Family Health Magazine - DENTAL HEALTH
A Healthy Smile in the Golden Years
Oral health and long term care
Moving to a long term care facility is a very significant life event. Moving is stressful, often involving a great deal of planning and many decisions. As you make this change to your living arrangements, it is important to think ahead and plan for your oral health care needs.
Through the years, you visited the dentist to maintain your teeth. You may have had root canals, periodontal work, and crown, bridge or implant reconstruction done. All of this dental work can cost tens of thousands of dollars. The last thing you want now is for your dental health to be ignored.
Aging and oral health
The effects of aging mean that many factors can make oral health care more complex.
Dry mouth – A dry mouth (xerostomia) can occur for many reasons. Radiation to the head and neck, age, changes in hormones, and changes in the body’s immune (defence) system and much more can cause it. A dry mouth can also be a side effect of some medications. This condition can rapidly lead to cavities affecting all the teeth, including those with crowns or caps. Many people are surprised to find all of their heavily restored teeth crumbling from the inside out.
If you wear a removable or partial denture, dryness can make the friction unbearable. You may avoid wearing the denture, or use it with chronic pain. Continuing to wear it though it hurts can have serious long-term consequences.
Multiple restorations – Restorations like fillings, crowns, or inlays in the mouth can be made with many different materials. They can wear at different rates. Some materials may need to be replaced more often. If you have a forceful bite and large fillings in your back teeth, make sure the fillings are assessed regularly for leakage and potential fracture. Sharp edges should be smoothed to prevent cuts and bites to the soft tissue in the mouth.
Removable prostheses (dentures or partial dentures) – If your weight changes, dentures or partial dentures will fit differently. A poor fit can cause sores in the mouth. Eating and speaking also become a challenge. If you cannot eat properly, then an assessment is required to see if anything can improve this situation. Clicking and clacking while talking indicates dentures that do not fit well.
The condition of dentures also needs to be regularly checked. Make sure there are no sharp edges to hurt the cheeks, tongue, palate or gums.
Inadequate nutrition and no longer enjoying food – Eating is a significant daily pleasure. A lack of certain vitamins and minerals can cause mouth sores and slow oral healing. First, consider whether a dental issue means you are not able to eat a full diet. Dealing with it helps eliminate nutrition issues that can affect your health. You may end up on a minced or puréed diet just because there are problems with your mouth.
Manual dexterity – If your hands do not work well, it can be very difficult to insert and remove a prosthesis, and to floss or even brush the teeth. Tools are available to make some of these tasks easier. A caregiver may also be able to help with these tasks. Continuing to have regular hygiene treatments with your dental team is important.
Mental clarity or dementia – Oral health care may not be considered a priority. We must rely on our health care team to assist in these situations. Removable prostheses may become misplaced and lost.
Planning for your oral health care
If you are moving into long term care, how do you prepare for this transition? What can you do to maintain your oral health care? Here are a few suggestions.
- Have a complete oral examination by a dentist, including a panoramic X-ray. This exam is necessary for everyone, even if you have no teeth. It checks for disease and assesses your anatomy for current or potential problems. The dentist can check your teeth, as well as bone, sinuses, and other key anatomy.
- Write down the name of your family dentist, any major dental surgeries you have had, and care instructions.
- If you have had implant surgery and reconstruction, have the surgeon write a letter explaining the types of implants, and the types of crowns or bridges (screw-retained or cemented). This information will help if a dentist or another surgeon must remove them for health reasons.
- If the recommended way to clean your mouth and prostheses is complex, write out instructions. Include the names of mouth rinses you use, where supplies can be obtained, and who will pick them up.
- Label all removable dentures. Local dental laboratories can place identifiers on your dentures to aid identification. If you have ever had roommates, you will know things occasionally go missing. Being able to find your teeth is worth this extra step!
- Communicate. At your new residence, talk to your health care team about your dental care needs. Provide a copy of your health care plans, including your dental documentation. Although health care providers are often very busy, talking when you first move in will aid greatly in identifying your needs and preventing misunderstandings. Discuss your expectations and work on finding reasonable solutions to maintain your health.
- Your family is another resource. Talk with family members about the assistance you need from them to care for your oral health. If you wish, your family can communicate with your caregivers too.
- Plan for preventive and emergency dental treatment. If you are not able to understand or make decisions, appoint someone to consider your dental care. If a guardian or trustee is appointed, decide whether that person needs to be contacted to approve the treatment, and how you will get to your appointment.
- Most long term care facilities do not have dentists, dental hygienists or denturists onsite. Ask whether there are mobile dental clinics that visit your location.
- Make an advanced care plan and a personal directive. A personal directive is a written document that plans for your future. It outlines who should make decisions for you if you cannot. When you prepare this document, include an oral health care plan.
Your oral health care is part of your overall health care. When you move to a long term care facility, you can take steps to continue caring for your oral health. Be sure to let your caregivers know if you are having problems with your mouth, or if you find you require more assistance with your oral care.
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2018, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [GO_FHcd15]