As you get older, have you noticed any of these changes?

Your mouth feels very dry
Loss of taste or a change in the way foods used to taste or feel in your mouth
You are getting more cavities than before
Chewing and swallowing now takes more effort

Dry mouth is a common side effect of many prescription medications taken more commonly later in life. Dry mouth can make it hard to eat, swallow, or talk. It can also lead to tooth decay or infection. If left unchecked, tooth decay can lead to tooth loss, which further affects your ability to eat, speak and smile.

As you age, it becomes even more important to take good care of your oral health. One common misconception is that losing your teeth is inevitable as you get older. This is not true. If cared for properly, your teeth can last a lifetime. By adopting healthy oral habits at home, making good choices about diet and seeking regular dental care, you can help your teeth last a lifetime.

Why is good oral health important?

Oral health is linked to general health and your ability to age well. Poor oral health is linked to increased risk of cardiovascular disease and aspiration pneumonia, and it can complicate the medical management of illnesses such as diabetes.

Missing teeth, poorly fitting dentures, oral infections, or mouth pain can affect appetite, food enjoyment and ability to chew, which results in poor nutrition. Poor oral health may affect your everyday life by causing pain and suffering, disrupting sleep, and affecting your overall wellbeing.

Why do the elderly face more challenges in maintaining good oral health?

There are certain conditions that make it more challenging to practice good oral hygiene for the elderly.

Elderly with stroke or tremors may have difficulty holding a toothbrush, while arthritis can make it painful to hold a toothbrush. Alzheimer’s disease or other forms of dementia can affect their approach to oral health too. The elderly may find it more difficult to clean their teeth properly if they have problems with their hands or arms, or if their eyesight is poor.

How should I care for my teeth as I age?

You can keep your teeth healthy by practicing the “3 Wells”

Eat well:
Sugars and acids in our food can cause tooth decay and erosion. Protect your teeth by reducing the frequency of eating sticky and sugary food such as cakes, desserts, kuehs and sweets.

Drink well:
Drink plain water after meals and snacks, and after taking medications. Keep your mouth moist by sipping water frequently. Reduce intake of caffeine drinks such as coffee or tea.

Clean well:
Brush morning and night, using a soft toothbrush with fluoride toothpaste on gums, tongue, and teeth. Clean dentures daily with a denture brush and liquid soap to remove plaque from all surfaces and rinse well.

You should also visit a dentist regularly, even if you wear dentures. Talk with your dentist about how frequently you need to visit for a check-up.

Does your arthritis make toothbrushing difficult? Here are some oral care tips.

Choose a manual toothbrush with a large handle and small head (e.g. children toothbrush) so that you can reach the back areas of your mouth. 

Modifications can be made to your existing toothbrush, such as inserting the handle through a tennis ball or foam roll; you can also wrap a sports grip tape around the handle. Your dentist can also make a personalised grip for your toothbrush using impression material.

Alternatively, you may consider an electric toothbrush with a small head, as less technique and movement are required.

Why do I have to see a dentist before starting my osteoporosis medication?

Medications are usually prescribed for osteoporosis to prevent bone loss and reduce the risk of fracture. Some are taken by mouth (oral), while others are injected (intravenous).

Examples of osteoporosis medication:

These medications can have side effects and have been linked to osteonecrosis of the bone in the jaws. This occurs more often when the drugs are given intravenously or when consumption of oral medication is beyond three years. “Osteo” means bone and “necrosis” means death. Osteonecrosis of the jaw may result in pain, swelling and pus discharge from the gums. There may also be spontaneous bone exposures, non-healing tooth extraction sockets and loosening of teeth.

Undergo a dental examination before starting osteoporosis medication so that infected teeth can be treated or extracted, and ill-fitting dentures adjusted or changed. After you have started taking the medication, follow up with good oral care and regular dental check-ups.

How can you help a loved one who has difficulty maintaining a healthy mouth on their own?

You should promote self-care if your loved ones can brush their own teeth. However, some may require assistance or are solely dependent on you to provide oral care.

For loved ones with mild dementia, encourage them to care for themselves and keep to a regular routine by providing reminders.

For loved ones with moderate to severe dementia, oral care may become more challenging. They may forget what to do with toothpaste, how to rinse, or may be resistant to assistance from others. Try the following tips:

Provide short, simple instructions: Walk them through the process. Say: "Hold your toothbrush." "Put toothpaste on the brush." Then, "Brush your teeth."

Use a “watch me” technique: Hold a toothbrush and show them how to brush their teeth.

Hand-over-hand technique: Place your hand over the person’s hand, gently guiding the brush around the teeth surfaces and gum line.

Try different types of toothbrushes: You may find that a soft bristled children toothbrush works better than an adult brush. Alternatively, an angled brush or triple-headed toothbrush is easier to use than a standard toothbrush. Experiment until you find the best choice.

If your loved one seems agitated or uncooperative, postpone brushing until later in the day.

How can I tell if someone with dementia has dental problems?

There may come a time when the person with dementia is unable to say that they are experiencing pain or discomfort in their mouth or teeth.

As a caregiver, look out for several behavioural changes which may indicate that someone with dementia is experiencing dental problems:
Refusal to eat (particularly hard or cold foods)
Frequent pulling or rubbing at the face or mouth
Leaving previously worn dentures out of their mouth
Increased restlessness, moaning or shouting
Disturbed sleep
Refusal to take part in daily activities

How can you help a loved one who has swallowing difficulties (dysphagia) or is on tube feeding?

Even if a person is not able to eat or drink, it is very important to brush the mouth and teeth to prevent build up of bacteria.

Before performing oral care, raise the bed into an upright position or have your loved one sit up and have a towel close by to wipe up any toothpaste foam or saliva.

Oral care techniques:
Use a gauze to remove any large debris
Use a small amount of sodium-laureth-sulphate free (non-foaming) toothpaste or dip toothbrush in antiseptic mouthwash and shake off excess
Gently brush all tooth surfaces for two minutes. Tilt the brush toward the gums so that you are brushing the gum line and move in small circles
Gently brush the tongue and the roof of their mouth if you can
Remove excessive toothpaste and mouth rinse with a towel

Foam swabs are less effective in removing plaque, but they can be used if teeth are absent or for those who are experiencing mouth sores.