I caught up with my 94 year old Grandma this week. She’s in a nursing home now, her health slowly deteriorating. It’s challenging to see this once vibrant lady barely able to get up out of a chair. Her lifetime attention to diet to maintain her enviable petite hourglass figure, now bellied by a cocktail of medications that bloat her, thin and dry her skin which is blotted with bruises and feels like paper, and frail arms unable to set her hair as she’s worn for most of her life, nor brush her teeth adequately. As she says herself, it’s not easy getting to 94, but it’s an accomplishment not everyone achieves.

Assisted Care is 24/7 But Oral Health Rarely Features

Nan gets great care, has attentive family who visit most days, many who are trained in health, including two dentists! Yet despite this, things get neglected, or more likely under-prioritised in the 24/7 care now needed to keep her comfortable. This is common for many elderly and disabled living in assisted care, and oral health is often forgotten about until an emergency arises.

Dental Trips Are A Challenge For Those In Assisted Care Homes

A dental emergency for those in assisted living and the dentist who treats them can be an organisational nightmare: getting them to a dental practice, managing their meds to be able to do procedures safely, and getting them to be able to lie in a position for long enough to complete the procedure is almost impossible at times. Dry mouth (xerostomia) due to age and medications compounds the difficulties. Where once, most had all their teeth removed, many now keep some or many of their teeth.

Assisted Living Diets Are Not Always Oral Health Friendly

The food generally provided in assisted care homes is designed for easy or minimal chewing, for comfort, and to avoid choking, an elevated risk in this group. However it also promotes dental plaque and decay development as things like soft bread and biscuits tends to stick to teeth. Their reduced oral motor function or muscle tone, often means food is not properly cleared from the mouth either.

6 Tips For Reducing The Risk Of Dental Disasters In Those Living In Assisted Care

Here are six things you can do to help minimise plaque and decay growth in those living in assisted care homes: 

1. Drink tea - many struggle to drink enough liquids period. Water can become rather bland day in day out. Tea of any kind, except those with a large fruit component can be consumed in unlimited amounts, many have a naturally high concentration of fluoride that is protective against dental disease, just make sure it’s served free from milk, sugar or similar additives that promote decay. It can be consumed, warm, tepid or cold as desired.

2. Limit drinks other than water or tea to mealtimes - sipping on anything throughout the day that has sugar in it, including fruit juice or milk, or milk alternatives, is a recipe for dental disaster! 

3. Limit eating to mealtimes - this can be up to 5 times per day: breakfast, morning tea, lunch, afternoon tea, dinner. Grazing throughout the day is a recipe for dental disaster as the constant nibbling of food, or sipping of drinks with sugars, feed the bacteria in the mouth that promote plaque development and make acids that lead to dental decay. Having breaks of at least 2 hours between meals (except for plain water or milk and sugar free teas), allows the saliva to neutralise acids in the mouth and protect against dental decay. 

4. Use Xylitol - a birch or corn derived sweetener, relatively inexpensive to buy from health food stores, it’s been demonstrated to have protective benefits against dental disease. It has the sweetness of sugar without the damage as the bacteria that usually metabolise sugar to produce acids actually die when they metabolise xylitol. Xylitol can be added to tea or water as a sweetener if desired, although, no more than 4 teaspoons should be consumed per day as it can lead to flatulence, painful cramping and diarrhoea in excessive quantities initially. However after approximately 10-14 days, this generally passes as the gut microbiome adapts. Xylitol can also be used as a mouthwash - a teaspoon in a cup of water, swished and spat out before brushing, or instead of, if brushing is too difficult.

5. Use a high fluoride toothpaste daily - Some on the market have 1000ppm fluoride concentration. These can be bought from the pharmacist. The fluoride has specific anti-decay effects as well as inhibiting plaque development if used daily. These toothpastes are slightly more expensive than the standard ones, but far cheaper than a visit to the dentist!

6. Use a mouth rinse of warm salt water and olive oil  - many commercial mouthrinses have alcohol in them which can be very drying and uncomfortable for those in assisted care to use, especially if they are already experiencing dry mouth. A tablespoon of olive oil in a cup with a half - one teaspoon of salt (adjusted for personal taste) and say 200mL warm water mixed together will taste a lot like hot chips, mmmmmm! The oil has a lubricant effect, the salt a cleansing and saliva-stimulating effect, and tap water has fluoride in it, depending on the location. There’s no science to support this, but personal experience has found this is popular for oldies, disabled and young kids who don’t like the taste of mint. The good news is it won’t do any harm. You could also add xylitol to this for a salty sweet twist, think salted caramel perhaps? This mouthrinse is easy and cheap to prepare and can be used twice daily or after every meal if desired.

 Assisted Care Living Comfort Involves Good Oral Health

Please print this out and share it with your loved one’s career, organisation or home staff, as well as family members. Encourage them to adopt these principles for all people in their care. These small changes are easy and relatively cheap to implement, importantly they aren’t time consuming either. But done every day, they can make a world of difference to a dear person’s ability to talk, eat and smile!  And who doesn’t want to avoid a trip to the dentist if possible!

By Dr Christine May, dentist, health writer and speaker, founder of FaceWell & ViDe. This article first appeared on FaceWell.

All information in this article is of a general nature only and does not replace specific advice given by your own health practitioner following a consult.