Oral Hygiene and the Elderly

HOW OFTEN SHOULD A WORKER PROVIDE ORAL HYGIENE?

Many healthcare workers are relieved to find out that toothbrushing twice a day and flossing once a day offer sufficient protection against cavities. That’s because dental plaque takes about 24 hours to reoccur once it has been thoroughly removed. Assist the person with oral hygiene in the morning when you help him with his personal care and again at bedtime before he settles in for the night. (Some facilities may have policies that differ from these guidelines so find out about the rules in your workplace).

Check the care plan before you provide mouth care. Some people have special needs. The care plan will tell you the type of oral care the person needs and how often it should be done. For example, some people require mouth care as often as every 2 hours. If the care plan does not include information that you need, check with the person’s doctor, dentist or health care professional.

RISK FACTORS FOR ORAL PROBLEMS

Many factors increase the risk of oral problems. These include lack of knowledge about mouth care, poor eating habits, and poor oral health practices. Illness or certain medications may cause dry mouth, bad breath, a bad taste in the mouth, a coated tongue, or sore gums. Other factors that affect oral health include:

• Poorly fitting dentures
• People who are not able to eat or drink (e.g. unconscious)
• People receiving oxygen therapy
• Mouth breathing
• A tube or airway in the mouth
• Exposure to alcohol or tobacco
• Suctioning

WHO IS SUSCEPTIBLE?

Certain groups are more likely to have oral problems. The elderly, for instance, are at high risk for mouth problems. Age-related changes can have a negative impact on oral health in several ways:

• Many older people lose their teeth due to periodontal disease. About half of the people in the United States who are 65 years or more wear dentures. Many others have no teeth at all.
• The surface of the teeth often wears down with age.
• Older people tend to have weak jaw muscles, making it more difficult to chew food. This change can lead to poor nutrition.
• The sense of taste decreases with age, contributing to poor nutrition.
• Saliva decreases, resulting in dry mouth. Older people are also more likely to take medications, which can lead to dry mouth.

Certain products are available to reduce the symptoms of dry mouth. Extra fluids may help too.

Other at-risk groups are those with certain types of autoimmune disease or renal (kidney) disease. About 40% of patients who receive chemotherapy for cancer develop stomatitis. Stomatitis can be very painful and can create difficulty with eating, drinking and talking.
Human immunodeficiency virus (HIV) attacks the body’s immune system, making it difficult to fight disease. Common problems include dry mouth, mouth ulcers and sores, and swelling of the salivary glands. People who are very ill, unconscious or dying are also at increased risk for oral problems.
It’s a mistake to assume that oral problems are inevitable. In most cases these problems can be prevented or successfully managed. Careful and regular oral hygiene, early reporting of unusual symptoms, regular dental visits, treatment with appropriate pain medication and antibiotics are all measures that can improve and resolve mouth problems.

OBSERVING FOR PROBLEMS

As you provide oral care, you may become aware of problems. If you notice unusual symptoms or anything else that you are not sure of, call the person’s health care professional. Early detection can often prevent small problems from developing into serious complications. Some of the signs and symptoms to report are:

• Bad breath
• Loose teeth
• Problems with swallowing
• Dry, cracked, or blistered lips
• Complaints of pain or discomfort
• Chipped, broken, or discolored teeth
• Chipped, broken, or poorly fitting dentures
• White patches in the mouth or on the tongue
• Bleeding, swelling, redness, or sores of the lips, mouth, tongue or gums

People who are confused may not be able to tell you when they have pain or discomfort. You will have to watch for signs of a possible problem. Pay close attention if the person begins grinding her teeth, hitting her jaw, or pulling on an ear.
Some people may refuse to eat, refuse to wear their dentures, or throw their dentures across the room. These could be signs of pain or discomfort and should be reported.