Oral Care for Dependant Seniors

I just finished reading Dying From Dirty Teeth by Angie Stone RDH, BS.  Quite an eye opener, something I had never even thought about.  Along with this book, articles on pneumonia have been appearing in my dental hygiene journals.  It was time to learn more, and see exactly what this was all about.  

At the same time I read Angie's book,  I accepted an invitation to speak to a class of students learning to be certified nursing assistants.  These ladies and gentlemen are the front line in helping seniors and other dependent people live better lives. (I know how very important dental assistants are to my profession, and can't work without their help.  DA's make my day run smoothly, so I  can greatly appreciate how hard CNA's work to take care of their patients.) 

CNA's are asked to do many things to make our loved ones healthier and more comfortable.  Dental care should be on that list but often, because it's "invisible," it can get overlooked.   It's hard to do if you are not trained in it.  It's even harder to do if your patients won't open their mouths.  Yet it's vital for health.  I appreciated the opportunity to teach this class the importance of oral care from a dental hygienist's perspective.  CNA's need our help in providing the right tools for a speedy, efficient job.  Our seniors need our oversight to be sure it is done correctly, daily, and with dignity.

Today's column will address why it matters, and suggest my favorite tools, protocols and procedures to help prevent problems for yourself, your parents or other loved ones.  As always, see your dental professionals for further information.

For lack of toothbrushing and oral care, our dependent senior citizens are dying.

Aspiration pneumonia

Poor oral care is causing them to inhale oral bacteria, rotting food debris and stomach contents into their lungs, causing aspiration pneumonia.  Sleeping with dentures in their mouths is also a big no, another source for a potential cause of aspiration pneumonia.   Angie Stone's book notes (page 64) that it costs over $30,000 to treat this when it occurs. That's not such a pretty picture, is it?

In a previous post, even before reading Angie's book, I wrote about denture wear, denture care and the connection to pneumonia.  Pneumonia is THE leading cause of death in the frail elderly.  Thirty percent of those with pneumonia die due to aspiration pneumonia.   Read on to learn about tools you can use to improve the quality of life for someone you love.

If the mouth is not healthy, the body is not healthy.

Medical science has worked hard to extend  life expectancy.  We now live longer, but at what cost?  Many seniors suffer from chronic illnesses and are medically fragile.  Seniors aged 65 to 69  take on average 14 prescription medications daily.  Those over age 80 take 18 medications daily.  The most common side effect of all these medications is dry mouth.  (Have you  been following my blog? Then you know I consider saliva to be liquid gold.)

When I see a patient that takes two or more medications, I know they have dry mouth conditions. To me, that means they are at extreme high risk for tooth decay.  Along with more cavities, I also know they probably have a gum infection.  Keep in mind that these are the people I see; the healthier people who come in to see a dental professional at least twice yearly.  

Along with aspiration pneumonia, our seniors also face an increased risk of other oral-systemic connections such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, dementia, and thrush.  In those with weak immune systems, their bodies can not fight the overload of oral pathogens that enter their blood system, their stomachs, or their lungs from gum disease, tooth decay, and poor oral hygiene.  That is why we say that if the mouth is not healthy, the body is not healthy.  Lack of oral care in our dependent seniors starts them on a downward spiral of illness, pain and possibly preventable death. 
We can do better.  We have the tools, and for their sake we need to rise to the challenge and see they have the care they need.

commercially enlarged handle

Oral care does not have to be perfect.  Do your best. 

Tools

#1. The toothbrush- yes, it seems obvious, but for those with limited dexterity, function or mental decline, even brushing properly can be a challenge.  Brushing twice a day with an electric toothbrush for at least two minutes is ideal.  

Bicycle handle - creative!

For those administering care: I suggest dry brushing with a manual toothbrush.  No toothpaste, no water. This will get the plaque off, without the foam getting in your way.  Have the senior sit down,  Stand to the side of the patient.  (Do not stand directly in front of them.  If they spit, their bodily fluids land on you.)  Curl your arm around their head, cupping their chin in your hand.  This supports their head.  Brush with gentle, small, circular motions.  For those with arthritis, making the toothbrush handle bigger may be helpful.   Foam, duct tape, bicycle grips, anything to enlarge the handle so it is more comfortable to the senior or the caregiver may be helpful.

A better brush to do the job faster

If they won't open their mouth, do your best.  Even if you only brush the front teeth and the cheek sides of their teeth, that'll improve their oral health tremendously.  That'll at least get the food debris out. 

If they have an electric brush, so much the better.  No dry brushing here, though, electric brushes really need to be wet to work properly. 

Regardless of what type of brush you have, be sure to brush the gums.   Brush into the gums, brush the roof of the mouth, the cheeks and the inner lips.   Then add toothpaste for the freshness.  More on that in a moment. 

It has the bigger handle, as well as a sanitizer for brush heads

My favorite electric tooth is the 30 Second Smile Toothbrush.  It is quick, easy to hold, the patient just needs to bite gently into it and let the brush do the work.   It makes short work of brushing teeth. I still recommend  dry brushing with a manual brush  to clean the cheeks, roof of mouth, and tongue.  

#2. Toothpaste- yes, another obvious product, but which one??   

Some basics first- Only a pea sized amount, regardless of brand or type. Many seniors have sensitive tongues and can not tolerate spicy (to them) toothpastes. It may take trial and error to find a mild enough paste.     

Which do I recommend?   
 Consider a non foaming type.  Pastes without sodium lauryl sulfate (SLS) do not foam. SLS is often in many toothpastes, so search the internet for brands that do not contain it.

  Here are my favorite suggestions:
             Toothpastes with 100% xylitol (more on this in a moment.)
             Lusterbrush by Spiffies:  this gel is originally for babies but works perfectly well for seniors and is safe to swallow.
              Livionex Toothpaste- works by repelling plaque for tooth surfaces.  I wrote about this paste in my most popular blog post.

#3. Xylitol- the wonder sugar 

I love everything about xylitol.  If you can not get a toothbrush, let alone floss into someone's mouth, this may be the best thing you can use.  Xylitol is a sugar alcohol and helps keep the mouth healthy. It comes in mints, sprays, toothpastes, mouthwashes, wipes, even in bags just like sugar. Sprinkle straight xylitol right in their mouth, put it in coffee, be creative, it tastes great!   You can even cook with it, cup for cup.  (Go easy initially, though!  Too much, too soon can cause gastric distress.  Your body does get used to it.) 

-Five serving per day reduces plaque buildup by 60% (and that's without even brushing!! )
-Protects Teeth from Cavities
-Inhibits Bacteria Growth
-Helps Reduce Thrush, Angular Cheilitis
-Stimulates Saliva Flow- perfectly safe for those with dry mouth
-Safe for Diabetics
-No Aftertaste
-100% natural

(I wrote about xylitol in my post entitled Mouth Magic.  Learn more there!  The only drawback is that it is lethal to dogs.)  Giving seniors five servings of xylitol per day in the form of mints, sprays, or toothpastes will help them have a healthier mouth.  Of course, it's not ideal to forgo brushing but something is better than nothing.  

#4. Dry mouth products- without saliva and oral care, the teeth and gums go downhill fast. Tooth decay takes over and the teeth rot away.   

Pick one or two of my favorite products to try.  Help keep the whistle wet throughout the day:

-100% Xylitol -Any product (Spry, Epic, and many others) 

-MedActive- “Spilanthes” is an herb that stimulates saliva flow* awesome**

-Xylimelts and Oracoat
-Act Dry Mouth Lozenges
-Rincinol - soothes the tender tissues
-Neutrasal - the #1 product for treating mucositis as well as dry mouth
-Salese - lozenges

Just to be crystal clear- here's my NO, NO, NO column:

-Cough drops

-Lemon drops

-Anything with sugar/carbohydrates

-Flavored waters, sugar coffees

-Gatorade/sports drinks

#5. Tooth decay prevention and remineralization products: We need to kill the bad bacteria, and put minerals back in the teeth. All of these are non prescription:


MI Paste Plus- smear some on the teeth and let sit - apply after brushing twice a day
Basic Bites- chocolate that tastes good and is great for the teeth, a win-win in my book.
Carifree - an entire product line to kill bacteria, raise the pH of the mouth, and put good minerals back in the teeth. 

Learn more about  fighting tooth decay in my post entitled: Tooth decay is not okay 



#6. Gum Disease- ideally after brushing you need to clean in between the teeth.  

Xylitol: to the rescue again. 

Piksters go in between,use w/ xylitol toothpaste 

Piksters: easy to use and fast, to clean in between the teeth
Floss: if you are extra lucky to have the world's best caregivers

#7. Denture and appliance care- 

Take all appliances out during sleep.
Soak the appliances and scrub daily.
Dentasoak wins high praises with it's ability to kill 99% of the oral pathogens on it.

When cleaning the appliances- fill the sink with water and hold the appliance firmly, scrub with a denture brush - NOT your toothbrush. 
Rinse well
Be aware of ill fitting dentures.  If they spend more time on the night stand than in the mouth, see a dentist.  

#8. Weekly oral care with a Registered Dental Hygienist- worth every penny!
Just like your grandmother has a weekly hair care appointment, consider having a weekly oral cleaning appointment.  Grandma's wash, set and curl was a short appointment.  How about a 10 or 15 minutes basic brushing, flossing and rinsing with an RDH to improve the oral health of you or your loved one.  This would be a shorter appointment than a checkup and cleaning.   Remember, one episode of aspiration pneumonia costs $30,000 to treat.  A weekly visit with your favorite dental hygienist may well be the bargain of the century!

In recap: 
Whether your senior is in full dentures, partial dentures, or is lucky enough to have his or her own teeth, everything in their mouth needs to be cleaned as much as possible.  Leaving food debris, plaque, and bacteria on their teeth or dentures leaves them prone to breathing in bacteria and causing aspiration pneumonia-- seriously dangerous to those in frail health. 


It's time to stop this epidemic of poor oral care for our dependent seniors. They lack the basics of oral hygiene care.   The pain and destruction it causes is preventable.  We know how.  Aren't they worth it?

My father and me :)

Keep Smiling!

Barbara 


P.S.  I've given you a list of my favorite products.  Many you or even your health providers may not know about.  Try them out.  I have no financial interest in any of these.  I use them because they work.  It may take some trial and error to find what works for you.  If you find a different product, please share with me.  I'm always on the hunt for best products to help do the job of cleaning, disinfecting, remineralizing, healing, and improving oral health.