• treatment may have to be done in a wheelchair.

• some clients may not tolerate being reclined back much in dental chairs, or reclined at all. This leaves them having to sit completely upright and you as the provider standing for treatment.

• support workers or family may be present during appointments depending on client's independence

• if client has xerostomia, water breaks may be necessary

• mid-day appointments may be more convenient

• arthritis

• grip strength

• attention/memory

It's important when teaching oral self-care aids that we as dental hygienists take into consideration the client's dexterity.

Some modifications to help clients with dexterity are

• toothbrush handles that are extended may be easier for patients

• toothbrush handles with grips on them to increase diameter

• electric toothbrushes

• floss with toothbrush- like handle

• water flossers

Without proper oral self-care this can increase plaque, calculus, risk of caries, and periodontal disease. If oral health isn't being sufficiently taken care of this can increase patients' risk of systemic conditions.

• Cardiovascular disease (CVD) and stroke

• Diabetes

• Osteoporosis

• Malnutrition

• Pneumonia

• Gum disease and bad breath

It's important oral health education and oral self-care aids are heavily emphasized at dental hygiene appointments. Elderly patients have a weaker immune system. This puts them at a higher risk of developing systemic conditions.

There is a bilateral connection between oral health and systemic diseases.

As dental hygienists, we can educate our elderly clients on this connection and bring awareness. We can also ensure proper oral self-care is being implemented in their day-to-day lives.

• Over time, the enamel, the outermost layer of the tooth, may thin due to natural wear and tear.

• Thinning enamel makes teeth weaker and more vulnerable to decay, which can result from general aging.

Dentin Changes:

• Dentin, the layer beneath the enamel, may experience changes with age.

• Dentin naturally thickens over time, leading to the yellowing or darkening of teeth as it becomes more visible through the translucent enamel.

Gum Recession:

• The gums tend to recede gradually with age, exposing parts of the tooth root.

Reduced Salivary Flow:

• Saliva production tends to decrease as individuals age.

• Reduced salivary flow can result in xerostomia, impacting the ability to cleanse the mouth, neutralize acids, and prevent tooth decay.

Tooth Mobility:

• Teeth may become more mobile as supporting bone density decreases over time.

Jaw and Muscles:

• The support structure for teeth may be affected due to the loss of bone density in the jaw.

• Masticatory muscles may experience atrophy, impacting the efficiency of chewing.

These physiological changes are crucial for dental professionals and caregivers to tailor oral health care for older individuals.

• Emphasize the importance of routine dental visits for professional cleanings and examinations.

• An early detection of issues can lead to the prevention of more significant problems.

Proper Brushing Techniques:

• To avoid irritation and damage to sensitive gums, highlight the importance of using a soft-bristled toothbrush.

• Instruct on gentle circular or back-and-forth brushing motions, ensuring coverage of all tooth surfaces.

• Encourage brushing twice a day for at least two minutes each session.

Managing Xerostomia/ Saliva Substitutions

• Recommend sugar-free gum or candies to stimulate saliva production.

• In chronic xerostomia cases, suggest using saliva substitutes or artificial saliva to maintain oral moisture.

Denture Care:

• Emphasize the importance of removing and cleaning dentures daily to prevent plaque buildup and irritation.

• Stress proper storage of dentures in a cleansing solution when not in use.

Orthodontic Considerations:

• For individuals with orthodontic appliances, reinforce meticulous cleaning around brackets, wires, and other components.

• Regular orthodontic check-ups are crucial to address any issues promptly.

Nutritional Guidance:

• Encourage a balanced diet rich in essential nutrients, including calcium and vitamin D, for overall oral and bone health.

• Discourage excessive consumption of sugary and acidic foods and beverages.

Oral Cancer Screenings:

• Reinforce the importance of regular oral cancer screenings during dental check-ups.

• Encourage self-examination for unusual changes in the mouth, lips, or throat.

Adaptation to Physical Limitations:

• Consider adaptive tools, such as electric toothbrushes or floss holders, for individuals with physical limitations.

• Ensure that dental hygiene practices are adapted to the individual's capabilities.

• Aging adults experiencing cognitive decline may forget to brush or floss or have trouble with dexterity, they may be less aware of oral health importance.

• Dental caries are very common in cognitively impaired patients because of poor oral hygiene due to a lack of support from caregivers and regular dental care.

• Possibility of an increased likelihood of infections like thrush due to a decline in oral health care.

  
  

Inability to Communicate Pain: 

• May struggle to report or explain dental discomfort.

• Those advancing in age may have difficulties with expressive and receptive communication when speaking about possible oral health issues they may be experiencing.

  
  

Resistance to Care: 

• May resist hygiene or dental visits.

• Agitation is a common aspect seen in those with cognitive impairments such as Alzheimer's and dementia, the dental office can be a very sensory-ridden environment that may cause them to be upset

  
  

Unhealthy Dietary Habits: 

• May be more likely to eat sugary or unhealthy foods due to declined awareness of health importance.

  
  

Dental Appliances Challenges: 

• May have difficulty adapting to dentures or bridges.

• Memory loss or dexterity issues associated with cognitive decline may cause some denture users to struggle when using dentures

  
  

Financial/Organizational Issues: 

• May have trouble managing dental health-related logistics

Borreani, E., Wright, D., Scambler, S., & Gallagher, J. E. (2008). Minimising barriers to dental care in older people. BMC oral health, 8, 7. https://doi.org/10.1186/1472-6831-8-7

Chen, X., Clark, J. J., Chen, H., & Naorungroj, S. (2015). Cognitive impairment, oral self-care function and dental caries severity in community-dwelling older adults. Gerodontology, 32(1), 53–61. https://doi.org/10.1111/ger.12061

Ho, S. Y., Walsh, L. J., Pradhan, A., Yang, J., & Lopez Silva, C. P. (2024). Perspectives of oral health therapists on the barriers to oral care provision in nursing homes in Singapore: A qualitative analysis. Special Care in Dentistry, 44(1), 157–165. https://doi-org.georgian.idm.oclc.org/10.1111/scd.12833

Potts, E., Naderi, R., Hashmani, K., Catic, A., & Kiefer, L. (2023, September 15). Modifying oral hygiene techniques to improve oral health - dimensions of Dental Hygiene: Magazine. Dimensions of Dental Hygiene | Magazine.

https://dimensionsofdentalhygiene.com/article/modifying-oral-hygiene-techniques-to-improve-oral-health/

Raphael, C. (2017). Oral Health and Aging. American Journal of Public Health, 107(S1), S44–S45. https://doi.org/10.2105/ajph.2017.303835

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Sano, M., Cummings, J. L., Auer, S., Bergh, S., Fischer, C. E., Gerritsen, D., Grossberg, G., Ismail, Z., Lanctôt, K., Lapid, M. I., Mintzer, J., Palm, R., Rosenberg, P. B., Splaine, M., Zhong, K., & Zhu, C. W. (2023). Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition. Agitation in Cognitive Disorders: Progress in the International Psychogeriatric Association Consensus Clinical and Research Definition, 1–13. Cambridge University Press. https://doi.org/10.1017/s1041610222001041

Sobral, A. I. G. D. P., de Araújo, C. M. T., & Sobral, M. F. F. (2018). Mild cognitive impairment in the elderly Relationship between communication and functional capacity. Dementia & neuropsychologia, 12(2), 165–172. https://doi.org/10.1590/1980-57642018dn12-020009

Financial Constraints:

 One of the primary barriers to dental care for the elderly is financial constraints. Many older adults live on fixed incomes, such as pensions or social security benefits, which may not cover the cost of dental treatments. Traditional Medicare typically does not cover routine dental care, leaving many elderly individuals without insurance coverage for essential dental services. As a result, they may forgo or delay dental visits, leading to untreated oral health issues.

Limited Insurance Coverage: 

Even for those with dental insurance, coverage may be limited or inadequate.

Lack of Transportation: 

Mobility issues and lack of transportation can pose significant barriers to accessing dental care for elderly individuals, particularly those who no longer drive or have difficulty traveling long distances. Limited access to public transportation or affordable transportation services can make it challenging for older adults to travel to dental appointments, especially if they live in rural or underserved areas with few dental providers.

Physical and Cognitive Impairments: 

Elderly individuals with physical or cognitive impairments, such as arthritis, dementia, or Parkinson's disease, may face additional challenges in accessing dental care. Difficulties with mobility, communication, or understanding instructions can make it challenging for them to receive dental treatments safely and effectively.

Fear and Anxiety:

 Dental anxiety is common among people of all ages, but it can be particularly pronounced in elderly individuals who may have had negative experiences with dental care in the past. Fear of pain, discomfort, or embarrassment may prevent older adults from seeking dental treatment, even when they are experiencing oral health problems. Without appropriate support and accommodations, dental anxiety can become a significant barrier to accessing care for elderly individuals.