people still think of "dental health" as only related to the teeth, when in fact there is much more to be considered. The gums, all other oral tissues including bone, the swallowing ability, saliva flow and quality, any trauma, eating ability, and just general comfort are some of the less obvious areas considered by dentists when assessing an elderly person’s mouth.
The older generations especially often still only think in terms of (a) ‘Am I in pain now?’, and (b) ‘Can I chew my food?’.
There is much more to consider, and every year we are seeing more research linking dental health to general medical health (and thus to longevity).
Some aspects of the ageing mouth
Figure 1 and Figure 2 (picture below) unfortunately are not uncommon examples of mouths of elderly patients:
In Figure 1: only the lower front teeth remain and there is no replacement for the back teeth. There is little saliva for lubrication and to aid remineralizing of the teeth. We can see there is much new decay (especially around the necks of the teeth), some of which has been there for some time untreated.
This pattern of decay is typical in an elderly mouth, especially if dry and with a compromised oral hygiene. As a general comment, darker leathery decay is slower spreading compared to very soft yellowy decay which is more aggressive.
We should also not ignore the very real issues of self esteem and appearance that can be adversely affected by such dental conditions. Clarity of speech and an ability to communicate are also important considerations that affect our elderly, and oral health may be a factor to a varying degree in all these issues.
In Figure 2: we see the upper arch of the same patient. As well as more decay, here we see sharp broken teeth as well, which could cause trauma to the lips, cheeks or tongue.
The skin of the elderly becomes very friable, and the lining of the mouth is no different.
Ulcers caused by sharp edges or damage while brushing can make chewing or swallowing difficult and painful.
But we also note that what saliva is present is frothy. This is not normal.
There are two types of saliva coming from different types of glands in the mouth: They are basically the runny (frothy) type and the stringy type.
Saliva is a whole complex topic in itself - but probably of more interest to oral health professionals!!
Quantity and quality are important however, both to fight decay, and to lubricate tongues, cheeks, and dentures etc.
We need saliva to help dentures stay in place too – for example, two sheets of wet glass are much harder to separate (are more cohesive) than two sheets of dry glass.
The other thing we should note is that while this patient has upper and lower teeth, they will not meet well for chewing.
So the food will not be easily broken down as the first step to digestion and access to nutrition and nutrient absorption by the stomach.
What can you do as a carer?
2. Poor saliva flow:
3. Poor mastication (chewing) of food:
Oral health is a very complex issue which unfortunately is going to become even more of a problem than it is already. It can be a very expensive issue to address also, and requires a lot of resources applied to the problem. With a better understanding of some of the science of dentistry, there are however some things that carers and the elderly alike can do for themselves to reduce the risks and issues, by prevention and early intervention.
I trust that this short article has highlighted some of the issues or oral health that a lay person can observe and then seek treatment for if appropriate.
By: Dr Richard Outridge, B.D.Sc.(Qld), General Practice Dentist - Date: 29 February 2009
We welcome your comments on this article. Comments are submitted for possible publication on the condition that they may be edited. We also require a working email address - not for publication, but for verification.