It is a rare person who enjoys going to the dentist. In fact, only about two-thirds of Americans visit the dentist each year – and often for emergencies, rather than the routine checkups all of us are recommended to have. It’s not surprising, then, that more than a quarter of us are walking around with untreated cavities, according to the U.S. Centers for Disease Control.
Money plays a big role in dental neglect: high income Americans are twice as likely as those with low incomes to visit a dentist and those numbers have continued to erode at the lower end of the economic ladder in recent years. Still, even many people with dental insurance and other financial resources avoid going to the dentist, and for the aging, the consequences of dental neglect can be especially profound.
Unfortunately, there’s a bit of a Catch 22 here: dental care can be very difficult for elderly patients, yet it is essential for their health.
Manhattan dentist Marc Lazare has outlined a number of common factors that make oral hygiene challenging for the elderly.
- Arthritis frequently makes it difficult for an older person to hold and maneuver a toothbrush, and makes flossing very difficult or impossible. Special brushes that are easier to grip can help, as can electric brushes (which require less effort) and floss holders with ergonomically designed handles. People who have difficulty taking care of their teeth at home can also benefit from more frequently visits to the dentist for checking and professional cleaning.
- Elderly patients often have dry mouths due to age-related decreases in saliva, frequently made worse by medications taken for other health conditions. Dry mouth, in turn, can contribute to the person having difficulty swallowing, as well as tooth decay, infections, gum disease and other uncomfortable or painful conditions in the mouth that hinder care both in the dentist’s office and at home.
- Bone loss and fragility can make it difficult for dentures to fit comfortably and bar patients from having missing teeth replaced by implants.
- The memory loss, confusion and depression that are common in elderly people can make a visit to the dentist difficult to impossible.
At the same time, oral cancer becomes more common with age, weakened immune systems make the elderly more susceptible to viral and bacterial infections, and nerves in the teeth recede, which can result in cavities that go unnoticed until the decay is advanced. All of these factors argue for consistent dental care and oversight for older people.
So what is the caretaker of an older person to do?
In addition to using brushing and flossing devices that make self-care a bit easier, high-fluoride toothpaste and daily fluoride rinses are recommended as an extra layer of protection against cavities for people whose arthritis or other movement-limiting health conditions make oral hygiene difficult.
For patients with dementia, communication before and during the dental appointment is critical. Some dentists specialize in treating older people but most don’t. In either case, when making a dental appointment for someone with dementia, the caregiver should alert the office to the special needs of their loved one, including letting the person making the appointment know that the caregiver will accompany the patient, needs to speak with the dentist or hygienist before treatment, and stay with the person in the examination room. It is also a good idea to set the expectation, ahead of time, that the visit may take longer than it would for a patient without dementia. If the practice does not respond positively, it may be time to look for a different dentist.
In providing care for patients with dementia, the American Dental Association recommends:
- That noise and other distractions be minimized when providing care. For example, while some dentists use televisions or music to distract patients and give them something to focus on during treatment, it is a good practice to ask that the TV, radio or other device be turned off before a patient with dementia enters the treatment room.
- The dental association also recommends allowing a trusted caregiver to remain with the patient during treatment to provide reassurance.
- The dentist should approach the patient from the front, at eye level, using nonverbal communication, such as smiling and eye contact, while introducing him- or herself.
- Because a patient with cognitive limitations may become easily overloaded, instructions should be simple and sentences short, such as, “Please open your mouth.”
Even with the best preparation and the greatest patience, if you are the caregiver it’s important to prepare yourself for the possibility that a dental visit may not be able to be completed, as this recent story illustrates.
If you are the caregiver of a frail, elderly ICS member, or one with dementia, you can ask your loved one’s care manager to help you find a dentist with experience treating geriatric patients. The care manager will work with our Provider Relations Department to find the best fit.