Tooth Decay Prevention Strategies For Seniors

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Introduction

Oral health is often neglected among the elderly, despite its significant influence on overall health and quality of life, including psychological well-being. Various comorbidities such as cardiovascular diseases and diabetes, stemming from prolonged exposure to specific risk factors and genetic alterations, detrimentally affect oral health in this demographic.

Healthcare providers and government agencies prioritise elderly health promotion to enhance their quality of life. Moreover, oral diseases are increasingly prevalent globally due to urbanisation and shifting lifestyle demographics.1,2

The WHO Global Oral Health Status Report of 2022 indicates that nearly 3.5 billion people worldwide are affected, with approximately 2 billion individuals experiencing dental caries in permanent teeth.

What is tooth decay?

Shafer described dental caries, preferably known as tooth decay as “an irreversible microbial disease of the calcified tissues of the teeth, characterised by demineralisation of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitations.”3 In simple terms, it is the breakdown of the surface of the tooth due to acids produced by pathogenic bacteria.

Although a variety of methods are known for the prevention and management of dental caries, it is a major health problem with manifestations persisting throughout life despite treatment.

Aetiology of tooth decay in old age

Age-related changes in oral health

As the human body ages, various oral conditions tend to emerge gradually. Among the key components of human anatomy, teeth undergo their own ageing process. Signs of ageing teeth include discolouration such as yellow or blackening, increased fragility, sensitivity, loosening, and receding gums. Ageing teeth are associated with a range of potential health issues. Among these, dental caries, periodontitis, and incomplete tooth fractures are common age-related dental disorders in the elderly, with caries, particularly root caries, and periodontal disease being primary concerns.4

Age-related changes pose challenges in restorative treatment due to the narrowing of pulp chamber space caused by the proliferation (hyperplasia) of secondary and tertiary dentin and profuse calcification in the radicular pulp.5

Existing comorbidities

Numerous older adults are affected by diabetes mellitus (DM), an often-seen hormonal condition that leads to gum disease, delayed wound healing, taste alteration, and dental infections. Those with diabetes are more prone to oral fungal infections causing conditions like stomatitis. Additionally, diabetic individuals who wear dentures are more likely to develop sores (traumatic ulcers) in the mouth where the dentures sit compared to those without diabetes, possibly due to slower healing or delayed wound repair.

Older adults with diabetes need to prioritise oral hygiene not just to prevent cavities but also to help manage their blood sugar levels effectively.

Stroke and dementia may precipitate a decline in one's capacity for self-care, necessitating assistance with fundamental daily tasks. Research indicates that individuals affected by dementia frequently exhibit inadequate oral hygiene practices, along with symptoms such as gum bleeding, the formation of periodontal pockets, lesions on the oral mucosa, and diminished salivary production.

As individuals age, both significant and smaller salivary glands experience degenerative alterations. Conditions like Sjögren’s syndrome, as well as various medications like antidepressants and certain diuretics, are recognised for diminishing saliva production. Prolonged usage of these medications can heighten the risk of developing cavities and periodontal ailments. Xerostomia, characterised by the sensation of dry mouth, is frequently reported among elderly individuals. Additionally, they may encounter challenges in speech and swallowing, as well as symptoms like burning mouth syndrome and changes in taste perception. 

Certain patients may adopt habits of consuming acidic foods and beverages to encourage saliva production, inadvertently leading to significant erosion of tooth surfaces. Consequently, this erosion can compromise dental aesthetics, particularly when front teeth become noticeably shortened, presenting challenges for oral restoration.6

Nutritional deficiency in older age

Elderly individuals aged 65 years and above are often susceptible to nutritional deficiencies due to the accumulation of various illnesses and impairments associated with ageing.7 These may encompass cognitive and physical decline, symptoms of depression, emotional fluctuations, and diminished oral health, in addition to socioeconomic shifts. Collectively, these factors can significantly impact the delicate balance between nutritional requirements and actual intake.

For instance, dental decay can cause both pain and eventual tooth loss, restricting an individual's food options. The inability to eat, combined with discomfort, pain, and anxiety, can result in a reduced intake of essential nutrients. Consequently, dental caries and its associated effects emerge as risk factors for nutritional deficiencies.8

On the other hand nutritional deficiencies, specifically lacking in Vitamin D, Vitamin A, and Protein Energy Malnutrition (PEM), have been linked to oral health conditions like enamel hypoplasia and atrophy of salivary glands.

Thus, nutritional deficiencies and dental caries mutually increase the risk of occurrence in old age.

Challenges in accessing dental health services for the elderly

Global reports indicate a prevalent issue of underutilisation of professional dental services among older individuals, especially among those facing socio-economic disadvantages. This problem is exacerbated in many developing nations where the elderly encounter challenges accessing oral health care due to a scarcity of dental professionals. 

Limited mobility, particularly in rural areas with inadequate public transportation, poses a considerable obstacle to accessing services. Moreover, financial constraints post-retirement, coupled with a lack of established dental care practices and negative perceptions towards oral health, may dissuade older adults from seeking dental treatment. Additionally, fear of potential discomfort can heighten apprehension towards unfamiliar individuals, thus impeding effective communication with oral health care providers.

Tooth decay prevention strategies

Oral health programs for older people

Oral health initiatives target improving the well-being of institutionalised elderly individuals. For instance, a program catering to nursing home residents offered comprehensive dental services including examinations, treatments, and education for both staff and residents. Results showcased a decline in dental decay, periodontal issues, denture-related problems, and enhanced oral hygiene.

Implementation of regular brushing by caregivers alongside professional dental care correlated with reduced pneumonia risks, febrile episodes, and mortality while improving the daily functioning and cognitive abilities of residents. Other programs emphasised caregiver education to overcome barriers in providing oral care, resulting in improved knowledge, attitudes, and oral health outcomes for both caregivers and residents. 

Additionally, a dental health promotion initiative utilising the PRECEDE (Predisposing, Reinforcing, and Enabling Courses in Educational Diagnosis and Evaluation) model yielded notable enhancements in the oral health of a cohort of healthy elderly individuals. Similarly, oral health promotion interventions incorporating self-monitoring strategies demonstrated improvements in oral health behaviours, attitudes, and overall health status among the elderly.9

Regular dentist visits for oral health counselling

Regular dental appointments play a crucial role in enhancing the oral health of seniors. Elderly individuals may require assistance with their oral hygiene routines, and caregivers should actively support them in this aspect. Depending on the individual's needs, caregivers may need to stand behind the elder and tilt their heads to ensure thorough cleaning of all areas of the mouth. It's vital to provide oral health education and guidance to caregivers responsible for supervising or aiding in the patient's oral care. 

Drawing from previous research on oral health challenges and preventive measures, a personalised 'Personal Care Package' can deliver tailored oral health advice to frail elderly individuals and their caregivers, considering factors like their level of dependency, medical conditions, and living circumstances.10

Diet modifications

Due to various health conditions and illnesses, older individuals are particularly susceptible to malnutrition, underscoring the importance of dietary management to enhance their oral health. A balanced diet rich in calcium is advised for older adults to support healthy bones, teeth, and gums. Foods such as salmon, dairy products, green peas, and brown rice are good sources of calcium. 

It is crucial to limit the consumption of sugary foods, as they can heighten the risk of cavities. Furthermore, dehydration can exacerbate dry mouth symptoms. Therefore, seniors should be encouraged to increase their water intake throughout the day to alleviate dry mouth discomfort. Those experiencing severe dry mouth may require medical intervention and should consult a physician for appropriate treatment.

Clinical intervention

Elderly individuals need to incorporate appropriate mechanical aids to maintain oral health. Older adults should aim to brush their teeth at least twice daily. For those who are unable to brush independently, caregivers should gently brush their teeth in circular motions, ensuring thorough coverage of both the teeth and tongue.

With age, tooth sensitivity becomes more common, and seniors may benefit from using specialised toothpaste designed for sensitive teeth. It is recommended to use toothbrushes with soft or medium bristles, replacing them every 3-4 months based on the condition of the bristles. 

While brushing helps remove food particles, flossing is also crucial for thorough cleaning. Though flossing may pose challenges, especially for individuals with dementia, caregivers can encourage and assist them if possible.

Oral hygiene aids such as electric toothbrushes and other cleaning tools can be beneficial for seniors with limited mobility. Toothbrushes featuring flexi-grip handles are particularly suitable for those struggling with grip strength, while foam tubes can be attached to toothbrush handles to enhance grip stability.10

In older age demographics, the use of fluoride has proven effective in preventing dental caries. Both topical application and mouth-rinsing with fluorides through toothpastes have demonstrated efficacy in reducing the occurrence of root surface caries lesions, among active older individuals and seniors residing in long-term care facilities.

When combined with chlorhexidine rinsing, topical fluoride application additionally aids in preventing tooth loss in older individuals. Chlorhexidine mouth rinses along with chlorhexidine acetate/xylitol gums are associated with reduced occurrence of denture stomatitis and gum inflammation prevalence among frail older individuals.

Summary

In conclusion, effective tooth decay prevention strategies for seniors encompass a multifaceted approach addressing various aspects of oral health care. Incorporating suitable mechanical aids and regular dental visits is crucial for maintaining oral hygiene, particularly for those with limited mobility or cognitive impairments. 

Dietary modifications, including a balanced diet rich in calcium and reduced intake of sugary foods, play a significant role in preventing dental caries and promoting overall health. Clinical interventions such as fluoride application and chlorhexidine rinsing have shown efficacy in reducing tooth decay and associated oral health issues among older individuals. Moreover, oral health promotion programs tailored to the needs of elderly populations, along with caregiver education, are essential for enhancing oral health outcomes and overall well-being in seniors.

References

  1. Janto M, Iurcov R, Daina CM, Neculoiu DC, Venter AC, Badau D, et al. Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review. Journal of Personalized Medicine [Internet]. 2022 [cited 2024 Sep 12]; 12(3):372. Available from: https://www.mdpi.com/2075-4426/12/3/372.
  2. Baiju RM, Peter E, Varghese NO, Sivaram R. Oral Health and Quality of Life: Current Concepts. Journal of Clinical and Diagnostic Research : JCDR [Internet]. 2017 [cited 2024 Sep 12]; 11(6):ZE21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535498/.
  3. Karunakaran R, Somasundaram S, Gawthaman M, Vinodh S, Manikandan S, Gokulnathan S. Prevalence of dental caries among school-going children in Namakkal district: A cross-sectional study. J Pharm Bioallied Sci [Internet]. 2014 [cited 2024 Sep 12]; 6(Suppl 1):S160–1. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157258/.
  4. Heng C. Tooth Decay Is the Most Prevalent Disease. Fed Pract [Internet]. 2016 [cited 2024 Sep 12]; 33(10):31–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373711/.
  5. Xie Y, Chen S, Sheng L, Sun Y, Liu S. A New Landscape of Human Dental Aging: Causes, Consequences, and Intervention Avenues. Aging Dis [Internet]. 2023 [cited 2024 Sep 12]; 14(4):1123–44. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10389823/.
  6. Leung KC-M, Chu C-H. Dental Care for Older Adults. Int J Environ Res Public Health [Internet]. 2022 [cited 2024 Sep 12]; 20(1):214. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819414/.
  7. Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, et al. Risk Factors for Malnutrition in Older Adults: A Systematic Review of the Literature Based on Longitudinal Data123. Adv Nutr [Internet]. 2016 [cited 2024 Sep 12]; 7(3):507–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863272/.
  8. Singh S, Talmale P. Impact of dental caries and nutritional status on oral health related quality of life in young Indian adolescents. Journal of Oral Biology and Craniofacial Research [Internet]. 2023 [cited 2024 Sep 12]; 13(4):506–10. Available from: https://www.sciencedirect.com/science/article/pii/S2212426823000544.
  9. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Comm Dent Oral Epid [Internet]. 2005 [cited 2024 Sep 12]; 33(2):81–92. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1600-0528.2004.00219.x.
  10. Kossioni AE, Hajto-Bryk J, Janssens B, Maggi S, Marchini L, McKenna G, et al. Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults. Journal of the American Medical Directors Association [Internet]. 2018 [cited 2024 Sep 12]; 19(12):1039–46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1525861018305802.

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Alongkrita Bordoloi

Msc Health Management Student at City University

Dr Alongkrita Bordoloi, a dentist by profession hailing from India possess a robust background in healthcare sector with clinical expertise. Passionate about integrating healthcare with strategic health management, Alongkrita has a proven track record in delivering exceptional patient care, effective leadership, and strategic planning.

Alongkrita has honed her skills in healthcare administration, project management, and customer service through diverse roles, including Assistant Dentist and Public Health Intern roles in India. Her recent experience as a Brand Ambassador and Marketing Assistant in UK demonstrates her versatility and integrity. In addition to her professional experience.

Alongkrita has actively participated in volunteer activities, such as contributing to COVID-19 patient care and community engagement with Savesoul India. Her education at CITY, University of London further solidifies her expertise, with notable achievements in academic excellence and leadership.

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