Oral Health for Older Adults
Published: 16 August 2020
Published: 16 August 2020
Poor dental health has been linked to heart disease, stroke, diabetes and even certain cancers (Jordão et al. 2019).
While oral health issues are not inevitable with age, older adults over 50 are significantly more likely to experience problems with their teeth and gums (Ngai 2019).
We need to consider the mouth care we are delivering to our older patients - particularly those who are residents in aged-care facilities, where oral and dental disease are prevalent (VIC DoH 2018).
Hospitalisation is also linked to a deterioration in oral health, especially for patients who are intubated (Terezakis et al. 2011).
Oral health can be defined as ‘the ability to eat, speak and socialise without discomfort or active disease in the teeth, mouth or gums’ (AIHW 2018).
It is integral to a person’s overall wellbeing and quality of life and contributes significantly to positive ageing (SA DoH 2020a).
Oral health comprises:
(SA DoH 2020a)
There are a number of reasons why older adults are more likely to experience oral health issues.
Older adults are increasingly more likely to retain their natural teeth, which require routine care. Due to functional decline, cognitive impairment, frailty, comorbidities and other issues commonly associated with ageing, older adults may become less able to self-manage their oral health. This, in turn, increases the risk of disease or infection (SA DoH 2020a).
There are also physiological changes to the mouth that occur with age. Teeth become brittle and more prone to chipping or cracking, allowing bacteria to enter through the damaged areas and cause decay. The production of saliva - which helps to clear food particles, reduce bacteria and neutralise damaging acids - also decreases, leaving the mouth dry and the teeth more vulnerable to decay. Dry mouth, also known as xerostomia, affects about 25% of older adults (Ngai 2019).
Medicines may worsen the issue, as polypharmacy and common medicine classes can cause xerostomia as a side effect. This can lead to decay, oral infection or even aspiration pneumonia. (SA DoH 2020b).
Other factors that contribute to oral decline include a weakened immune system, lifestyle risks such as smoking, drinking and diet, and menopause - which may cause xerostomia or tooth loss (due to bone thinning) (Ngai 2019; ADA 2016).
On top of this, there are significant issues surrounding oral health in Australian residential care due to insufficient staffing, lack of training and oral hygiene being an overall ‘low priority’. This may exacerbate any existing oral health issues (Bite Magazine 2019).
Poor oral health can significantly affect an older adult’s wellbeing and quality of life.
(SA DoH 2020a)
Poor oral health may also cause:
(SA DoH 2020a, c)
Condition | Type of issue | Signs to look for |
Angular Cheilitis | Lips |
|
Glossitis | Tongue |
|
Candidiasis (Thrush) | Tongue |
|
Gingivitis | Gums and tissues |
|
Periodontitis | Gums and tissues |
|
Oral cancer | Gums and tissues |
|
Ulcers and sore spots | Gums and tissues |
|
Stomatitis | Gums and tissues |
|
Xerostomia | Saliva |
|
Tooth decay | Natural Teeth |
|
Root decay | Natural Teeth |
|
Dentures that need repair or attention | Dentures |
|
Poorly fitted dentures | Dentures |
|
Poor oral hygiene | Oral cleanliness |
|
(Adapted from SA DoH 2020c)
The best way for healthcare professionals to improve and care for the oral health of clients is routine assessment.
Your facility should have a standardised assessment that all staff are trained on and are familiar with. It should assess and record all of the components of oral health:
This assessment should be carried out and recorded upon admission (or as close as possible) and followed up on a frequent basis to ensure changes are monitored and can be treated in a timely manner.
Oral hygiene should be assessed twice per day (VIC DoH 2018).
Developing a personalised oral health care plan for each resident is a key step in ensuring that good mouth care is maintained.
Once problem areas have been identified, it’s important to put a specific oral health care plan in place, ensuring that the necessary treatment is carried out and the overall health of the mouth can be improved.
Some older adults may resist oral care, especially if they have dementia or delirium. They may:
(SA DoH 2020a)
The following are some strategies for working with this behaviour and helping the client feel comfortable while performing oral assessment and care:
(SA DoH 2020c)
There are also techniques that can be attempted to improve access to the client’s mouth. Start by bridging and move down the list in order until you find a technique that works.
(SA DoH 2020c)
An effective oral health care plan will involve the documentation of assessment findings along with any barriers to effective hygiene.
The plan should also include which tools and products are to be used to maintain good oral health care. These might include:
It is important to involve the patient and encourage participation in their own oral health care as much as possible. It is crucial, therefore, that the following is also included:
It is important that clients have access to professional dental care on a regular basis – including routine examinations.
The final priority for any hospital or aged care facility is to ensure that training is appropriate for the oral needs of the clients.
Clients should be encouraged to:
(SA DoH 2020a)
Oral health can have a dramatic effect on the overall health and wellbeing of clients.
Staff should be aware of oral health care including barriers, obstacles, the effects of diet and medicines and how to perform the right care for the needs of each client.
Good oral health care should become ‘part and parcel’ of life at your ward or care facility rather than something you ‘have to do’, and is a case where leading by example can go a long way.
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Question 1 of 3
Sophie is a resident in an aged-care facility. She has dementia and is afraid of being touched. Peter, a nurse, is trying to perform oral care. However, Sophie is not responding well to any of the techniques and is becoming distressed. What should Peter do?
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Zoe is a copywriter and blogger from the UK. Once working as an Operating Department Practitioner in a busy Orthopaedic theatre suite specialising in regional anaesthetic techniques, she now writes for the health industry due to disability. Using the education and skills learned as a nurse, along with the experience of being disabled – Zoe is passionate about helping health professionals communicate better with their patients via social media, blogs and websites. In her spare time, Zoe is a governor at her local primary school, and is writing a play about invisible illness. See Educator Profile