Oral care for the elderly: Dry mouth and cavity prevention

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/