Elder Care Interprofessional Provider Sheets

Oral Care for Older Adults

Karen Tam, RDH, MSDH, PhD, Dental Hygiene Department, Pima Community College, Tucson, AZ

July 2017

TIPS FOR PREVENTING DENTAL CARIES IN OLDER ADULTS

  • Use an electric toothbrush or a soft manual toothbrush twice a day
  • Use fluoride daily or antimicrobial rinses when indicated
  • Use an interdental cleaner (dental floss, soft pics, interdental brushes)
  • Visit a dental care professional regularly
  • When patients have caregivers, involve them in the plan for and administration of oral care

The prevalence of edentulism (loss of some or all teeth) among adults aged 65 and older in the U.S. had declined from 23% in 2008 to 19% when last measured in 2012. Rates differ, however, among population groups. The highest rates are among Native Americans and African Americans, and the lowest rates among Asians and Hispanics. Rates are also higher in low-income populations.

As a result of adults retaining their natural teeth longer, there is a higher risk over time of developing dental caries (cavities), periodontal (gum) disease, and a variety of other oral health issues (Table 1). This edition of Elder Care will focus on prevention of dental caries and other selected oral health conditions in older adults.

Table 1. Oral Health Issues in Older Adults
Angular chelitis*
Gingival overgrowth
Attrition (wear-and-tear tooth loss)
Missing teeth
Dental carries
Oral/pharyngeal cancer
Failing dental restorations
Oral candidiasis
Dry lips; dry mouth
Oral mucositis
Gingival abrasions
Periodontal disease
Gingival erosions
Poor oral hygiene
*swelling and redness at corner of mouth

Preventing Dental Caries

With age, older adults are at risk for new or recurrent caries, particularly on the root of teeth as gum recession occurs. They are also at risk for periodontal disease from inadequate plaque removal in the past.

A number of activities can help prevent these caries. They include consistent fluoride exposure, mechanical removal and chemical control of dental plaque biofilm, and regular professional dental care. These goals can be achieved for older adults who have no dental complications by receiving regular dental care and following the standard oral hygiene routine of brushing twice a day with a fluoridated toothpaste and a soft manual toothbrush or electric tooth brush, using a daily interdental cleaner (flossers, soft pics, interdental brushes). Some older adults may not have the dexterity to use simple dental floss.

Oral Care for Patients with Special Health Conditions

While the aforementioned approaches are appropriate for patients with no special dental or oral health problems, prevention and control of dental caries and other oral health conditions must be individualized based on a person's oral health and general health status.

For individuals susceptible to dental caries, the American Dental Association (ADA) recommends the use of fluoride varnish. Fluoride varnish is a resin base that contains a high concentration of fluoride (22,600 ppm or 2.26% fluoride). It is painted on the teeth and dental root surfaces. In addition to this being a procedure performed by dental professionals, licensing regulations in most states authorize physicians, nurse practitioners, nurses, pharmacists, and physician assistants to apply fluoride varnish.

Another approach to preventing dental caries is the use of re-mineralizing pastes that contain calcium and phosphate (MI paste). The paste is smeared onto demineralized teeth before bed with a finger or cotton-tipped applicator and left on the teeth overnight.

Preventive protocols for older adults with other selected health conditions, including the most recent (2014) recommendations from the Centers for Disease Control and Prevention about oral care for patients on mechanical ventilation, are shown in Table 2.

Included among these preventive protocols is the use of chlorhexidine rinses to prevent buildup of bacteria in dental plaque. Chlorhexidine is recommended for patients on ventilators, patients with mental and physical disabilities, patients with chronic conditions that predispose to xerostomia (dry mouth), and patients in long-term care facilities (Table 2). Chlorhexidine is also recommended to reduce or prevent development of oral mucositis and candidiasis in immune suppressed patients.  

Table 2. Preventive Protocols for Older Adults with Selected Health Conditions
Chronic Conditions Associated with Xerostomia (Dry Mouth)
Physical and Mental Disabilities
Patients in Long-Term Care Facilities or Hospitalized on Mechanical Ventilation
  • At-home use of over-the-counter 0.05% sodium fluoride rinse, and 1.1% sodium fluoride gel or 0.4% stannous fluoride gel
  • In-office, fluoride varnish applied two times a year
  • 0.12% chlorhexidine gluconate rinse. Wait 60 minutes before applying fluoride and 60 minutes after brushing
  • Saliva substitutes, frequent water intake
  • Modification of the toothbrush with enlarged handle
  • At-home use of over-the-counter 0.05% sodium fluoride rinse, and 1.1% sodium fluoride gel or 0.4% stannous fluoride gel
  • In-office, fluoride varnish applied two or three times a year
  • 0.12% chlorhexidine gluconate rinse. Wait 60 minutes before applying fluoride and 60 minutes after brushing
     
Patients in Long-Term Care Facilities
  • Fluoride varnishes applied twice/year
  • Saliva substitutes
Patients on Mechanical Ventilation and Low-Functioning Patients in Long-Term Care
  • Saliva substitutes
  • Foam suction swab with 0.12% chlorhexidine gluconate rinse every 4 hours
  • Moisturizer for lips and mouth every 2 to 4 hours

Oral Care for Adults with Caregivers

For older adults with caregivers, effective routine oral care can be difficult. Taking care of someone else's oral care requires patience, skill, and willingness to be proactive, especially when the older adult is unable or unwilling to cooperate. This makes the caregiver an important part of the oral health team. Table 3 is a guide to help caregivers provide the basic essential oral care.

Table 3. Caregiver's Oral Health Guide

  • Look for a comfortable place in which to perform daily oral care. It doesn't have to be in a bathroom.  
  • Assure good lighting.
  • Allow the patient to sit at a table.
  • Explain to the patient what is going to happen and what is being done.
  • Either sit or stand to help the patient brush and floss.
  • Caregiver can be next to or behind the patient.
  • Give positive feedback when the patient is being cooperative.
  • Develop a routine. Be creative.
  • Consult with the patient's dental team about oral lesions that don't resolve in two to three weeks.

References and Resources

  • Fitzgerald J., et al (2015). Outpatient mediation use and implications for dental care: Guidance for contemporary dental practice. J Can Den Assoc,
  • 2015; 81:f10.
  • National Institute of Dental and Craniofacial Research.  Dental Care Every Day:  A Caregiver's Guide.
  • Prendergast V, Kleiman C. Interprofessional practice: Translating evidence-based oral care to hospital care. J Dental Hygiene  2015; 89(1):33-35.
  • Razak PA,  et al. Geriatric oral  health: A review article. J Internat Oral Health, 2014; 6(6):110-116.
  • Slade G D, Akinkugbe AA, Sanders AE.. Projections of U.S. edentulism prevalence following 5 decades of decline. J Dental Res. 2014;
  • 93(10):959-965.
  • Wu B, et al. Edentulism trends among middle-aged and older adults in the United States: comparison of five racial/ethnic groups. Community Dent Oral  Epidemiol. 2012; 40(2):145-153.