General / Helping Someone You Care for Keep Their Pearly Whites
By Eileen Beal, MA
The good news: With advances in fluoridation and
dentistry, increasing numbers of older adults are
keeping their teeth. And the more teeth you have,
the longer you live.
The not-so-good news: Those who have kept their
teeth are prime candidates for late-life cavities
and gum disease. Both can be painful and lead to
system-wide inflammation that plays a significant
role in worsening several medical conditions,
including diabetes, heart disease and pneumonia.
This new reality means if you care for an older
loved one, you need to make sure they are caring for
their teeth. And not just so they can keep cavities
and gum disease (periodontitis) at bay.
“The mouth plays a major role in people’s self-image
and over-all sense of well-being,” says Dr. Kavita
P. Ahluwalia, an associate professor of dental
medicine at Columbia University Medical Center in
New York City.
The Big 5
“A lot of things are coming together to promote
cavities, gum disease and other conditions that lead
to tooth loss and poor oral health,” says Dr. Peter
DeGolia, Director of the Center for Geriatric
Medicine at University Hospitals Case Medical Center
in Cleveland, Ohio.
The most important of those “things” are:
- Dry mouth (xerostomia) Hands-down, the 30
percent drop in saliva production that comes with
aging – and the acidic environment it creates in the
mouth – is the major factor contributing to tooth
and gum problems.
- Medications “There are over 400 medications
– for high blood pressure, incontinence, depression,
neurologic conditions, etc. – that can cause or
worsen dry mouth,” says Dr. Marco Rouman, DDS, MFDS,
head of Case Western Reserve University Dental
School’s new geriatric dentistry program.
- Plaque The production of oral plaque – a
gummy and corrosive mix of bacteria, food particles
and substances found in saliva – explodes as the
mouth becomes dryer and more acidic.
- Receding and inflamed gums Gums recede
naturally with age, leaving the roots of teeth
exposed to plaque. Plaque build-up leads to gum
inflammation which, says Dr. DeGolia, “sets the
stage for late-in-life tooth loss.”
- Bone shrinkage Age-related shrinkage of jaw
bones leads to ill-fitting partial and full
dentures; mouth, palate and gum sores; and chewing
and nutrition-related problems.
The fact that all these “things” increase as a loved
one is dealing with functional decline — due to
worsening chronic conditions, such as arthritis or
osteoporosis; progression of a neurological disease,
such as Parkinson’s; or advancing Alzheimer’s
disease or a related dementia – can lead to apathy
about dental care or resistance to care.
“Most often resistance to care is due to some form
of dementia,” says Dr. Rouman. “For that reason,
it’s always recommended that as soon as a person has
received a dementia diagnosis, that they get as much
of their future dental work done as possible.”
There’s no getting around the fact that helping a
loved one with his or her dental care needs, or
providing care, can be challenging. That help (or
care) begins with making sure the person is:
Using a saliva substitute Sugarless gum and hard
candy stimulate saliva, but if they don’t work,
there are many commercial products available, says
Dr. Degolia. “They don’t just address the dry mouth
issue,” he adds; “they make a significant
improvement in people’s quality of life, too.”
Brushing with the right brush For everyone, that
means a toothbrush that they can hold, which for
some people means brushes with modified grips (see:
For some, especially those with functional concerns,
it may mean an electric or sonic toothbrush. For
those using dentures, it means two brushes: one for
the mouth and one for the dentures. “With brushes,
and all oral care products, there are a lot of
choices, so get the dentist’s assistance in making
the right choices,” advises Dr. Rouman.
Using an appropriate tooth cleaner Products for
sensitive teeth and that include enamel
strengtheners are best. For those who have
swallowing and/or spitting problems, gels, which
don’t create much foam or require constant spitting
and rinsing, are probably the best choice.
Rinsing Antibacterial mouthwashes keep plaque at bay
and freshen breath. Rinsing with water several times
a day helps with bad breath and dry mouth.
Seeing a dentist Older adults should see a dentist
twice a year: three times a year after 75. And,
advises Dr. Degolia, those with complex oral
problems or cognitive decline should probably see a
geriatric dentist because “they have the skills and
comfort level to work with those individuals.”
Paying For Care
Most private insurance plans (including Medicare
“advantage” plans) cover only basic dental care.
While dental services may be covered through regular
Medicare and some may be available through state
Medicaid programs, they are provided only in
specifically designated situations. That means
dentists’ visits and procedures must be paid
To keep those costs manageable, check out local
dental and dental hygienist schools, most of which
have “clinics” that provide low-cost care. To find a
dental school in your area, go to the American
Dental Association website
Federally Qualified Community Health Clinics also
provide low-cost basic dental services for those
with limited or no dental insurance.
If a loved one is enrolled in Medicaid and resides
in a nursing home, he or she may be eligible for the
Incurred Medical Expense benefit which can often be
used to pay for dental services. To find out if he
or she is, consult his or her Medicaid Caseworker.
Since dental health and physical health are linked,
your loved one (or you) should make sure that what’s
going on in the dentist’s office makes it into
his/her primary care physician’s, specialist’s and
pharmacist’s records. “It’s very important for
everyone to be communicating,” said Dr. Rouman.
Independence is a big and constant concern for older
adults and, in some cases, the person you are caring
for isn’t going to be all that forthcoming if they
are having dental or mouth problems. That means you
need to be on the look-out for signs that all is not
“Pain,” says Dr. Ahluwalia, “is a major indicator
that there is a problem and people are usually
pretty good about telling you about that…But there
are others, too: avoidance of foods they once
relished, a hand to a cheek, a bad mouth odor,
popping or clacking dentures or wearing them only
when they go out.”
“Picking up on those clues,” she adds, “means
constant vigilance and recognizing what you are
seeing and hearing.”
Eileen Beal is a Cleveland, Ohio-based writer who has been writing about caregiver issues for more than a decade. This article was written with the support of a 2013 MetLife Foundation Journalists in Aging stipend administered through
New America Media and the
Gerontological Society of America.