This blog is written for people who have entered or are preparing to enter aged care, their families and carers…
By the time people enter aged care their general health has usually become very delicate. They have reached the point that caring for themselves with their usual skill and capacity is no longer possible. Their dental health is also in a very fragile and precarious state, but in the flurry of activity that is required to secure a place in an aged care facility, teeth and gums are almost always forgotten. And honestly, who would even consider dental health when vast amounts of complex paperwork, sale of the family home, management of possessions and the demands of medical care are dominating every thought and spare moment of time?
Although it is entirely understandable that teeth are easily relegated to the backseat, our neglect of this issue has resulted in a serious burden of distressing, painful and difficult to treat dental disease for our elderly people in aged care.
How has this situation come about?
People are now keeping their teeth longer; well into their old age. A mere 30 years ago, the majority of older people entering aged care had lost most, if not all of their teeth and only had dentures to care for. This is no longer the case. Many older people now have most, if not all of their teeth when they enter aged care.
In part, this phenomenon reflects a shift in people’s thinking that occurred in the late 1970's and continued into 1980's and 90's. Teeth changed from a troublesome burden to be removed, into an asset to be kept as long as possible.
In part it is also a result of our skill as a dental profession, supporting people to keep their teeth longer than was possible in the 1800’s and early to mid 1900’s.
Although keeping our teeth for our lifetime represents a great advance, it is in fact a very mixed blessing because teeth become far more vulnerable to disease as we age, and treatment becomes far more challenging.
The reasons are:
Dry mouth is common in older people, and dry mouth massively increases the risk of dental disease. This condition is related to the ageing process, but it is also made far worse by medications. Virtually every medication impacts on the ability of our saliva glands to produce the saliva that cleanses the mouth and protects the teeth.
The dexterity people used to have to care for teeth is severely reduced. This can be due to arthritis, restricted arm mobility, Parkinson’s disease and the shaky frailty of advanced old age.
Add to this the food that is served in aged care homes. It is often very soft, high in starches and sugar to make it more tempting to eat. Breads, biscuits and desserts are served daily. Relatives bring chocolates and sweet snacks when they visit. Although this is understandable (in advanced old age we believe that we do not have much to look forward to beyond our next meal or treat), its compromises dental health to a degree we urgently need to consider.
The presence of diabetes (a common condition as we age) substantially increases the risk of gum disease.
People with dementia and Alzheimer’s disease very often forget to clean their teeth, and cravings for sweet food can increase with these conditions.
Dementia and Alzheimer’s disease can prevent people from communicating that they have dental pain. This creates a significant burden of unaddressed suffering.
The poor mobility of older people can make accessing dental treatment difficult to impossible.
Many of the medications older people take compromise the capacity of dentists to deliver the dental care they need. Anti-coagulants, corticosteroids, immune suppressants and osteoporosis medications make dental care such as tooth extractions complicated, and increase the risk of poor and delayed healing.
Poor dental health increases the risk of stroke, heart disease and lung disease. It increases the risk of developing diabetes and the severity of diabetes in people already affected.
We cannot apply pressure to the aged care facilities and their staff to make this problem go away. They are already over-burdened by the physical needs of the people they serve, and the situation is more widespread than any one staff member or indeed aged care facility to handle.
How can we support our older people at this time?
Get the dentist involved as soon as possible. If possible, seek a dental assessment prior to entering aged care, and treat any problems as early as you can. Make routine dental care a normal part of life. Now, more than ever, people need regular support from their dentist and the advice that will maintain dental health. Develop a strategy with your dentist for future visits if mobility becomes compromised.
As a relative, do not automatically give chocolates and sweets as gifts. Your presence is the greatest present you can offer people at this time.
Offer to brush the teeth of your relative when you visit them – only do this if they have lost the capacity to do so for themselves and do not force this onto them. Cleaning another person’s teeth requires a lot of tenderness and understanding, and it is very challenging for people who are not dentally experienced. However, it is a very powerful gesture of deep care for another person.
Talk to the nursing home staff about reducing the sugar and starch content of the food that is served. Do not expect change. In having the conversation, you are bringing their awareness to the problem of high sugar foods and their impact on dental and indeed general health. Not only does this support your relative, it offers the same care to every resident who may not have a person to speak on their behalf.
Dental disease at every stage of our lives is a reflection of the fact that we (on the whole) have not yet made the health of our mouths an essential part of our general healthcare consideration. By the time people enter aged care, the truth of this is starkly revealed. Although we want the problem fixed by our healthcare authorities, it is our individual responsibility to eat with deep respect for our body and teeth, and care for our mouths that is so poignantly highlighted.
The problem of poor dental health in aged care is a significant one, that will not be arrested in the foreseeable future.
In the meantime, we can heed the call to take responsibility for our dental wellbeing and that of the people in our care, and ensure that we call upon the ongoing support and advice of dental professionals throughout our entire lives.
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