Oral health is central to wellbeing of older people – and it’s easy for your team to make a positive impact
More and more of the population are living into late old age. This is a positive development – however it is creating new challenges for the dental team, such as how to deal with an increasing number of patients with root caries.
Good oral health certainly allows older people to stay healthy, but people who have lost teeth, or are experiencing dental pain, tend to avoid harder-to-chew vegetables and protein-based foods, instead choosing softer fatty and sugary foods. This alone can cause general health to deteriorate due to malnutrition. Furthermore, poor oral health has been linked to systemic diseases such as diabetes and cardiovascular disease in older people. We should also not forget the impact on older people’s social lives and the reduced self-esteem and quality of life that can result.
Physical difficulties and mental impairments can also affect people’s ability to brush their teeth effectively and for this reason carers need to assist them where necessary. Older people might find using a large-handled or soft-grip toothbrush easier. The best advice for older people is that they keep seeing their dental team regularly. The dental team can make a positive impact by giving advice on oral hygiene and tooth-brushing technique, as well as by prescribing medical toothpastes and antibacterial mouthwashes when these are needed.
Another big problem is dry mouth, which has been reported to affect 30-78% of older people. If you spot this as a problem during your examination, try and find out whether this has an obvious cause, such as the medications they are taking, and advise them to see their doctor if you can’t find a reason.
The number of root caries is rising – what steps should your dental team take?
The roots of teeth are a particular cause for concern, since age-related gum recession encourages root caries. In fact, the aging of the population has created a veritable root caries epidemic in recent years. For example, in Germany the prevalence of root caries lesions increased from 15.5% in 1997 to 45% in 2006, among 65 to 74 year-olds. Roots are particularly vulnerable and root caries lesions can spread-fast and quickly infect the pulp. Root caries are also difficult to restore, as dental interventions can increase fragility, making the teeth more liable to breakage. Unfortunately root caries frequently result in tooth loss.
So the focus should be on prevention. The first step for the dental team is to identify the patients with a risk of developing root caries and provide them with dietary and oral hygiene advice. You can also prescribe them a high-fluoride product, such as toothpaste, which can be easily incorporated into their daily oral hygiene routine. Recent research shows that high-fluoride toothpaste (more than 1450 ppm fluoride) can inactivate early-stage root caries lesions, as well as prevent them. Using a fluoride mouth rinse can also help.
Good oral health for life is a desirable objective that begins its journey in youth but increases steadily in importance through to old age. It’s the greatest challenge – but can make a world-of-difference to your older patients.
 Locker 2003; Liu, Dion et al. 2012
 Michaelis and Schiffner 2006.
 Wierichs and Meyer-Lueckel 2015