Embracing Preventive Oral Care for Older Adults

The other day, I found myself discussing the importance of preventive oral care with a patient. To my surprise, she exclaimed, “Preventive care for me? I’m 69 years old; that’s for kids!” Chances are, you’ve encountered similar reactions from your patients. It’s a common misconception we must address when communicating with older adults and educating young practitioners on the significance of prevention.

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In the realm of preventive dentistry, there’s no one-size-fits-all approach, considering the uniqueness of each patient. However, one undeniable truth emerges – prevention should play a vital role in the treatment plan for older adults. According to the Census and the NIH [1], the U.S. is on the brink of a “silver tsunami” where, by 2035, there will be more older adults than youth. Despite this, a notable percentage of older adults, particularly those in poverty, still grapple with elevated levels of periodontal disease and untreated caries, including troublesome root caries.

In a recent publication by our team (Mulligan, Enciso, Suarez) [2], we underscored that the primary focus of preventive oral health strategies for older patients should revolve around four key issues:

• Root caries
• Periodontal disease
• Oral cancer
• Salivary gland hypofunction

Root Caries: Protecting Natural Teeth

Root caries in older adults is a prevalent issue caused by factors such as poor plaque control, dietary choices (high in sugar and carbohydrates), dry mouth, and smoking. Its early diagnosis and prevention will determine the success of keeping natural dentition.

Here’s how we tackle it:

• Educate on good oral hygiene and food choices
• Explore modified toothbrushes or powered options
• Utilize fluoride in various forms (gel, varnish, SDF) [3]
• Consider alcohol-free chlorhexidine mouthwash and varnish [4]
• Introduce salivary substitutes and stimulants
• Implement Atraumatic Restorative Treatment (ART) [5]

Periodontal Disease: A Multifaceted Challenge

According to NIH and CDC periodontal disease affects about 70% of older adults, influenced by factors like poor oral hygiene, medication side effects, smoking, poor nutrition, substance abuse, poor health literacy, and limited access to care. Our approach to prevent it:

• Stress the importance of routine dental cleanings
• Advocate smoking cessation
• Improve dietary habits and oral care
• Recommend chlorhexidine mouthwash
• Prioritize patient education

Oral Cancer: Staying Vigilant

Older adults face a higher risk of oral cancer, being 65 years and older is independently associated with poor prognosis of oral/pharyngeal cancer [6]. Encourage self-examinations, regular screenings, and lifestyle changes:

• Conduct annual oral cancer screenings
• Address risk factors like smoking and heavy alcohol consumption
• Protect against lip cancers with UV ChapStick, sunblock, and hats
• Consider laser treatment for lip cancer [7]

Salivary Gland Hypofunction: A Dry Mouth Dilemma

Dry mouth affects 20-30% of older adults [8], increasing the risk of oral issues and impacting prosthetic retention. Causes include medication side effects, systemic conditions, Sjögren’s syndrome, and alcohol overuse. Combat dry mouth with:

• Salivary stimulants like sugarless gum or candies
• Artificial saliva substitutes
• Daily fluoride treatments (gel, varnish, SDF)
• Regular dental visits
• Pilocarpine, Cevimeline
• Explore electrical stimulation, gene therapy, and stem cell therapy

Looking Ahead: The Future of Preventive Dentistry

While these preventive measures are crucial today, ongoing research explores exciting possibilities in the realm of dentistry, from changing the oral microbiome to innovative treatments like tissue engineering and regenerative therapies. Stay informed and keep evolving in the realm of preventive dentistry.

For a deeper dive into these topics, check our references or consider joining our certificate or master programs. We look forward to welcoming you to our next session!

Image: Dr. Suarez at the USC Dental School of Dentistry performs a clinical examination on a patient.

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Are you looking for improved ways to diagnose, treat, and manage the oral healthcare of older patients?  Explore our online master’s and certificate program in Geriatric Dentistry.

References:

1. 2020 Surgeon General’s Report Oral Health in America: Advances and Challenges. Rochelle Rollins, PhD, MPH; Scott L. Tomar, DMD, DrPH; and Judith Albino, PhD
2. Suarez-Durall P, Mulligan R, Enciso R. Oral health for baby boomers: Past, present, and future. Spec Care Dentist. 2023
3. Grandjean ML, Maccarone NR, McKenna G, Müller F, Srinivasan M. Silver Diamine Fluoride (SDF) in the management of root caries in elders: a systematic review and meta-analysis. Swiss Dent J. 2021;131(5):417-424.
4. Tan HP, Lo ECM, Dyson JE, Luo Y, Corbet EF. A randomized trial on root caries prevention in elders. J Dent Res 2010;89(10):1086–90 Oct. doi:10.1177/0022034510375825.
5. Sundaragopal N,Hou L, Enciso R.Efficacy of non-invasive and minimally invasive techniques for the prevention/management of root caries in older adults – A literature review, Dentistry Review, Volume 2, Issue 4, 2022,100061,ISSN 2772-5596.
6. Ryan Camilon P, Stokes WA, Nguyen SA, Lentsch EJ. The prognostic significance of age in oropharyngeal squamous cell carcinoma. Oral Oncol. 2014;50(5):431-436. 2013.12.013
7. Lai M, Pampena R, Cornacchia L, Pellacani G, Peris K, Longo C. Treatments of actinic cheilitis: a systematic review of the literature. J Am Dermatology 2020;83 (3):876–87.
8. Agostini BA, Cericato GO, da Silveira ER, et al. How common is dry mouth? Systematic review and meta-regression analysis of
   prevalence estimates. Braz Dent J. 2018;29(6):606-618.