Oral health care for elders
by Carol Bradley Bursack, Editor-in-Chief
Oral health care for our aging loved ones is another of those many issues where frustration can nearly drive a caregiver nuts. Caregivers can feel helpless because there are so few viable options.
My mother-in-law, Alice, had her own teeth throughout her life. As her mental and physical health deteriorated, so did her oral hygiene. By the time she moved to a nursing home, her teeth were beyond repair. As they rotted into little black nubs, she told me that the looks of her front teeth bothered her. I felt terrible for her, but I knew she was unable, physically or mentally, to go through having them removed, which was the only viable alternative to keeping them.
She did develop an abscess which was taken care of by antibiotics, and the teeth didn't seem to cause her physical pain other than that. As her dementia got worse, she no longer mentioned her appearance. Her ability to chew was affected, which happens to many elders. That was distressing, but all we could do was our best.
Oral Care: Are Those With Dentures in a Better Position?
My dad had dentures since he was in his 30s, because medication for another health issue destroyed his teeth. When teeth are pulled the bone tends to deteriorate and because dad wore dentures for nearly half a century there was little bone left. The relining and replacing on his dentures had been going on for years. We used every adhesive available. However, keeping his dentures in place, during his later years was a huge challenge.
One incident with my dad illustrates an ongoing problem for nursing homes. His lower denture plate disappeared one day. Many elders will begin eating a meal, and if their dentures bother them, they may take the teeth out and put them on the food tray by their plate. When the tray is collected--you get the picture--into the garbage they go. Whether this is what happened to dad's teeth or whether he put them in his own garbage can we'll never know. It was evident, however, I had my work cut out for me.
We went to the dentist with dad in full-blown dementia mode. He didn't understand what was being done, even though he acted like a perfect gentleman throughout the checkup. Although, we couldn't get him into the dental chair, the dentist was kind enough to perform the examination while dad sat in his wheelchair.
The diagnosis was what I expected. There was almost no remaining bone structure for the teeth to adhere to, therefore actually fitting him with comfortable dentures was not an option. The dentist used the old mold to have new lower plate made and we went back to "gluing" his teeth in with a denture bond.
Oral Care: What's the Best Approach for the Caregiver?
First, understand there is only so much you can do at this stage. As distressing as it is to know your loved one is having a difficult time enjoying food and eating a healthy diet, you can't magically give them a new set of teeth. Brushing what they have left, or taking good care of their dentures is vital. However, even basic oral care can be a huge issue if the elder is paranoid or in pain from other issues.
Flossing? Great idea if you can do it. If you can't, don't beat yourself up. This is one of those issues where your best has to be good enough. Sometimes it gets down to swabbing the nubs of the teeth with water and keeping an eye out for infection or pain. Soft foods and supplements may have to stand in for a healthy diet.
For example, my mother had a tooth that was snagging her cheek. I took her to the dentist who said she needed to have the tooth removed. Due to her age and genetics, the roots were practically wound around her jaw--and my mother could not stand the oral surgery needed to correct the problem.
Instead of moving forward with surgery, the dentist had a new temporary filling material. He filled the tooth with this material which smoothed out the tooth. This procedure provided my mother with some relative comfort, a level of comfort she lived with until her death.
Oral Care: Drop the Guilt
About all you can do is take your loved one oral checkups and suggestions, if you can. Keep their mouths as clean as possible and watch for signs of distress if they can't articulate pain. It's a case where you must do what you can, and then let it go.
You may feel you haven't done enough, but realize you may have exhausted the treatment options. Talk it out with the dentist, other health providers, and caregivers who have experienced the difficulty of elder oral care.
Indeed, effective oral health care for frail, demented seniors is a puzzle yet to be solved.