Comfort and care for an elderly population

Uncategorised

  Posted by: Dental Design      1st August 2023

The average life expectancy is increasing year on year, and in the UK a third of people are now expected to see their 100th birthday.[i] Whilst this is a fantastic achievement for our health systems, it in turn requires appropriate dental care for an increasingly older population. Clinicians may find that with each passing day, a larger number of elderly patients will ask for support with the common condition xerostomia, otherwise known as dry mouth.

Prevalence in a geriatric population

Xerostomia is a growing issue for the elderly population; its numerous potential aetiologies are commonly linked to the health status of an older patient. Public Health England labels dry mouth as the most common side-effect of the 200 most prescribed medications,i and as nearly four million elderly people in the UK take upwards of five different medications at any one time,[ii] it’s easy to see the cause for concern. Dry mouth is also heavily linked to individuals that undergo head and neck cancer (HNC) treatment, or live with Sjögren’s syndrome. Both of these are more likely to affect a patient within the latter half of their life.[iii], [iv]

It is important to differentiate xerostomia and hyposalivation. Both are commonly researched together; xerostomia is the personal sensation of having a dry mouth, whereas hyposalivation is an objective decrease in saliva. As a subjective complaint, xerostomia patients may not always display the clinical symptoms of hyposalivation, but it is equally important to treat their discomfort.

Elderly patients who experience xerostomia undergo a severely negative impact to their quality of life (QoL),[v]with common difficulties including taste loss, dysphagia, increased dental caries, periodontal disease, and overall oral pain.[vi] Patients who have previously required minimal dental intervention across their entire life could begin to experience uncharacteristic issues after developing xerostomia– should the condition not be recognised and managed in a timely manner. Their mouth could contain multiple instances of decay and infection, as a lack of saliva leaves bacteria unchallenged, and food particles cannot be washed away as frequently as they once were.

Whilst these can be severe issues for patients of all ages, dry mouth can exacerbate oral health management for elderly patients. This demographic makes up a large proportion of the population with dentures, and xerostomia can have debilitating consequences for those that require them.

Difficulties for dentures

Whether partial or complete, it is generally considered the norm for those over 75 to wear some form of dental prosthesis.[vii] Patients with dentures can experience a fuller dentition, which is functionally and aesthetically beneficial.

Fully edentulous patients with a denture rely upon the wetting mechanics of saliva to assist the retention of a prosthetic.viii Without a layer of saliva between the denture and the oral mucous membrane, stability is unreliable. This results in difficulties chewing and speaking,[viii] and is overall extremely uncomfortable for the patient. Food particle removal is especially important for denture wearers, as there can be difficult to reach gaps for bacteria to thrive within. The absence of saliva to remove these particles can lead to an increase in potential decay too.[ix]

Both an ill-fitting denture, and the presence of food between the denture and gumline can lead to denture sores. These can be extremely painful for a patient, and can interfere with proper dental hygiene, increasing the risk for further infection.[x]

Managing xerostomia

Xerostomia patients can manage their oral health whilst effectively taking care of their salivary condition, improving their quality of life.

Monitoring older patients before they report symptoms of xerostomia can help manage the condition when it arises. The causes of xerostomia are often not preventable; HNC radiography treatment is necessary for many patients, with xerostomia an unfortunate side effect, and a similar position applies to the use of multiple medications. Communicating with patients about their current general health could help you identify those that are at potential risk in the future, whilst improving your rapport and trust with your patients.

Chewing gum can be used as a tool to improve life with xerostomia. Its masticatory stimulation causes the salivary glands to produce more fluid, and increasing the number of days it is used has seen an overall improvement in the rate of salivation.[xi] Recommending your patients use sugar-free gum also minimises any risk of tooth decay.

Specially designed mouth sprays, toothpastes and mouthwashes could be recommended to patients to play a role in a regular oral health routine. Specific products can increase saliva flow, relieving the issues associated with xerostomia.

To alleviate oral discomfort and combat tooth decay, consider prescribing Xerostom from Oraldent for your patients. Xerostom contains xylitol to prevent caries, and is clinically proven to increase salivary flow by to 200%.[xii] The extensive range of products includes toothpaste, mouthwash, mouth spray, pastilles and a saliva substitute gel, so your patients can restore their mouths’ natural defences in a way that is completely comfortable.

As xerostomia begins to take a hold of nearly 30% of people’s oral health in their later years,[xiii] dentists can be confident that they are fully equipped to provide comfort for a growing geriatric population.

For more details, please visit Oraldent.co.uk, call 01480 862080 or email info@oraldent.co.uk

Bio – Julia Svec

Julia Svec is the Product Development Manager for Billion Dollar Smile Cosmetics Ltd. She has spent the last ten years working in collaboration with dentists, laboratories and manufacturers in North America, Europe and Asia researching and developing effective and safe non-peroxide teeth-whitening products for professional and home use.  

 

[i] Public Health England. (2015) What is Known About the Oral Health of Older People in England and Wales, A review of oral health surveys of older people.

[ii] Age UK. (2019) Age UK calls for a more considered approach to prescribing medicines for older people. Available at: https://www.ageuk.org.uk/latest-press/articles/2019/august/age-uk-calls-for-a-more-considered-approach-to-prescribing-medicines-for-older-people/ [Accessed May 2023]

[iii] Maggiore, R., Zumsteg, Z. S., BrintzenhofeSzoc, K., Trevino, K. M., Gajra, A., Korc-Grodzicki, B., … & CARG-HNC Study Group. (2017). The older adult with locoregionally advanced head and neck squamous cell carcinoma: knowledge gaps and future direction in assessment and treatment. International Journal of Radiation Oncology* Biology* Physics, 98(4), 868-883.

[iv] Brito-Zerón, P., Baldini, C., Bootsma, H., Bowman, S. J., Jonsson, R., Mariette, X., … & Ramos-Casals, M. (2016). Sjögren syndrome. Nature reviews Disease primers, 2(1), 1-20.

[v] Hahnel, S., Schwarz, S., Zeman, F., Schäfer, L., & Behr, M. (2014). Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study. Journal of dentistry, 42(6), 664-670.

[vi] Shetty, S. R., Bhowmick, S., Castelino, R., & Babu, S. (2012). Drug induced xerostomia in elderly individuals: An institutional study. Contemporary clinical dentistry, 3(2), 173.

[vii] Public Health England. (2015) What is Known About the Oral Health of Older People in England and Wales, A review of oral health surveys of older people.

[viii] Al‐Dwairi, Z., & Lynch, E. (2014). Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions. Gerodontology, 31(1), 49-55.

[ix] Kurapati, M., Pradusha, R., Sajjan, M. S., Ramaraju, A. V., & Nair, K. C. (2020). Management of Xerostomia: An Overview. Trends in Prosthodontics and Dental Implantology, 10(1 & 2), 20-23.

[x] Mark, A. M. (2020). Common oral sores and infections. The Journal of the American Dental Association, 151(8), 640.

[xi] Dodds, M., Haddou, M. B., & Day, J. (2022). The effect of gum chewing on xerostomia and salivary flow rate in elderly and medically compromised subjects: A systematic review and meta-analysis.

[xii] Ship, J. A., McCutcheon, J. A., Spivakovsky, S., & Kerr, A. R. (2007). Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy‐induced dry mouth. Journal of oral Rehabilitation, 34(10), 724-732.

[xiii] Wick, J. (2007). Xerostomia: causes and treatment. The Consultant Pharmacist®, 22(12), 985-992.

 

No Comments

No comments yet.

Sorry, the comment form is closed at this time.