Increasing oral health in populations

Oral Health

Seniors have specific oral health needs. Meeting those needs requires an increase in personal hygiene, an improvement in lifestyle habits, and an increase in oral health service use. When these core needs are met, the specific oral health issues that affect seniors can be minimized, leading to improved health outcomes. Increasing personal hygiene requires shifts in attitudes toward oral health care, access to information, and access to affordable oral health care tools that are designed specifically for seniors. Lifestyle habits have a tremendous impact on oral health. Diet, smoking status, and drug and alcohol use are all factors that impact oral health. Accessing oral health services is difficult for many seniors. Some may live in rural areas where accessing oral health is physically difficult. Others may not be covered. In fact, most seniors do not have insurance coverage for oral health care. Not being able to afford oral health care is a major reason why seniors do not access oral health services. Therefore, expanding insurance coverage to include oral health is a critical component of addressing the health needs of seniors.

Aging leads to changes in the composition and amount of saliva, as do medications that many seniors may be taking. Dry mouth, or xerostomia, is a common complaint among seniors. Cavities, halitosis, and tooth loss are also issues that may impact all patients but can have serious implications for seniors. The most important oral health needs in older patients include the following.

Changing Attitudes Changes Behaviors

Attitudes toward oral health care impacts the amount of time and energy an individual spends on daily hygiene practices. Similarly, attitudes toward oral health services will impact the actual number of times the person will visit the dentist. Changing the attitudes of seniors regarding oral health can help them address the critical need of improving oral hygiene in their daily lives. In addition to affordability, seniors may avoid the dentist due to fear of pain or fear of detecting a serious disease.

More Frequent Visits

Seniors need to visit the dentist more for regular checkups, screenings for oral cancer and decay, and for ensuring that dentures and other prosthetics fit properly. Ironically, the patients who need oral health services the most are not accessing them. According to Vargas, Kramarow & Yellowitz (2001), 75% of edentulous persons only visit the dentist "when needed," about twice as many as dentate individuals (p. 5). Minority patients are also half as likely to avail themselves of oral health services than their white counterparts (Vargas, Kramarow & Yellowitz, 2001). The higher a person's level of educational attainment, the more likely they are to use dental services (Vargas, Kramarow & Yellowitz, 2001). Therefore, socio-economic class is critical factor in oral hygiene, and can be considered a risk factor for developing specific diseases. Minority patients need to visit the dentist more often.

More Affordable Care

All patients need more affordable dental care. Seniors especially need more affordable dental care because they have more frequent and pressing needs related to oral health. The vast majority (79%) of dental visits are paid out of pocket, as only 22% of seniors over the age of 65 are covered for dental care (Vargas, Kramarow & Yellowitz, 2001). Until the situation is remedied through policy changes, seniors can find out about dentists who offer low-cost services to those who need them ("7 Oral Health Concerns Most Common in Seniors," 2014).

Information and Education; Teaching Old Dogs New Tricks

The way to inform and educate seniors depends on the individual, and his or her communication styles and preferences. Some seniors may prefer to read about oral health on their own, via pamphlets, books, or the Internet. Others may want personalized discussions with health care workers like dentists, dental assistants, or nurses. Some seniors may prefer classroom settings. Language and culture will also determine how the individual is educated regarding oral health.

The more teeth seniors keep, and the more seniors keeping more teeth, means that it is more important than ever before to educate seniors as to proper oral health habits like brushing and flossing. As many as one-third of seniors over the age of 65 have lost all their teeth, although this number has been steadily declining due to improvements in access and use of oral health services (Vargas, Kramarow & Yellowitz, 2001). Ironically, though, the more teeth seniors keep, the more likely they are to experience caries and other problems (Lamster, 2004). Seniors are actually more at risk for developing dental caries, or cavities, than children are ("7 Oral Health Concerns Most Common in Seniors," 2014; Lamster, 2004). About one-third of people over the age of 65 in the United States have untreated cavities in either the crown or the root (Vargas, Kramarow & Yellowitz, 2001). This may be due in part to a lifetime of poor dietary habits and their cumulative effect on causing tooth decay. Dental caries can cause severe pain, and when left untreated, may lead to tooth extraction. Seniors are more susceptible to dental caries, and seniors with other oral health issues like dry mouth will experience faster rates of cavity growth and a more difficult treatment process (Lamster, 2004). Therefore, seniors will require oral health tools like toothbrushes that suit their lifestyle.

Tools and Ergonomics

Seniors may need specially designed tools and products to maintain their oral health. Such tools can eliminate key barriers to product use. Designing dental tools for seniors with poor dexterity, decreased mobility, or pain can therefore improve oral health outcomes in senior populations. With the help of friends and family members, seniors may need to adapt their own toothbrush, by attaching a Velcro strap, using a bicycle grip like the one on handlebars, attaching a tennis ball, or an elastic band ("Toothbrush Adaptations," 2011). These self-help methods offer low-cost solutions. Many seniors also find that electric toothbrushes are easier to handle. The key is finding a solution that makes regular (twice daily) brushing a likelihood. Given that regular brushing prevents problems like dental caries, preventative dental hygiene can depend on having the right tools. Likewise, flossing can be difficult with people with pain or limited dexterity. Floss holders may be helpful, and some seniors may receive assistance from their home health providers.

Communication

Personal reminders by nurses, doctors, family, and peers help seniors remember to brush their teeth regularly, and keep their dental appointments. Seniors in assisted living facilities or nursing homes may need their health care providers and nurses to help by placing the toothbrush in prominent position and asking the individual if they have been keeping up with their hygiene regimen.

Nutrition and Diet: The Two-Way Street

Diet is one of the main lifestyle factors affecting oral health in seniors. A poor diet can lead to oral health problems like dental caries or gum disease. Likewise, oral health problems like tooth loss and pain can lead to poor diet and malnutrition. This is why nutrition and diet are two-way streets in oral health. Oral health promotes good nutrition, and good nutrition promotes oral health.

Seniors need to consume fresh fruits and vegetables to maintain a healthy body and mind. Yet having fewer teeth, dentures that do not fit, or having any kind of mouth pain may lead to the person not being able to chew crunchy foods like fresh fruits and vegetables. This can be partly remedied by sticking to softer fruits like banana, mango, or berries. Vegetables can be softened by lightly cooking them, and some vegetables like salad greens, are not crunchy.

Diabetes is a common disease among seniors that causes problems like gum disease (United Way of Tucson and the Alliance of the American Dental Association, 2005). Adult-onset diabetes is linked to poor dietary habits such as the overconsumption of simple carbohydrates. Therefore, improving diet will help reduce problems associated with diabetes and also promote oral health.

Regular Screening for Oral Cancer

Seniors need regular screening for oral cancer because they are at high risk for developing it. Seniors are seven times more likely than their under-65 counterparts to be diagnosed with oral cancer (Vargas, Kramarow & Yellowitz, 2001). Median age of oral cancer diagnosis is 64 years (Lamster, 2004). Oral cancers are deadly, and some studies have shown more deaths result from oral cancer than skin cancer (Vargas, Kramarow & Yellowitz, 2001). There are several types of oral cancers, including cancers of the lip, pharynx, and oral cavity. Usually oral cancers are detected on or under the tongue, but can manifest in glands and jawbones as well (United Way of Tucson and the Alliance of the American Dental Association, 2005).

Survival rates have not improved appreciably in spite of advancements in detection and treatment methods, making prevention more important than any other factor (Lamster, 2004). Smoking and heavy alcohol use are the most common risk factors for oral cancer (Lamster, 2004). Early detection maximizes survival. However, there is a disparity in early detection rates between whites and non-whites given the differential access of the oral health system (Vargas, Kramarow & Yellowitz, 2001). Many patients with oral cancers are asymptomatic during the early stages, experiencing no pain, making dental visits crucial for early detection.

Reduce Dry Mouth

Dry mouth, also called xerostomia, is the lack of saliva in the mouth. This is a condition that especially affects old people, but as many as one in four individuals suffer from dry mouth occasionally ("What is Xerostomia?" n.d.). Old people are affected more often by xerostomia in part because of their medication regimen. At least five hundred different drugs list xerostomia as a major side effect ("What is Xerostomia?" n.d.). Certain diseases can also cause xerostomia. "Uncontrolled bacterial growth" is one of the problems that can result from dry mouth, which is why seniors who take medications need to check that their mouths are in good condition (United Way of Tucson and the Alliance of the American Dental Association, 2005). Also people who wear dentures are at an increased risk for xerostomia (United Way of Tucson and the Alliance of the American Dental Association, 2005).

Cosmetic Needs

Cosmetic needs are as important as medical needs in some cases, as healthy mouths and smiles can promote social functioning and psychological well being. As people age, their dietary and lifestyle habits may contribute to teeth discoloration. However, even the healthiest of lifestyles without smoking or coffee cannot prevent the thinning of the enamel coating on the teeth. When the outer layer of tooth enamel wears away, the darker inner layer of bone-like tissue called dentin shows through ("Oral Care," n.d.). Some foods and beverages like tea and coffee can change the dentin directly ("Oral Care," n.d.). The cosmetic implications of poor oral health cannot be underestimated in seniors, as it may lead to problems related to well being, social health, and mental health. Therefore, seniors need to be aware of the interventions available to them in the form of teeth bleaches and whitening tools, dentures and other prosthetics that can cover up lost teeth, and orthodontic work to make up for the fact that tooth loss may lead to changes in jawbone.

Dentures

Edentulism, or teeth loss, is a common problem among seniors. Seniors over the age of 65 have an average of only 18.90 teeth, out of their full 32 ("7 Oral Health Concerns Most Common in Seniors," 2014). Seniors living below the poverty line are twice as likely to have experienced total tooth loss than those living above the poverty line (Vargas, Kramarow & Yellowitz, 2001). Minorities are also more likely to experience total tooth loss vs. whites (Vargas, Kramarow & Yellowitz, 2001). Tooth loss is not only an aesthetic issue, but it can affect speech and other factors related to quality of life. Seniors who have lost all their teeth may wear prosthetics, which present their own set of potential problems. Similarly, tooth loss can lead to changes in eating habits that may be unhealthy for seniors. Not replacing individual missing teeth can cause structural problems in the mouth such as an uneven jawbone ("Oral Care," n.d.).

Dentures restore normal mouth aesthetics and functioning after tooth loss. However, dentures need to be cared for and fitted properly. There are also wide disparities in denture use and quality of dentures between socially advantaged vs. disadvantaged groups (Vargas, Kramarow & Yellowitz, 2001).

Understanding Systemic Disease

Seniors need to understand the proven links between oral health and problems like pneumonia, heart disease, stroke, and diabetes. Diabetes, pneumonia and other respiratory infections, heart disease and stroke have oral health components due to the bacterial composition of the mouth and its changes due to old age or pharmaceuticals. Lifestyle factors like smoking, drugs, or alcohol use can also have systemic effects, leading not just to problems like lung disease or liver failure but also to oral cancer. Likewise, periodontal disease makes it more difficult to control blood sugar in patients with diabetes (United Way of Tucson and the Alliance of the American Dental Association, 2005). Periodontal disease is linked to systemic disorders, including cardiovascular and cerebrovascular diseases, diabetes mellitus, and respiratory disorders in seniors," (Lamster, 2004). Moreover, Lamster (2004) notes "patients with periodontitis have been shown to be at increased risk for myocardial infarction, fatal myocardial infarction, and stroke." Gum disease can also lead directly to tooth loss.