Dental Care in the Elderly Helps Prevent Heart Attacks and Stroke
Due to advances in medicine and an increase in prolonged life expectancy, the number of older people will continue to increase worldwide. It is essential that all older adults practice and maintain good oral hygiene due to the high correlation between oral health and general health.
In fact, a report from The Netherlands adds to the evidence tying chronic gum disease to heart disease and stroke.
In a study published in the Journal of Epidemiology and Community Health, of more than 60,000 dental patients, those with periodontitis were twice as likely to have had a heart attack, stroke or severe chest pain.
Previous studies have linked periodontitis and atherosclerotic cardiovascular disease, but this is the first to investigate the link in a group of people this large, the researchers say.
About 4 percent of patients with periodontitis had atherosclerotic cardiovascular disease, compared to 2 percent without periodontitis, the researchers found.
Even after taking other risk factors for cardiovascular disease into account, such as hypertension, high cholesterol, diabetes and smoking, those with periodontal disease were still 59 percent more likely to have a history of heart problems, according to a report in the Journal of Epidemiology and Community Health, August 8.
“It’s clear that periodontitis is associated with chronic inflammation, so it makes sense biologically that if you have a heavy infection in your mouth, you also have a level of inflammation that will contribute to heart conditions,” said Panos Papapanou of Columbia University in New York, who has studied the association between gum disease and heart disease but wasn’t involved in the current study.
The research team suggests that gum disease develops first and may promote heart disease through chronic infection and bacteria in the circulatory system.
Dr. Bruno Loos, the senior author of the new report, said by email that “plausible mechanisms to explain the relationship” may include a common genetic background for the way the body handles inflammation, oral bacteria and immune responses.
Still, this kind of observational study can’t prove that gum disease causes heart problems.
“The association . . . does not provide proof (of causation), even when the results from our study corroborate findings from previous similar research,” study coauthor Geert van der Heijden said by email.
Papapanou said that while the new findings are from patients with a relatively high socioeconomic status, “we’re repeatedly seeing the same conclusion.”
“It seems all over the globe we have to consider this relationship,” Loos said.
Dr. Frank Scannapieco, chairman of the Department of Oral Biology at the University at Buffalo in New York, who wasn’t involved with the study, told Reuters Health that while the association of periodontitis and coronary disease is “robust,” the strength of the link is “moderate compared to traditional risk factors such as hypertension.”
Papapanou advises: “Take care of your oral health for oral health itself. If you know there’s a positive association between oral health and other diseases, would you ignore it? I wouldn’t.”
What You Can Do
Maintaining good oral health is not only vital to your systemic health—it can keep you smiling well into retirement. Brushing at least twice a day with fluoridated toothpaste and a soft-bristle brush is as important as ever. Flossing is very important, too—it helps to remove plaque from between teeth and below the gumline that your toothbrush cannot reach.
As you age, you may be more likely to develop gingivitis. Gingivitis is caused by the bacteria found in plaque that attack the gums. Symptoms of gingivitis include red, swollen gums and bleeding when you brush. If you have these symptoms, see a dentist.
Gingivitis can lead to periodontal disease if problems persist. In the worst cases, bacteria form in pockets between the teeth and gums, weakening the bone and causing the gums to recede, pulling back from teeth. This can lead to tooth loss if left untreated.
As you age, changes in salivary flow and content may further lead to gingivitis, as well as cavities. Because approximately 80 percent of all American adults suffer from some form of gingivitis, it’s important to see your dentist twice a year for regular cleanings and checkups. If regular oral care is too difficult for you (see below), your dentist can provide alternatives to aid in brushing and flossing.
Certain dental products are designed to make dental care less painful for people who have arthritis. It is sometimes recommended that people with arthritis try securing their toothbrush to a wider object, such as a ruler, to ease arthritic hand pain while brushing. Electric toothbrushes also can help by doing some of the work for you. Ask your dentist for other suggestions.
Try these Radius brushes – their ergonomic handles are great for arthritis and other muscular disabilities, as well as for aid in home care.
Oral cancer is one of the most common cancers, with roughly 35,000 new cases reported annually in the United States. Oral cancer most often occurs in people who are older than age 40. Oral cancer can form in any part of the mouth or throat. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic pain, loss of function, irreparable facial and oral disfigurement following surgery, and even death. Oral cancer has one of the lowest five-year survival rates of all cancers; this is primarily due to late diagnosis.
See a dentist immediately if you notice any of the following: red or white patches on your gums or tongue, a sore that fails to heal within two weeks, bleeding in your mouth, loose teeth, problems or pain swallowing, or a lump in your neck. Your dentist should perform a head and neck exam to screen for oral cancer during routine checkups.
As you age, you may develop dry mouth. Dry mouth (xerostomia) happens when salivary glands fail to work due to disease, certain medications, or cancer treatment. The condition can make it hard to eat, swallow, taste, and speak. Drinking lots of water and avoiding sweets, tobacco, alcohol, and caffeine are some ways to fight dry mouth. Your dentist also can prescribe medications to ease the symptoms of severe dry mouth.
Studies have shown that maintaining a healthy mouth may keep your body healthier and help you to avoid diabetes, heart disease, and stroke. Older patients who are planning to enter a nursing home should inquire about on-site dental care. People who do not have teeth still need to visit the dentist regularly, since many aspects of oral health, such as adjusting dentures and oral cancer screenings, can be handled during routine dental visits. The best way to achieve good oral health is to visit your dentist at least twice a year.
Advice for Caregivers
Today, many older adults are keeping their natural teeth longer than in the past. This is a good thing, but medical conditions can create a risk of serious dental problems. Also, elderly people may be dealing with serious illnesses, mobility issues or mental health conditions that make it even harder for them to take care of their teeth. If our parents are in assisted living or nursing homes, oral hygiene may get overlooked.
Potential Dental Problems
According to the American Dental Association (ADA), as our parents age, they are increasingly at risk for periodontal (gum) disease, especially if they are not able to keep up with good oral hygiene practices. This disease is often painless; but when left untreated, teeth can become loose and eventually lost. Also, diabetes increases the risk of infection and can worsen gum problems. In fact, a recent study by the ADA concluded that diabetes was connected with one in five cases of total tooth loss.
Older adults are often taking many medications that have dry mouth as a side effect, or they may have a medical condition that has dry mouth as a symptom. Without saliva to balance acids in the mouth, tooth decay becomes a potential problem along with painful mouth infections, such as oral thrush.
It’s not just our parents who are aging; their dental work is as well. Fillings, crowns, dentures and partial dentures sometimes become worn out and need to be replaced just when it becomes hard for them to get to a dentist.
Another serious risk for older adults is oral cancer, especially if they are or were smokers. According to the ADA, the average age when oral cancer is diagnosed is 62. Dentists always do cancer screenings during routine examinations because early detection saves lives.
How Caregivers Can Help
Just as our parents did for us, we can remind our parents to brush and floss daily. If they wear dentures, they also need them to be cleaned every day. With all the risks to their oral health, get them to a dentist regularly, and take a list of their medications along. If your Mom or Dad has arthritis or another disability that makes it difficult for them to brush or floss, ask their dentist to recommend some modifications to make the task easier.
If dry mouth is an issue for your parents, you can discuss the side effects of their medications with their physician. You want to help them get relief. Over-the-counter oral moisturizers, alcohol-free mouthwashes and sugar-free gum and lozenges can help. Make sure they are using fluoride toothpaste. Encourage them to drink plenty of water and to avoid drinking acidic fruit juices and carbonated sodas.
Keeping on top of your parents dental care is challenging when they are in a nursing facility. Having to deal with so many other health care needs, caregivers often don’t rank dental hygiene as a top concern. You may have to communicate specific oral hygiene needs to the staff. Also, be mindful of your parents’ eating habits. If necessary, get input from the nursing staff. If they are not eating as much as usual, they could be experiencing dental pain or dealing with an ill-fitting denture.
It may feel like a strange role reversal, but now it’s our turn to do for our parents what they did for us. Their quality of life depends on good dental health, and we must ensure that their dental needs are met for as long as they are with us.
Here are some suggestions to help you help your elderly parent maintain their dental health
1. Be proactive: if your parent is dependent on you to take them to dental appointments there is no better time than now to do it than now to get things back into good health and set a dental checkup instead of waiting for something to hurt.
2. If you have a parent at home with you or in a long term care facility brushing 2 to 3 times a day would go a long way to reducing cavities and promoting better gum health.
3. Use of a daily fluoride mouthwash or high fluoride content toothpaste can also help reduce cavities. Speak to your dentist about these products.
Try ACT Sensitive for an alcohol-free, non-burning flouride mouthwash option.
4. A chlorhexidine mouthwash can help reduce cavities and gum disease in patients that are not able to brush effectively.
5. You could also be trained to brush for your parent if they are unable to do so themselves.
7. If they are okay with gum chewing, chewing a piece of sugarless, xylitol containing gum for five to twenty minutes after a meal or snack out can help reduce cavities.
Good dental health is something that many take for granted. Being able to eat whatever we want, to speak without fear of a loose denture falling out or being too self conscious to smile due to cavities or missing teeth is a hardship faced by many older adults.
Poor dental health can result in health problems. For example, if you have missing teeth or loose teeth you may out of necessity choose softer foods to eat , which tend to be more more processed, with little or no fiber; a diet low in fiber can lead to a greater incidence of colon cancer.
I hope this article has shed a little light on a common issue of dental health in the aging adult. Remember that by being proactive, you can help prevent not only dental issues, but other, potentially life-threatening complications.