The Importance of Oral Hygiene and Dental Care for Older Adults

When you’re a kid and your parents make you brush your teeth, you often meet it with reluctance. Depending on your age, maybe tears. Most kids try to get out of brushing their teeth, as it just seems like a chore.
For the most part, when you get older, you start to…if not enjoy it, recognize the medical and social importance of oral health. And so brushing and flossing become normal parts of your daily routine. This is especially true as dental care has improved and proper care became expected.

But for older adults, oral hygiene and dental care often become more difficult. As routines break down, mobility is compromised, and less time is spent on personal care, brushing and flossing too often takes the back seat. And this can be dangerous: teeth and gums are already weaker in older adults, and disease can strike more quickly and be more harmful.
There are many dental health issues that come with aging and many intersecting comorbidities that can contribute to deteriorating oral health. That’s why it is extremely important that older adults understand the risks and dangers of poor care, continue to see their dentist, and practice daily oral hygiene. You might not still get rewarded by your parents, but it is still just as rewarding.

Oral Health and Older Adults

Oral health in older adults is getting better, especially for Boomers born after mass fluoridation started in 1945. But, much like fluoride isn’t in the water in every state, health varies from area to area. A few statistics show us the big picture:

• 13% of Californian’s over 65 have no longer have any natural teeth
• 25% of Americans over 65 overall all have no natural teeth
• 23% of older adults from 64-75 have severe periodontal disease
• Men are 20% more likely than women to have severe periodontal disease
• At all ages, people from lower income classes are more likely to have periodontal disease
• 31,000 adults each year are diagnosed with oral and pharyngeal cancer
• 7,400 adults, mostly over the age of 65, die from oral and pharyngeal cancer each year
• The mortality rate from oral cancer is 44% for white adults, and 73% for African Americans

No matter what numbers you look at, it is clear that dental health is a serious issue for older adults. And the reasons why it is are why there are many hygienic issues for older adults: socialization, routine, mental health issues, and forgetfulness.

• Socialization. When you begin to socialize less and less, certain social norms can fall away. People stop paying attention to how they dress, stop bathing as much, and stop taking care of their teeth. That’s one of the (many) reasons socialization is so important: maintaining those bonds acts as motivation to take care of yourself.
• Routine. This is part of socialization, to an extent. After retirement or after a spouse or partner dies, it is easy to fall out of a routine. You don’t go out at “normal” hours, you don’t have a set place to be, you don’t have regular things to do. The patterns your days used to follow become disrupted. That means the other parts of your routine, such as oral hygiene, tend to fall by the wayside.
• Depression. Depression can exacerbate, and be exacerbated by, the lack of socialization and routine. Depression lowers your sense of self-worth and makes it harder to practice self-care. That’s why depression needs to be treated by professionals. It isn’t just about “being sad”; for anyone, but especially older adults, it is dangerous and potentially deadly.
• Dementia/forgetfulness. Taking care of dental health for older adults with dementia is challenging, But even for many older adults who do not have late-stage dementia or Alzheimer’s, remembering little things can still be difficult. However, as with medication management technology, there are many ways to set reminders to practice good oral hygiene.
• Dexterity and Mobility. Brushing your teeth might not seem like physical work when you are younger, but as hand-eye coordination, arm, and wrist strength weaken, it becomes more difficult to manage. That can mean less motivation and worse results when teeth are brushed (to say nothing of how difficult/painful flossing can become).

Oral Health Issues in Older Adults

Above, we talked about tooth loss, periodontal disease, and oral cancer, but those are far from the only issues that can arise from poor oral care. Other, often related, problems include:

• Root disease
• Exposed roots
• Uneven jawbone
• Xerostomia, or dry mouth

Additionally, one of the primary issues in older adults, whether we are talking about oral health or general health, is comorbidity. These are compounding symptoms that can make each condition worse. For example, tooth loss makes it harder to eat fruits and vegetables, which increases the likelihood of eating unhealthy processed foods, which can exacerbate other issues such as diabetes.
For many seniors, dry mouth is a concern, which increases the chance of decay and infection since saliva has a plethora of important antimicrobial components, not to mention minerals to help rebuild enamel. As a result, lack of saliva can break down teeth, leading to cavities, infection, and possible tooth loss, which can, as we saw, lead to other problems.
Dry mouth can be a natural result of aging, but it can also be the result of many medications. On the often-gruesome list of “potential side effects” that accompany many medications, dry mouth might not seem like a huge issue, but it can create and compound many problems. It’s important to talk to your doctor and your dentist about all possible side effects and take steps to manage them.
So how do you prevent these issues? By practicing good oral health.

The Good News about Dental Care For Older Adults

Here is some good news about oral health for older adults: just because it might be more important to take care of your teeth doesn’t mean it is significantly harder. It’s more or less the same process for every age:

• Drink fluoridated water.
• Brush your teeth with fluoridated toothpaste twice a day.
• Floss at least once a day, if possible. If mobility and dexterity issues prevent flossing, a Waterpik is your best alternative.
• Avoid any form of tobacco. It is never too late to quit, and the benefits are quick to see.
• Limit alcohol consumption.
• Listen to caregivers.
• Find a routine that works for you.
• Do not ignore dry mouth. It’s not just a small thing, but a potentially serious health issue.
• Visit your dentist on a regular basis, meaning at least one exam per year and ideally two cleanings. If you have periodontal disease, you may need more frequent and deeper cleanings. Even if you have no natural teeth, dentists can check for lesions, growths, and other signs of cancer or other issues.

Seeing the dentist is extremely important, and there are low-cost options for lower-income older adults in the Bay Area. So explore your options.
We’re told our whole lives to brush your teeth and take care of your oral hygiene. There’s a good reason for that: it is important for your whole life. Making sure that you take continuous good care of your mouth and teeth can help you stay social, feel better about yourself, and maintain overall good health.
At Institute on Aging, our programs and services help older adults, their families, and caregivers explore aging together, through good times and bad, as an adventure and a journey. Contact us today to learn more.