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Oral care for the elderly: Periodontal disease

3/22/2018

Linda Postma, RDHAP providing in-home care.

The trend in dental care has evolved to include many strategies for retaining our teeth throughout our lives. Dentists can place crowns, fillings, implants, and bone grafts, in many cases. All of these efforts will be lost if we do not retain our periodontal health.

In other words, the bone that holds each tooth in our mouth must stay healthy in order for us too retain our teeth. The most important strategy for keeping our teeth includes regular dental hygiene care appointments, or dental cleanings. This includes a variety of procedures that the RDHAP can provide, including: prophylaxis. root planing, and periodontal maintenance.

Prophylaxis: Commonly called a "cleaning" or "prophy", this procedure is preventive dental hygiene care. The goal of the prophylaxis is to help the patient prevent periodontal disease from taking hold in their mouth. The RDHAP removes calculus (tartar), plaque, and stain from above and even below the gumlines. These appointments should include:

measuring pocket depths, a method used to evaluate bone levels around each tooth
evaluating gum health (healthy gums are generally pink and firm)
checking for bleeding gums, a sign of infection in the gums
assessing plaque accumulation (plaque contains the live, disease causing bacteria)
helping the patient maintain or improve their oral self care - brushing, flossing, or whatever works best for them - in order to prevent disease.

Root planing: Patients who have signs of active periodontal disease need treatment to stop the disease, a procedure called root planing or root debridement. This procedure:

removes calculus from below the gumlines, allowing the tissues to heal and slow the disease process
includes local anesthetic or topical anesthetics, for patient comfort
can be completed in one appointment or several appointments; treating all or only involved teeth.

Periodontal maintenance: Once a patient has had active periodontal disease and has completed treatment, they often require more frequent and involved cleaning appointments. During this appointment, the RDHAP:

evaluates pockets depths, checking for disease activity
checks gum health, including bleeding, tissue color, tone, and tenderness
assesses plaque accumulation
thoroughly removes calculus and plaque above and below the gumlines, using topical anesthetics as needed
helps the patient maintain or improve their oral self care - brushing, flossing, or whatever works best for them - in order to prevent disease.
determines the best interval for future periodontal maintenance appointments in order to prevent further disease activity

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Oral care for the elderly: Dry mouth and cavity prevention

3/15/2018

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As anyone who has been to the dentist in the past 20 years knows, the goal of dentistry is to retain as many natural teeth as possible, replacing those teeth that are lost. Our goal has moved from "dentures for everyone over the age of 60" to keeping and maintaining our teeth. We know that the more natural teeth a person has, the better they can eat, swallow, talk, and smile.

Maintaining a healthy mouth is more challenging as we age. Those in assisted living, skilled nursing care, or memory care are at the most risk for increased periodontal disease and tooth decay. Many adults spend hundreds, if not thousands, of dollars on crowns, implants, periodontal treatment, and fillings, just to see them lost as they age. But why is this? Does this need to happen? Is this the natural course of oral health? It doesn’t need to be.

Dry lips and skin

Dry mouth is a real problem*, not just a Biotene marketing tag line. Many of the medications we use have a side effect of dry mouth or a reduction of saliva. Saliva is extremely important. It makes talking, chewing, and swallowing easier. Digestion begins in the mouth with the food's exposure to the enzyme amylase in the saliva. Saliva also helps with swallowing, helping to get the food smoothly and thoroughly from our mouths to our stomachs. The neutral pH of saliva helps to neutralize the acids typical in many foods and beverages. Without the saliva present to reduce the acidity, chemical are pulled from the teeth to make this happen, hence the beginning of a cavity.

It is often difficult to change medications, but sharing with your physician that your mouth is very dry can spur the conversation about possibly finding an appropriate substitution for the offending medication. The addition of over-the-counter dry mouth reducers can help manage eating and sleeping - the time at which dry mouth can cause the most oral damage. Biotene has several different options that your RDHAP can recommend. Xylimelts from Oracoat can be beneficial in helping those with severe dry mouth sleep through the night. CTx2 Spray and CTx2 Xylitol Gum by Carifree, is easy to carry around and can aid in hydrating the mouth and facility eating, talking, and sleeping., to name a few.

Sometimes those with dry mouth may have a cool beverage handy. The dentist and RDHAP recommendation is to make that beverage water. Sugar-sweetened beverages of course contain sugar, and those sugar-free alternatives usually have a lower pH - more acidic – that make your teeth a prime target for tooth decay. The RDHAP can also place fluoride varnish to further protect teeth. This will be address in a future post.

* Shetty SR, Bhowmich S, Castelino R, Babu S. Drug induced xerostomia in elderly individuals: An institutional study. Contemporary Clinical Dentistry. 3(2). April-June 2013. Retriever from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425100/

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Oral care for the elderly: Periodontal disease

Oral care for the elderly: Dry mouth and cavity prevention

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