Elderly woman wearing glasses and in wheelchair holding hands with a younger woman

Dental Care for Older Adults

Aug 13, 2018

Author: Dr Natalie Bradley, BDS, Dip. SCD, MFDS, RCSEd

According to calculations by the United Nations Department of Economic and Social Affairs, the world's population of 70-year-olds is expected to skyrocket between now and 2050. The Pew Research Center reports that the U.N.'s figures estimate the centenarian population will jump to an astounding 3.7 million worldwide by then! People will need a healthy set of teeth to live their golden years to the fullest. That means dental professionals must tailor their dental care for older adults to accommodate this growing demographic's special needs. As a dentist, how can you help older patients? Being prepared for a few common clinical and interpersonal challenges can help you give your older patients (classified as 65 years and older) the best possible care.

Challenges of Dental Care for Older Adults

For some aging patients, attending regular dental checkups may be difficult. This may be due to physical mobility limitations or mental disorders like dementia. Certain medical conditions, such as Parkinson's disease, may also make it difficult or uncomfortable to sit in a dentist's chair for an exam. Some patients may need special adaptations, such as equipment that can tilt a wheelchair for a prophy.

Dental professionals need to carefully assess their older patients' capabilities. Treat all older adults with dignity and don't assume a shortcoming before one arises, but be aware that hearing loss, vision problems and memory issues may prevent a patient from understanding and complying with your instructions. Be patient and thorough in explaining treatment. If a person relies on a relative or friend to drive them to appointments, it may help to leave a copy of your care instructions with that person, as well.

Reduced Dexterity

At home, many older people may find maintaining their oral hygiene difficult. Stiff joints, hand tremors and poor motor skills may make it difficult to hold a toothbrush. Less efficient brushing may lead to increased plaque accumulation, which increases the risk of dental caries and periodontal disease.

Recommending that your older patients use an electric toothbrush or a specialized grip with their manual toothbrush can help them brush more efficiently and comfortably. Electric toothbrushes can also be helpful for caregivers who provide oral care for seniors.

Dry Mouth

Dry mouth is often a problem among older adults, especially for individuals who take multiple medications or have received head and neck radiation.

To help ease the discomfort of dry mouth, you can recommend dry mouth mouthwash.

Aside from making eating and speaking uncomfortable, dry mouth increases patients' risk for dental caries. To combat this risk, recommend that patients use a high-level fluoride toothpaste. You can also recommend that your patient periodically receive an in-office fluoride treatment like fluoride varnish, typically two to four times per year for patients at risk for caries.

Root Caries

Your older patients may have exposed root surfaces due to gingival recession. Root caries can develop rapidly if there are compounding factors like dry mouth that increase a patient's risk for dental caries. It can also be difficult to restore root surfaces if caries develops and progresses, especially for patients with other care needs, such as dementia, that compromise their compliance and access to care.

Prevention is key in preventing and controlling root caries, including using a high-fluoride toothpaste and periodically receiving an in-office fluoride varnish treatment. Regular dental examinations are also critical in spotting carious lesions early so that they can be halted or reversed before they have a chance to progress. This also avoids restorations, which as well as being invasive could be potentially tricky.

How Can Older Patients Reduce Their Risk of Dental Disease?

As dental professionals, one of the best things we can do to help our older patients is to arm them with a checklist of advice:

  • Brush twice daily with a recommended high-level fluoride toothpaste.
  • Avoid rinsing after brushing to get the full benefits of fluoride.
  • Avoid sugary foods, drinks and snacks.
  • Avoid acidic foods, drinks and snacks.
  • Avoid tobacco products.
  • Keep up with regular dental visits to check for gum disease, tooth decay and oral cancer, as well as to receive preventive care.
  • Visit the dentist between check-ups if you notice any broken teeth, pain, bleeding gums, mouth ulcers, lumps or any other oral health concerns.

You are your patients' best ally no matter what their age. With a little awareness and preparation, you can help your oldest patients achieve whole mouth health.