Dental Care for Seniors
Our society celebrates many coming-of-age customs which focus primarily on the young and their trek to adulthood. However, once you reach your golden years, celebrations are often limited to over-the-hill and retirement parties. There is no doubt that people are living longer than ever before. Such a shift has a profound impact on many aspects of society which include maintaining the health and well-being of an aging population.
“The lifespan of any civilization can be measured by the respect and care that is given to its elderly citizens.” – Arnold J. Toynbee
There are many dental challenges for older adults; some of which alter the ability to receive the dental care needed.
Ageism. Ageism is prejudice or discrimination on the basis of a person’s age. Some older adults perceived their concerns were downplayed by health care providers, that they encountered a dismissive communication style and did not receive the treatment needed. Some providers demonstrate an unwillingness to treat older adults because of internalized societal age biases and negative attitudes towards the elderly, time constraints, and lack of appropriate reimbursement.
Access. In patient surveys, the need to maintain access to dental care is often the No. 1 concern of oral health. Many older adults find it difficult to visit the dentist. This may be due to lack of transportation, cognitive ability, general health or mobility. Older adults living in nursing or residential care may be particularly difficult to treat, especially if they cannot be easily transported.
Resources. For many adults, dental insurance ceases or is reduced at retirement and, combined with a lower overall income level, resources become scarce. If you factor in the complex dental treatments that may require additional resources to maintain and protect, this can become very taxing on an individual.
Dental Carries. Similar to those in young children, older adults experience carries at a rate of about one surface per year, with root carries being more predominant. Those in nursing homes typically experience double the rate of carries than those living in a community with peers. Conditions such as arthritis, Alzheimer’s and dementia may impair the ability to perform daily oral hygiene. Automated toothbrushes are beneficial for patients with limited dexterity and arthritis. Fluoridation will also help improve the oral health of older adults. Studies suggest that fluoridated water has an overall positive effect on oral health and decrease in dental carries.
Dry Mouth. More than 400 medications cause dry mouth, including medications commonly prescribed for older adults such as drugs for anxiety, depression, nasal congestion and hypertension. You may consider speaking to your medical care provider to see if any medications could be substituted for those causing the dry mouth. Furthermore, some systemic diseases can negatively affect salivary glands such as diabetes, Alzheimer’s disease, Parkinson’s disease and depression. Regular sips of water throughout the day, limiting alcoholic beverages and beverages high in sugar and caffeine, avoiding salty and spicy foods and mouthwashes containing alcohol as well as sucking on sugar-free candies, gum or lozenges can all help to minimize dry mouth.
Periodontitis. This is a condition where inflammation of the tissue around the teeth can cause shrinkage of the gums (gum recession) and loosening of the teeth. It is highly prevalent in older adults. Changes to the immune system and decrease in good oral hygiene can contribute to the progression of periodontitis.
While it is clear individuals are aging, placing generalizations for dental or medical care is not helpful. The 95-year old man we see out jogging may need a different type of care than the 55-year old man who has suffered a stroke and is unable to walk. Each patient must be treated as an individual and their care planned accordingly.
CDA Dentistry for the Ages, part I and II, July 2015, August 2015
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