17 Sep 20

For many months the COVID-19 pandemic and lockdown made it impossible for elderly patients to see their dentist, and getting a routine appointment is still very difficult while practices try to catch up with their backlog.

Additionally, research has shown that regular teeth cleaning can help reduce the risk of contracting COVID-19 and other infections, so oral hygiene is doubly important as the winter comes on. And it’s not just professional carers who can have a role here. Most of us know someone elderly, so it may be worth discussing their oral health with them, as a healthy mouth can really improve their wellbeing and general health.

Older patients may have particular issues to do with managing their dental hygiene, or may have dentures to keep clean, so here are a few tips for older patients and for carers or family members on keeping their mouth healthy at home.

General oral hygiene

  • Brush twice daily for two minutes with fluoride toothpaste, such as BioMin® F*
  • Just spit out the toothpaste after brushing – don’t rinse it away, as the toothpaste continues to work while it’s in the mouth
  • If you have reduced manual dexterity, consider investing in an electric toothbrush which times your brushing and will do all the rotational movements itself
  • Small interdental brushes can be helpful in removing food and debris in between the teeth, and are easier to use than floss if you have reduced dexterity. These come in a variety of sizes
  • If you suffer from a dry mouth due to illness or to any medications you take, ensure that you sip water regularly throughout the day, use a sugar-free chewing gum to promote salivary flow, and speak to your dentist about other saliva substitutes that can be prescribed. Spray bottles from the pharmacy, filled with water, can help moisten the mouth. Avoid coffee and smoking as this reduces your salivary flow further, and keep off alcohol and alcohol based mouthwashes as these can worsen dry mouth
  • If you have severely limited dexterity and are unable to brush or open your mouth, consider using a mouthwash instead, which can clear away some bacteria.

Denture hygiene

  • Sip water before inserting and removing dentures to make it more comfortable
  • Do not sleep with your denture in your mouth. In the evening remove your denture, and wash it under cold water in a water-filled basin with soap and a soft bristled toothbrush
  • Leave your denture in a glass of water overnight. Keeping it in your mouth causes a humid environment overnight, allowing for decay and gum disease to fester. When we sleep, our saliva rate reduces, making us more vulnerable to bacterial attack. It also increases the risk of aspiration pneumonia
  • When brushing in the morning and night, take your denture out and brush your teeth separately from it
  • If you find that you still have food stuck on your denture, you can use a denture cleaner to help.

Advice for carers and relatives

We probably all know someone who is elderly, and it may be that a simple question to an older friend or relative about their teeth, may start a conversation about oral hygiene, which could help them improve their general health and wellbeing.

If you are caring for an older relative, or are a professional carer, the following advice may help you take care of their oral health:

  • Everyone, even those with dentures, should see a dentist regularly, so they may need you to make an appointment for them or take them along
  • Some medications may have high sugar content or cause dry mouth problems. Sometimes a sugarfree alternative is available, or sips of water, especially at mealtimes, can alleviate the discomfort of a dry mouth, especially if the patient is wearing dentures which can become sore
  • Try to encourage them to keep their consumption of sweet food and drinks down, ideally restricted to mealtimes
  • If the patient is in the early stages of dementia, they should be encouraged to carry out their own mouth care for as long as possible, though they may need to be reminded or supervised. The carer can give them the brush and show them what to do. Here too an electric toothbrush can help, as can a fluoride toothpaste like BioMin F* which continues to act over several hours.

In the later stages of dementia or frailty, the person may lose the ability to clean their teeth or stop understanding the need for oral hygiene, so a carer will need to take this on.

  • Explain what you are about to do as clearly as you can
  • Make sure they are comfortable, ideally tilted back to a 45º angle with something like a pillow behind their head to support it. Try standing behind them and a little to the side
  • Take out dentures if worn. Pull back the cheek and lips gently to see the teeth
  • Use a pea sized amount of fluoride toothpaste*. Dry brushing with just paste but no water can be easier for some patients
  • Brush the teeth and gum with small circular motions, working gradually round the mouth, and on all sides of the teeth. An electric or adapted toothbrush can make this easier
  • Brushing the tongue helps to remove bacteria
  • Ask the person to spit but not rinse
  • Keep the dentures clean as above
  • Denture loss – or worse, mixing up or sharing dentures – happens commonly in care homes. Mark the dentures at the back with the owner’s name using a safe marker.

Keeping your mouth clean and healthy is not just pleasant – it protects against dental and gum disease. This helps to prevent both tooth loss and a range of other potential health problems, especially infection from viruses such as pneumonia and COVID-19.

*BioMin F toothpaste features a continuous slow release mechanism, continuing to act for up to 12 hours, which helps strengthen teeth and prevent sensitivity. BioMin® C toothpaste is also available, for those who do not wish to use a fluoride toothpaste but also want the protection of the continuous release mechanism.

Carers may find training, available via Knowledge Oral Health Care, to be of interest, as it provides valuable information on the often neglected area of oral care.

With thanks to Dr Victoria Sampson, general dental practitioner, and Emma Clayton, dental therapist and oral health educator.