In the context of improved levels of education and better access to health care, we find that the percentage of elderly people in South Africa has dramatically increased and consequently, while previously the majority of older people were completely edentulous, this is no longer the case, with many people retaining some or all of their teeth well into their old-age.
As people become older, they are afflicted by many general health conditions that affect not only the health of their teeth and oral tissues but also their ability to care for their teeth, dentures and oral tissues. Some of these conditions include diabetes, hypertension, arthritis, dementia, Alzheimer’s and Parkinson’s disease. Treatment of these conditions usually involves multiple drugs each having their own side effects which could compromise both the quantity and quality of saliva that is produced. As a result the elderly are at risk for the development of extensive caries (tooth decay), periodontitis (gum disease) and opportunistic infections of the oral tissues; i.e. oral thrush. This is further exacerbated by their inability to properly care for their teeth and gums due to limited manual dexterity.
Oral health care for the elderly requires a multi-fold approach:
- Teeth should be brushed twice daily with a soft toothbrush with a small head. In people with limited dexterity electric toothbrushes can be very useful. It is important to ensure that all surfaces of the tooth are cleaned and the gaps were teeth are missing are not neglected. Daily flossing is advocated for cleaning between teeth. Interdental toothbrushes and floss-sticks may be used to clean interdental spaces when individuals lack the dexterity to floss. It is essential to clean the tongue to reduce the amount of bacteria in the mouth using either a toothbrush or tongue scraper. It is also advised that the elderly massage the mucosa of the cheeks, palate and edentulous areas to stimulate blood flow to the tissues.
- Denture care must include daily cleansing with commercially available denture cleansers and a soft brush. Denture users are advised not to sleep with their dentures as this may cause denture stomatitis or oral thrush which may be a pre-cancerous lesion. It is important to visit the dentist and seek treatment immediately if the denture area develops whitish patches, or becomes red, raised, or has a pebble-like appearance or if you experience a burning sensation or alterations in taste. Denture users should replace their dentures every 3 years as the tissues where teeth have been lost are constantly changing resulting in dentures becoming loose.
- Elderly people must visit their dentists at least twice a year and follow through on their prescribed treatment plans to ensure optimal oral health. Periodontal screenings in the elderly are especially useful at identifying advanced periodontal disease which is common in people having chronic systemic diseases.
Oral health directly affects and influences general health and ones’ sense of well-being. It is vital to appreciate that maintaining optimal oral health is not solely the responsibility of the dentist. Individuals must maintain a good oral hygiene regimen at home and ensure that they attend their dentists regularly and follow the treatment plans prescribed by their dentists to completion to maintain optimal oral health.