Dental health and hygiene

Definition

Maintaining good oral health is important at any age, but as adults grow older, good oral hygiene is even more important. Proper oral hygiene consists of brushing and flossing daily, visiting a dentist regularly, and treating any diseases of the mouth, gums, tongue, and teeth promptly. In the past, most people over the age of 60 had partial or complete dentures. Today this is no longer the case. According to the Centers for Disease Control and Prevention (CDC), in 2005, over 50% of Americans over the age of 60 still had most of their teeth.

Healthy teeth not only promote positive self esteem by contributing to a beautiful smile, they also help ensuring the ability to eat and maintain proper nutrition , and can help prevent complications from other diseases such as diabetes, heart disease , and stroke .

Description

In the past, it was assumed that as adults aged, they would lose most if not all their teeth. Today, however, the majority of individuals over the age of 50 still have most of their natural teeth, and there are many more options available to replace lost teeth and to save diseased teeth.

The foundation of good oral health is brushing the teeth at least twice a day using a soft to medium soft tooth brush and a toothpaste containing fluoride. When brushing the teeth a soft or medium soft tooth

brush should be used to clean all the surfaces of the teeth as well as the gums. For individuals with arthritis or other conditions that may limit their ability to hold or move a tooth brush effectively, an electric tooth brush may be a better option.

A tooth brush can reach much of the tooth surface, but dental floss is necessary to clean between the teeth. Flossing at least once a day can help promote a healthy mouth. To floss correctly, wrap a length of floss around the index fingers of both hands and stretch it between two teeth. Curve the floss around the base of one tooth and pull the floss back and forth. This process should be repeated between all the teeth. For individuals who find it difficult to grasp or hold a strand of dental floss, there are floss holders and individual flossers available at most drug stores.

For those with partial or complete dentures, good oral hygiene is still extremely important. Dentures should be removed and brushed with a tooth brush and toothpaste made especially for dentures. Each morning, prior to placing the dentures in the mouth, the mouth should be cleaned well and the gums and mouth brushed with a soft tooth brush.

In addition to daily care of teeth and gum, it is important to continue to have regular visits with a dentist. Regular teeth cleaning should be performed by a dentist twice a year. Even for individuals who are missing some or all of their teeth it is important to continue to visit the dentist on a regular basis. Not only can regular dental visits help keep teeth and gums healthy, a dentist can diagnose and treat condition of the mouth and gums such as oral cancer , decreased saliva or dry mouth , and problems with the gums, tongue, or jaw.

Demographics

According to the 2005 United States Census, there are 34.3 million people 65 years old or older in the United States. The CDC's 2005 Summary Health Statistics for U.S. Adults: National Health Interview Survey found that over one third of all adults aged 55 or older are missing all of their teeth. Among the races questioned, African Americans had the highest rate of missing all the teeth and those with the lowest income, regardless of race, had a higher rate of missing all their teeth.

Purpose

For people over the age of 55, good oral hygiene is important to help keep remaining teeth strong and healthy. For individuals with complete or partial dentures, proper oral hygiene may ensure comfort and proper fit of dentures or plates.

Keeping the teeth and gums healthy is only one reason to maintain good oral health. Painful or diseased teeth can impact proper nutrition and lead to declining health if the ability to chew is impaired and the diet becomes unbalanced. Plaque and tooth decay may lead to other health problems such as infections in the heart, lungs, and other parts of the body. Poor oral hygiene may also exacerbate medical conditions such as diabetes, arthritis, and high blood pressure .

Tooth decay and gum disease have been linked to an increased risk for heart disease, stroke, bone loss, and even some types of cancer . In 2007, the National Cancer Institute published a study that found men with a history of periodontal disease had a 64% increased risk of developing pancreatic cancer when compared to men with no history of periodontal disease. Among the many benefits of good oral hygiene and care is the prevention of periodontal disease. Part of any routine dental exam is screening for oral cancer. Oral cancer occurs most often in adults over the age of 40. If discovered early, oral cancer is highly treatable and may be cured.

Challenges

Adults over the age of 60 face many challenges in obtaining good dental care and maintaining proper oral hygiene, not the least of which is access to dental insurance. In 2006, researchers at the University of Buffalo found that only 11% of the seniors they surveyed had dental insurance, and 52% of those responding cited cost as the number one reason they did not receive dental care. The cost of treating adults over the age of 60 can be more than other age groups because much of the care involves repair and restoration. Previous dental work such as filling and crowns may have been in place for decades in some cases and may be failing. Even normal tooth wear may, over the years, substantially weaken existing teeth. All of these factors contribute to a higher cost of dental care for older Americans. Prevention, however, is still possible and helpful.

Additional challenges to maintaining good oral hygiene include other medical conditions common to older adults. Many of these conditions may impact dental treatment and make it more difficult for dental health professionals to successfully treat seniors. The American Dental Association (ADA) cites the following diseases as the most common ailments seen in independent and functional older adults: arthritis, cancer, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, hypertension , mental health conditions, osteoporosis , Parkinson disease, and stroke. Each of these conditions may require special attention during dental treatment.

The ADA suggests that dentists treating patients with arthritis pay close attention to the patient's tendency to bleed more easily and to the need for antibiotics or steroids during treatment. These individuals may also need oxygen during longer procedures. When working with patients with diabetes, difficulties healing and factors that may impact the patient's ability to chew must be considered. The individual's ability to eat a balanced diet and consume proper and adequate nutrition must be maintained.

The ADA also recommends that dentists treating older adults should ensure adequate pain management during dental work to avoid elevated blood pressure and stress related cardiac difficulties. Other factors that dentists treating older adults may need to consider include issues faced by patients undergoing cancer treatment, those with advanced periodontal disease and infection, and individuals who may suffer from dementia and may be uncooperative during dental treatment.

Risks

While adequate dental care is essential throughout the life span, there may be risks associated dental treatment. There are also risks associated with a lack of proper oral hygiene.

QUESTIONS TO ASK YOUR DENTIST

• How often should I visit my dentist?
• How much will it cost?
• Where can I obtain dental insurance?
• What toothpaste and tooth brush should I be using?
• Do I need additional treatment to improve my oral health?
• If I need dental treatment, how long will the procedure take and how many appointments are necessary? What kind of anesthesia will be used, if any?

During routine dental care and treatment bacteria may be released into the blood stream. These bacteria can travel to other parts of the body such as the heart, lungs, or brain and may cause infection. These same bacteria may contribute to the build up of a substance called plaque in the blood vessels. Plaque in the blood vessels contributes to heart attack and stroke. In ill or elderly individuals these bacteria may lead to pneumonia . To prevent these complications, dentists may prescribe antibiotics prior to dental work.

Many seniors have medical conditions such as diabetes and anemia or take medication such as blood thinners or aspirin that may make them bleed more easily. Dental work may cause excessive bleeding and lead to complications. Prior to any dental work, the dentist may require the patient stop taking medications that thin the blood. It may be necessary to stop taking such medications for several days to one week prior to the dental appointment if possible. During and following dental work, the dentist will carefully monitor for bleeding. Additional treatment such as packing with gauze pads or closing a wound with stitches may be necessary to stop the bleeding.

Dental work can be stressful for anyone, but for individuals with heart conditions or other diseases, such stress can be dangerous. Prior to undergoing dental treatment, patients should inform their dentists of any heart condition they may have. Medication may be prescribed to help the patient relax and to relieve anxiety and stress during dental work. Pain medication may be prescribed as well to be taken in conjunction with the medication administered during dental treatment.

KEY TERMS

Anemia —A disorder of the blood that occurs when there are not enough red blood cells produced.

Antibiotics —Medications that fight bacterial infections.

Arthritis —A group of diseases that cause joint pain, swelling, and inflammation. The two most common forms are osteoarthritis and rheumatoid arthritis.

Bacteria —Single-celled organisms that may be harmful or beneficial. Some bacteria cause infection and disease.

Blood thinner —Medication that prevents the blood from clotting, they are also called anti-coagulants.

Diabetes —A disease in which the body does not produce or properly use a substance called insulin and cannot convert sugar eaten into energy for the body.

Hypertension —High blood pressure.

Oral cancer —Abnormal or cancerous growths in the mouth. It may occur any where in the mouth including the tongue and gums.

Oral hygiene —Keeping the mouth, tongue, teeth, and gums clean to prevent disease and promote a healthy mouth.

Osteoporosis —A disease in which the bones become fail and brittle because of decreased mineral density.

Pancreatic cancer —Abnormal cell growth within the pancreas, the organ that produces insulin and other necessary hormones.

Parkinson disease —A progressive disorder of the brain that causes tremors, stiffness, poor balance, and slow movements.

Periodontal disease —Infection of the gums and tissue surrounding the teeth.

Plaque —There are two types of plaque. One type is a sticky substance that builds up around the teeth and causes bacteria to grow that harm the teeth. The other type is a fatty substance that builds up in the blood vessels and that may lead to heart disease and stroke.

Pneumonia —An infection of the lung that can lead in inflammation of the lungs and to serious illness.

Steroids —Medication that can reduce swelling, pain, and inflammation.

Poor oral hygiene and limited dental care can lead to conditions that cause poor general health. Among the diseases that may be caused or worsened by poor oral hygiene are diabetes, heart disease, stroke, cancer, and arthritis.

Tooth loss and poor oral health can cause chewing to become painful and, in some cases, impossible. This can make eating a balanced diet difficult and lead to malnourishment. In 2008, researchers from theHuman Nutrition Center on Aging at Tufts University found that, over the past ten years, nearly 50% of older Americans do not consume enough calories or nutrients. Many conditions considered a natural part of aging may actually be caused by poor nutrition. Many of these conditions may be preventable.

Results

The results of good oral hygiene and dental health are many and highly beneficial. Maintaining healthy teeth and gums can help prevent medical conditions such as heart disease, cancer, and stroke. A healthy mouth can keep conditions such as arthritis, diabetes, and osteoporosis from progressing as rapidly and may help reduce the occurrence of some symptoms.

Regular dental check-ups may help dentures and partials to continue to fit comfortably and may prevent the loss of additional teeth. They may also help older individuals maintain the ability to chew comfortably and to eat a balanced and varied diet ensuring that adequate nutrition is consumed. While oral cancer is more common in older people, early diagnosis can lead to early treatment and cure. Routine dental exams screen for this type of cancer.

Good oral hygiene and a healthy mouth can substantially impact the quality of life of people over the age of 60. Disease prevention, good health, and a positive self esteem may all result from having a healthy mouth and bright smile.

Resources

BOOKS

Katayama, Rodney S., 6 Minutes to Superior Dental Health (How to Protect Your Family in a Dental DiseaseSociety). Seattle, Washington: Elton-Wolf Publishing, 2000.

Lamster, Ira B. and Mary E. Northridge, Eds. Improving Oral Health in the Elderly: An Interdisciplinary Approach. New York, New York: Springer Science and Business Media, 2008.

Ship, Irwin. Clinician's Guide to Oral Health In Geratric Patients. Hamilton, Ontario: BC Decker Inc, 2006.

PERIODICALS

Boehm, Tobias K. and Frank A. Scannapieco, “The Epidemiology, Consequences, and Management of Periodontal Disease in Older Adults.” Journal of the American Dental Association September (2007): 26–33.

Ettinger, Ronald L. “Oral Health and the Aging Population.” Journal of the American Dental Association September (2007): 5S–6S.

MacEntee, Michael I. “Quality of Life as an indicator of Oral Health in Older People.” Journal of the American Dental Association September (2007): 47–52.

Michaud, Dominique S., Kaumudi Joshipura, Edward Giovannucci, and Charles S. Fuchs. “A Prospective Study of Periodontal Disease and Pancreatic Cancer.” Journal of the National Cancer Institute (2007):171–175.

Scully, Crispian, and Ronald L. Ettinger. “The Influence of Systemic Diseases on Oral Health Care in Older Adults.” Journal of the American Dental Association September (2007): 7–14.

Silverman, Sol. “Mucosal Lesions in Older Adults.” Journal of the American Dental Association September (2007): 41–46.

Stanford, Clark M. “Dental Implants: A Role in Geratric Dentistry for the General Practice.” Journal of the American Dental Association September (2007): 15–20.

Turner, Micheal D., and Jonathan A. Ship. “Dry Mouth and Its Effects on the Oral Health of Elderly People.” Journal of the American Dental Association September (2007): 34–40.

ORGANIZATIONS

American Dental Association, 211 East Chicago Ave, Chicago, IL, 60611-2678, (312) 440-2500, http://www.ada.org/.

Deborah L. Nurmi MS