Oral health in the elderly.


Poor oral health in the elderly and periodontal disease can be associated with diabetes, stroke, cardiovascular disease, respiratory disease, gastrointestinal problems.

Proper oral health in the elderly promotes oral comfort, assists in the ability to communicate,
improves nutritional status,
Poor or negligent oral care allows tarter to form, and this can lead to dental
plaque, gingivitis, severe periodontal disease, and dysfunction.

Benefits of good Oral health in the elderly.
-reduces the risk of respiratory infections;
-relieves discomfort produced by inflammation of the oral mucosa;
-improves nutritional status;
-improves speech; and
-improves outcomes for persons with wounds, stomas, or incontinence.
Dry mouth can contribute to irritated gums and dental decay. The goal of good
oral care is therefore to maintain mouth moisture, reduce dental plaque, and
decrease mouth bacteria to prevent colonisation of dental plaque.

Many medications play a role in the production of dry mouth, especially some
antihypertensives and antibiotics. For those with significantly reduced saliva
production, a saliva substitute or mucoadhesive gel can be used to produce or
replace moisture. These maintain mouth moistness over long periods of time by
leaving a coating on the mucosa and oral structures to maintain oral moistness
and promote saliva. Mouth pain can also be reduced using these gels because
they adhere to irritated tissue, thus decreasing airflow to the area.

Plaque is one of the leading factors in gum disease. Problems start with the
formation of tartar, which provides a rough surface on which bacterial dentalplaque can form.

It is imperative that diligent cleaning be undertaken of the teeth, false teeth, and the insides of the cheek and mouth to reduce dental plaque. Good oral hygiene is essential.

Mechanical and chemical debridement of the oral mucosa and teeth reducesdental plaque and mouth bacteria, and also stimulates the production of saliva. The avoidance or removal of dental plaque is a significant factor in preventing mouth infections.

This is therefore an important nursing responsibility.

Poor oral hygiene and periodontal disease leads to colonisation of the mouth with bacteria,
and subsequent microaspiration can lead to respiratory infections. Persons at risk
include the elderly, those with chronic aspiration problems, those receiving tube
feedings, and those intubated or with a tracheostomy. Meticulous oral care must
be part of any infection-control policy.

In attempting to maintain cleanliness, prevent infection, moisturise the oral
cavity, maintain mucosal integrity, and promote healing, oral care agents should
(Beck & Yasko 1993):

be mechanically and chemically atraumatic;
be non-decalcifying and non-toxic;
not interfere with saliva;

have acceptable odour and taste;
provide mechanical or chemical action to remove debris; and
provide moistening and lubricating action.
Undesirable practices
Unfortunately, traditional oral care has been fragmented and creative. The
following practices are not based on good evidence, and should therefore be

Use of inappropriate instruments and swabs

For residents unable to perform self-care with a toothbrush, nurses have used
lemon-and-glycerin swabs, cotton-tip swabs (often dipped in sodium bicarbonate
or dentifrice), gauze sponges wrapped on forceps, tongue depressors, and gauze
wrapped around fingers. Some caregivers have used hard-edged implements to
pry open (or prop open) the mouth.
These practices are potentially dangerous because cotton applicators leave
behind small fibres that residents can swallow or inhale. Fibres can become
trapped in the oral cavity causing bacterial seeding. Wood or hard-edged
implements can cause wounds to the oral cavity. In addition, the fingers of
caregivers can be bitten.

Carbonated drinks and commercially prepared fruit juices are acidic and can
further demineralise the teeth. Alcohol-based mouthwashes can act as oral
irritants, can dry out the oral mucosa, and have been linked with the occurrence
of oral cancer (Beck & Yasko 2001).

Use of lemon-and-glycerin swabs

Despite their popularity, these swabs have no mechanical or cleansing value, and
there is no evidence to support their continued use. They are acidic, and this
can damage teeth and promote mouth infections (Passos & Brand 1966). In
addition, glycerin absorbs water, thus drying out oral tissues.

Despite warnings in the literature about the effects of these swabs (Passos &
Brand 1966), many nurses continue to use them. Apart from the effects of the
lemon and glycerine in these products, cotton swabs are not designed for oral
hygiene, offer no mechanical debridement, and should never be used as part of
routine oral care.