07.18.2024 Juanita
Making dental care a priority for older adults
We've joined forces with Ingrid, prevention lead at mydentist, the UK’s leading provider of affordable dental care, to give care organisations some guidance and tips on oral health care for adults in care.
Ingrid Perry, MBE, Prevention Lead at mydentist
Oral health care for adults in residential care
With improvements in healthcare and better living standards, a greater number of older people are now keeping their own teeth for longer. While this is a good indicator that quality of life is on the rise, it does impact dental services, residential carers, and home carers who look after these individuals, and they can sometimes face challenges in providing and accessing oral health care.
For example, those who look after residents or older family members are more likely to encounter difficulties caring for an older person’s oral health because of their reduction in mobility, as well as losses in cognitive ability. Good oral healthcare for older adults is vitally important, as those suffering from poor oral health may be experiencing pain and discomfort, which will have a knock-on effect on their overall quality of life.
Their wider health could also be affected if they are unable to eat or drink, as this could lead to nutritional deficiencies. Older adults should be encouraged to keep their independence in maintaining a healthy mouth and should be offered support and guidance when needed to support them in achieving this.
How do you support those who struggle with mobility?
Residents suffering from arthritis or rheumatism may find holding and maneuvering a manual toothbrush around their mouth too difficult - however, an electric toothbrush that has a much wider handle could make the task much easier for them.
If purchasing an electric toothbrush is not feasible, you can modify a manual toothbrush handle by adding materials such as tennis balls, insulation tubing, putty, or handlebar grips for added support. These adaptations increase the handle size and overall length of the toothbrush, making it more manageable for those with limited dexterity.
When caring for an older adult, ensuring their toothbrush has a small to medium-sized head with soft to medium bristles is important. If the resident has difficulty using their arms or hands, their carer should assist them with toothbrushing, and carers should use disposable PPE such as gloves, an apron, and a face mask. It’s also a good idea to tuck a disposable napkin under the resident’s chin to catch any dribbles.
Ideally, teeth should be brushed twice a day with a pea-sized amount of fluoride toothpaste. Encourage the resident to spit out any excess toothpaste after brushing without using water or mouthwash, as this will flush away the protective fluoride, which needs to be maintained as much as possible.
How do you provide care for those who wear dentures?
Many older residents wear dentures. Some wear full dentures, while others may have a partial denture with only a few teeth on them. Dentures should also be cleaned daily, as you would with natural teeth, to remove any food debris that could cause discomfort.
Dentures can break very easily if dropped, so it’s important to clean them over a bowl of water or a soft towel. Again, wearing PPE, I recommend holding the denture firmly and using either a denture brush or a manual toothbrush with a non-abrasive denture cleaner to clean all surfaces of the denture. Once it looks visibly clean, leave it to soak in a denture cleaning solution – this will help to remove any plaque and stubborn stains. I also recommend avoiding the use of hot water with denture cleaning tablets, as this can distort the denture or make it become brittle. Some denture cleaning products are unsuitable for metal dentures, too. If you are unsure which product to use, ask your dental team for advice.
After the denture has been cleaned, the resident’s mouth will also need cleaning, even if they have no natural teeth. Again, using a soft to medium textured brush, gently clean the soft tissues and any natural teeth with toothpaste, as this will also freshen up their mouth. In order to keep the soft tissues in the mouth healthy, dentures should be removed at night to allow the tissues to heal unless there is a specific reason to keep them in. If you think about how your skin looks after a sticking plaster has covered it, your mouth can be the same if the soft tissues are permanently covered.
Sometimes, mouth infections such as denture stomatitis (thrush) can occur if dentures are not cleaned properly, so look out for very red areas under where the denture sits and red sore areas at the corner of the lips. Usually, antifungal lozenges or tablets are prescribed if the condition does not clear up after a couple of weeks. Speak to your dental team if you have any concerns.
If you use denture-soaking tablets, it’s important to ensure they are kept locked away, as they can be a choking hazard to confused residents or children visiting their loved ones. Many of these soaking tablets contain bleach, which, if swallowed, can cause the airway to swell and could result in a medical emergency.
How do you monitor for conditions such as mouth cancer?
Mouth cancer can occur in a number of places, including the lips, tongue, gums, and cheeks; early detection is crucial to the survival rate so everyone must know what signs to look out for.
Three signs and symptoms not to ignore are:
- Mouth ulcers which do not heal in three weeks.
- Red and white patches in the mouth.
- Unusual lumps or swellings in the mouth or head and neck area.
If you notice any of these symptoms, you must contact your dental team for advice as soon as possible so that they can provide further examinations and support.
If several carers are involved in a resident's mouthcare, it’s good practice to record on their care plan if you have noticed anything that gives you cause for concern so that this can be referred to if the issue remains a few weeks later.
How do you lower the risk of tooth decay?
Many residents tend to develop a sweet tooth as they age, but unfortunately, this can lead to tooth decay and gum disease.
Saliva in the mouth helps to neutralise any acids that cause tooth decay, but some medications, such as those prescribed for heart conditions, blood pressure and depression, can cause “dry mouth” (xerostomia), which reduces the saliva flow.
This not only makes chewing and swallowing food difficult, but also increases the risk of tooth decay.
Xerostomia is very painful, and sufferers often report a prickly or burning sensation in their mouth when they eat certain foods. If the resident finds their mouth becoming dry, you can encourage them to have regular sips of water.
Gels and sprays are also available to help with the symptoms of xerostomia, and a GP or dentist can advise you further on this.
A healthy, well-balanced diet is important for all ages, but particularly for older adults. If a resident enjoys having sweet treats, try to encourage them to have them as near to a mealtime as possible to lower their risk of tooth decay.
You could offer a variety of fresh fruits to snack on between meals, such as strawberries or sliced apples, or perhaps cubes of cheese with some savoury crackers as an alternative to sweets and biscuits. If they insist on having a confectionary, a large selection of "sugar-free" boiled sweets is available, but be mindful that too many of these can have a laxative effect.
How do you keep an eye on tooth pain?
If you notice that a resident appears to have had a change in their appetite, they could be suffering from toothache or another oral health condition. Ask them if they have pain when eating and seek further advice from a dentist if this is the case.
Usually, a dentist will advise you on how regularly they need to see you for a check-up. Even residents with no natural teeth still need to have their mouth checked every 1-2 years to ensure the soft tissues are healthy.
Some practices offer domiciliary dental care to residents who are unable to get to the practice due to mobility problems. You should ask your dental team if they provide this service or where you can access domiciliary care for your residents if they don’t provide it themselves and need support.
About mydentist
mydentist is headquartered in Kearsley, Manchester, and is the UK’s leading provider of affordable dental care, with over 530 practices across the country.
Led by Chief Executive Nilesh Pandya and Executive Chairman Tom Riall, mydentist employs over 7,000 practice and support colleagues and has a network of more than 3,000 dental associates in the UK.
mydentist supports more than 4 million patients a year and believes everyone deserves a great smile. That’s why mydentist is committed to helping more people than ever get access to the high-quality, affordable oral healthcare they need, whether that is through the NHS or affordable private treatments.
Need a dentist or want to start capturing detailed real-time oral care recordings?
Person Centred Software's digital social care record system, mCare, has all the features a care provider needs for oral care. mCare's Oral Health feature helps you record oral health assessments, update care plans tailored to people's needs, and capture highly detailed real-time recordings of oral care. Click here to learn more.
Need a dentist for your resident or care home? Find your local dentist here.
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