How to help our Parents, Grandparents and other Elders keep their teeth

By Dr. Janet Peterson

My grandfather lost his first permanent tooth at the age  of 89.  A lifetime of wear and tear on this upper canine had resulted in a crack that split the tooth and it had to be extracted.   He was lucky, though, in that a lifetime habit of brushing  twice a day and little or no snacking  between meals, in addition to good memory, allowed him to keep his oral  health.

My aunt was not so lucky.  In her mid-eighties she began to experience some memory problems.  Living alone, meals disappeared and she snacked on cookies and milk throughout the day.  She pretty much forgot to brush her teeth.  Her six month cleanings were followed by more and more repairs as decay encircled her teeth and  they broke off.  It was finally decided that a complete denture was the only reasonable solution.  Because of her frail health, two teeth would be extracted every two months to allow for healing.   Unfortunately, she passed away before the treatment plan could be completed – with only three teeth left and with  considerable embarrassment at the demise of her smile.

Memory loss is a big factor in the catastrophic increase in tooth decay  that so many elderly people experience.  It can be difficult to determine if this is a factor as elders  learn to “cover” memory lapses and we tend to respect their assurances that everything is all right.  Asking when their next dental appointment is may give a clue as to whether they are keeping up on dental check-ups.  If they have no appointment scheduled, getting an appointment is the first step.  Having someone go with them can be a good way of getting information from the dentist or hygienist as to whether there is an increase in the rate of decay in their mouth.  Because of the privacy rules of  HIPPA ( Health Insurance Privacy and Portability Act) ,  staff may be unwilling to discuss an elder’s health over the phone or by letter, whereas it is easy to have a three way conversation with the elder and their dentist or hygienist in person.  If there is an increase in rate of tooth decay,  it is necessary to find out what are the contributing factors and to start trying out possible solutions to slow this rate of decay.

The usual contributing factors and some first steps to mitigate them are:

Change in dietary habits with more frequent  snacking,  more sweets.

  • Provide balanced meals that require little or no preparation
  • Try to group sweets with a meal and decrease snacking between meals

Physical difficulty with brushing with weakness or uncoordinated hand movements or pain

  • Try an electric toothbrush,
  • Adapt the manual brush by bending the handle or enlarging it with foam

Apathy or depression – the attitude of “why bother?”

  • Engage the professional services of a psychologist or counselor
  • Discuss the benefits of good oral home care, and the downside of neglect – pain or missing teeth

Memory  problems leading to the forgetting of established daily habits

  • Place the toothbrush by the bathroom  sink in plain sight
  • Tape a note on the bathroom mirror – “Brush Teeth”
  • Remind the elder daily to “ go right now and brush your teeth”
  • Have staff at assisted living residence or nursing home remind the elder or brush for them

Problems of calling for a dental appointment or transportation to the office 

  • Have family or caretaker make appointment and arrange for transportation
  • If necessary, have office front office staff call to make appointment and arrange transportation

 

Dr Janet Peterson is a 1983 graduate of the Oregon Health Sciences University School of Dentistry and just recently retired after practicing as a general dentist in the Salem area for over 25 years.

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