ElderCare & Toothbrushing: Mythbusters & FAQ's

Our mission at Onsite Dentists of Texas is to increase access to the highest quality of oral & dental care to optimize for improved systemic health and an enhanced quality of life, especially for those underserved patients who may reside in a nursing home facility or may be homebound for a variety of health issues.

While our clinical team values the time we get to spend with each patient, we recognize that increasing access to high quality care goes well beyond what services we provide during each appointment. Instead, our greatest impact can be found when collaborate and educate family members and nursing home staff about how to better support their loved ones and residents towards better health.

We always offer in-home educational events & complimentary patient assessments, but we hope to reach more people via sharing in real-time how you can help.

So we thought starting with some simple, that EVERYONE can benefit from: brushing your teeth! While it may seem simple, and it is certainly something that most adults have mastered, there are a few obstacles and concerns that we've noticed some caretakers run into when they are confronted with the realization that they could help brush someone else's teeth. So here are some questions we've run into while working in this field, and most importantly, the answers to help you get brushin' ;)

Why can't I just let my parent (or an elderly person under your care or supervision) do the best they can with brushing their teeth? Don't all older people end up with dentures anyway?

On average, humans swallow approximately 3500-4000x per day, meaning any bacteria or inflammatory agent that is left in the mouth can be aspirated or swallowed at anytime. This is why we see a 38.92% decrease in pneumonia cases in patients who were part of a rigorous oral hygiene program vs those who were not, and patients who were in this oral hygiene program were also 89.57% less likely to be diagnosed with influenza. Basically, healthy, clean mouth = healthier, happier body.

In addition to disease prevention, keeping your natural teeth is the best way to maintain a healthy diet diverse in crispy fruits and vegetables. Dentures are a good option for someone who has no other options, but are functionally much less effective than natural, healthy teeth. Thus, we can and should do all that we can to maintain proper nutrition via a natural smile.

When teeth begin to be neglected, the spread of disease can occur quickly; so instead of just having "one bad tooth", the patient could experience 3 or 4 more teeth that "go bad" (ie. get a cavity, develop gum disease, etc) in a short period of time because the health of the whole mouth was not addressed with daily, routine oral hygiene.

Also, bacteria exists in your mouth whether you have teeth or not. And dentures require cleaning just as frequently as your own natural teeth (we'll discuss this more in an upcoming blog).

denture-cleaning

How do I know if I should help a senior brush their teeth?

There are two main reasons why we see aging patients begin to have a need for outside assistance for teeth brushing.

1) Decrease in dexterity, mobility, or difficulty controlling or maneuvering. The physical aging of the body can bring about numerous co-morbidities that can make tooth brushing more challenging: arthritis, post-stroke paralysis, tremors associated with Parkinson's disease or some other chronic neurological disorder, decreased hand strength. Regardless of the cause of these limitations, the patient still needs this care and would greatly benefit from assistance.

2) Decrease in mental acuity or motivation due to symptoms consistent with dementia, Alzheimers disease, and depression. Having staff members of a nursing home and/or family members remind and help the patient can be the difference between getting the care they need and not.

The patient cannot get out of bed. How is he or she supposed to brush without water and toothpaste?

Great question! Dry brushing for mechanical debridement is really the most important part of brushing the teeth. What does this mean? It means that a patient can stay in bed and brush their teeth without water or toothpaste. After they are done, they can swish and swallow water to remove any debris. If the patient may think this is "gross", but that was all food and debris that they intended to eat in the first place but got stuck on and between their teeth! If the senior is encouraged to dry brush, this means that the brush can be kept bedside, and that a patient can maintain some independence via this part of their routine if they are physically restricted from standing, but otherwise can operate without much assistance.

See the video here for a reference of what "dry brushing" looks like from our dental assistant Eddie demonstrating this practice on one of our patients.

When I try to help a senior brush his or her teeth, the gums bleed and/or the patient says it's uncomfortable?

The gums bleed because there is inflammation due to the build up of bacteria, plaque, calculus, etc. The human body is very smart, and it uses the blood as a "highway" of sorts to deliver the special cells and nutrients the body needs to fight an attack, whether it be bacterial or fungal infection, or trauma. So when the gums are bleeding, you can understand that the body knows that there is an infection, and it's sending blood to help. But as the teeth and gums are consistently cleaned, the body have a signal that basically says "hey. this is ok now. We don't need to send any more blood to this area."; which is when you see the bleeding decrease, and eventually stop completely, and the gums gradually become tighter and more pinkish in appearance instead of the red, swollen appearance it has when the bacteria is still present.

If the gums seem to be very bloody, you can use some gauze or a wet wash cloth to put pressure for a few minutes on the gums to help the area clot. The patient can rinse with water or warm salt water to help continue to support the tissue to heal with time.

My parent is in a nursing home because the nurses are supposed to help him/her with this kind of stuff. Why should I also be doing this?

Are you familiar with the phrase "It takes a village to raise a child"? Well, the same could very well be said for caring for an elder. Nurses and nurse assistants do a spectacular job caring for our elders, and they have a great deal of things to focus on and make sure all is right for each individual resident. More often than not, nursing home staff members consistently go above and beyond to care for these elders, and that includes caring for their teeth, their dentures, and anything else that can help improve a resident's quality of life.

That being said, sometimes there is turnover in staff at these home's and a new team member won't prepared or trained on these types of services. Also, it is often very busy in nursing homes taking care of some very compromised patients, so any additional support from the family to address these less acute needs only go to better help the patient. So basically, I encourage family members to be involved. This is a quick and relatively easy way to have a dramatic impact on the quality of life of your loved one.

If you'd like more information on this topic, or if you'd like to schedule your loved one for an oral health assessment and oral cancer screening, please contact our team at 214-368-0901 or you can contact our patient care coordinator directly at kasey@onsitedentists.com.