Quality Resource Guide

Preventive Oral Care for the Elderly Dental Patient 1st Edition

www.metdental.com

in cheilosis or glossitis. A deficiency of vitamin C

may result in gingival enlargement or bleeding.

14,15

Changes in diet are common in the elderly and

may relate to the oral health of the patient.

• Considerations of caregivers, residential

settings, and financial means

As adults age and if their health deteriorates there

is often a need to have a caregiver assist a patient

in maintaining their personal and oral hygiene. If

a caregiver is needed to provide oral healthcare

for a patient they should be educated along with

the patient about proper care. If more direct care

is needed for the elderly they may move to an

assisted living or nursing home. Over 8.7 million

Americans use long term care services and that

is expected to grow with the increase in life

expectancy.

Dental care in many assisted living

facilities has been shown to be poor.

Daily oral hygiene care in assisted living facilities

is often done by the nursing staff. It has been

shown that proper training of the staff may result

in better oral health outcomes,

though many staff

members lack training in oral care and perceive

lack of time and priority for oral care of patients

in assisted living facilities.

Often dental care

is sought outside of the assisted living facility.

This can be challenging not only related to the

ability to be transported to a dental care facility,

but older adults are the least likely group of people

to have private dental insurance, causing their

utilization of dental care to decrease.

Older

adults with a lower income have been shown to

have a greater incidence of tooth loss.

Elderly

individuals needing caregiving, living in an assisted

living facility or having low income face significant

barriers in accessing dental care.

As with all patients, obtaining consent for dental

procedures is an essential step in providing care

for elderly patients with special needs. When

consent is obtained, patients should have a full

understanding of the procedure that is to be

performed and the risks, benefits, and alternatives

to that procedure. They should have time to ask

questions about the procedure before deciding

on consent. An essential part of the consent

If an elderly patient experiences one or more

of the factors above it may impact his/her

ability to maintain adequate oral health. Dental

professionals should be aware of these factors

and consider the factors that may affect their

patients’ ability to receive oral care and/or maintain

oral health. Considering these factors, dental

professionals should provide recommendations on

preventative measures that will assist their patients

in maintaining their oral health.

Oral Diseases and

Preventative Measures

Because there are multiple factors that may

influence an elderly person’s ability to maintain

their oral health there are several oral diseases

that may be associated with elderly patients. Many

oral diseases occur as a result of diminished ability

to maintain oral hygiene.

• Poor oral hygiene

Many of the oral diseases covered below relate in

some way to poor oral hygiene. Poor oral hygiene

can be the result of decreased cognitive ability,

decreased motor skills, and low health literacy.

Oral hygiene recommendations should be tailored

to each patient’s specific needs, but below are

general recommendations that may be made to

elderly patients.

Plaque biofilm removal procedures through

brushing will assist in dislodging bacteria, food,

and plaque biofilms that accumulate in the oral

cavity. Brushing is the most common technique

used for biofilm removal. As people age, brushing

may become more difficult due to a decrease

in dexterity in their hands. Patients may benefit

from a power toothbrush or a larger handle added

to a manual toothbrush. The power toothbrush

generally has a larger grip and creates the

movement of the bristles without movements that

require full dexterity. Some patients may need

assistance or supervision when using a power

toothbrush to avoid misuse or possible damage to

the mouth. A larger handle on a manual toothbrush

may assist a patient who has difficulty grasping

a small handle due to a decrease in motor skills

or other diseases, such as arthritis, that limit the

process is that the person providing consent has

the capacity to fully participate in the informed

consent process.

Elderly patients may have impaired decision-

making capacity,

that may be difficult to discern

as many problems with memory or dementia go

undiagnosed. There are screening tools, such as

the Mini-Cog, that may help determine if the patient

is suffering from dementia. The Mini-Cog is a two-

part test that takes 3-5 minutes to complete.

It is administered by first asking the patient to

listen carefully and remember three unrelated

words (

i.e

., hat, penny, car). Next, the examiner

asks the patient to draw the face of a clock on

a sheet of paper at a specific time (

i.e.,

11:45).

Then the examiner asks the patient to repeat the

three words they were asked to remember. If the

patient misses all the three words the first time

this indicates some impaired cognition. If only one

or two words are missed this indicates possible

dementia.

If the dental care provider finds that

the patient has impaired cognition they should

suggest a medical evaluation or include family

members or caregivers in the consent process.

It also can be helpful to review consent verbally

and in writing for elderly patients and possibly

in large print if a patient has vision problems.

Consent requires communication between the

provider and the patient and the provider should

ensure that the patient is able to understand and

consent to dental procedures.

Health Literacy

Health literacy is defined as the degree to which an

individual has the capacity to obtain, process, and

understand basic health information and services

needed to make appropriate health decisions.

The health literacy of older adults has been

shown to be less than that of younger adults.

Higher levels of health literacy are associated with

better oral health status and better patient-dentist

communication. Those with higher health literacy

will more often receive regular dental care.

The

low health literacy of older adults can cause a

barrier to preventative care and treatment of oral

diseases.