| Physical Limitations Can Affect Oral Hygiene
Today, about 1 in 5 Americans has at least one disability that makes it harder to do daily tasks. Some people were born with their disabilities. Some may have become disabled by an illness or an accident.
People also are more likely to become disabled as they get older. In the United States, almost 50% of people who are 65 to 69 years old have some form of disability. More than 70% of people age 80 or older are disabled in some way.
The most common physical problems for older Americans are changes in how well they can see, hear, move or talk. They also can have problems with smell, taste, chewing or swallowing. These challenges and impairments can affect health, including oral health.
Gradual hearing loss is common as people get older. This is the most common source of physical limitations in older adults. Nearly one-third of Americans older than age 60 have a hearing impairment. So do about half of those older than 85. Doctors believe that exposure to loud noise over the years is one major cause of hearing loss.
Impaired hearing has no direct effect on oral health. However, it can make it harder for patients and caregivers to talk to each other. Instructions may not be clear. This can result in poor oral hygiene and poor home care after dental procedures. A patient who cannot hear well also may feel more anxious in a dental office.
Suggestions
- If you use a hearing aid, make sure that it is working properly. Wear it to your dental appointments. If the sound of dental instruments causes you discomfort, you may want to lower the volume on your hearing aid or turn it off during part of your visit.
- If you read lips or have partial loss of hearing, ask your dentist and other personnel to face you when they speak. Ask them to speak slowly and clearly. If you use sign language, arrange for an interpreter to come to the dental appointment with you.
- When the dentist or other staff members speak to you, ask them to turn off any background noise, such as a radio or suction that is being used in your mouth.
Visual limitations are the second most common impairment in people over 65. Nearly half of adults over 75 have some form of vision problems. Visual impairments include:
- Diabetic retinopathy
- Glaucoma
- Cataracts (very common)
- Macular degeneration
- Less ability to see or detect motion
- Age-related loss of visual sharpness
Vision changes can result from aging itself. They also can be caused by other medical problems. These include diabetes, certain types of high blood pressure, circulation problems, Sjögren's syndrome and others.
People with vision problems generally have difficulty reading, fixing meals, doing housework, shopping, driving and walking without help. A vision problem does not have any direct effects on oral health. However, it can make it difficult for a person to eat a balanced diet, visit the dentist, or examine oral problems at an early stage. As a result, people with vision problems may wait until they are in pain to seek dental treatment.
Suggestions
- It is not always obvious that a person has a vision problem. Make sure that people in your dentist's office are aware of your disability.
- Ask that someone guide you from the waiting area to the dental chair. In addition, if you have been at this dental office before, ask if the office has been changed since your last visit. You might be more comfortable if you know about furniture that has been moved and any new obstacles to avoid.
- Ask the dentist or hygienist to face you when speaking. Ask to be told about each step before it occurs — for example, when water or air will be used.
- Ask for instructions to be written in bold, large print. Ask someone to read them to you before you leave.
Orthopedic problems are the third most common physical limitation in people over 65. About 1 in 5 older adults has one of these problems. They include:
- Arthritis
- Back pain
- Deformities of the back, legs and arms
- Loss of legs or arms
- Osteoporosis
Arthritis can cause changes in the jaw joint, or temporomandibular joint (TMJ). This can cause pain and change chewing and sleep patterns. Treatment for arthritis often includes drugs that suppress the immune system. This can increase the risk of mouth infections.
People with severe TMJ problems sometimes have a lot of discomfort from grinding their teeth. This can lead to changes in diet that can damage nutrition.
Unlike arthritis, many orthopedic problems do not have direct effects on oral health. However, they can make it more difficult to get to your dentist's office. You also may have problems handling a toothbrush or floss. This can make it harder to take care of your teeth and gums. Devices are available to help you to care for your mouth and teeth despite pain or movement limitations. These include:
- Toothbrushes with enlarged handles
- Electric toothbrushes
- Devices to clean between teeth (floss, special brushes)
- Devices that squirt water into the mouth
Suggestions
- Ask for and accept help with your tooth brushing and flossing.
- Ask your dentist for advice on special devices that can help.
- Ask for and accept a ride to the office and help getting to the dental chair.
- Shift your position often during treatment.
- Ask to keep the appointment as short as possible.
Older people often report chewing problems. Sometimes this happens even for people who still have all of their natural teeth. Losing teeth can further reduce chewing efficiency. People with chewing problems may alter their diets. This can lead to poor nutrition, which can affect overall health, oral health and quality of life.
Swallowing problems can increase the risk of choking or inhaling food into the breathing passage. This is called aspiration. Stress or other medical problems may make swallowing problems worse. The most common causes of swallowing problems are neurological disorders and stroke. Parkinson's disease can slow the tongue and cause a loss of coordination when you chew and swallow. Arthritis and diabetes also can affect swallowing.
Speech impairment is the ninth most common chronic condition in people over 65. Speech patterns alter with age. So do the shape and function of the tongue. However, normal aging does not significantly alter speech in most people.
Many older adults take multiple drugs. Some people have a drug side effect called tardive dyskinesia. This can involve repeated tongue and mouth movements. People with this condition may feel frustrated. They may be reluctant to visit a dentist.
Suggestions
- Continue to visit your dentist regularly. This is important for several reasons:
- If you wear full or partial dentures, your dentist needs to see if they are fitting correctly and adjust them if needed.
- Regular checkups give your dentist a chance to detect tooth decay at an early stage, so you can avoid major dental work or losing teeth. Your dental hygienist and dentist will check the health of your gums and teeth. They can give you tips for dealing with problem spots so you can prevent periodontal (gum) disease and keep your teeth.
- Ask your dentist or dental hygienist how to improve your nutrition if you have trouble eating certain foods.
- Brush and floss your teeth daily to help maintain the health of your teeth.
- Tell your physician or dentist if you have problems with breathing, swallowing, eating or speaking. In some cases, a change in medicines can help, but this is up to your physician.
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As we age, taste and smell usually do not change that much. However, many people have medical conditions or take medicines that affect taste and smell. Conditions in your mouth also can alter taste and smell. These include:
- Periodontal (gum) disease
- Fungal (yeast) infections
- Trauma
- Dry mouth caused by medicines or problems with the saliva glands that decrease saliva production
A mouth that is constantly dry can increase the risk of tooth decay.
Suggestions
- Check with your physician and see if any of your medicines might be causing dry mouth (xerostomia). If so, ask whether they can be changed.
- Use an over-the-counter mouth moisturizer or saliva substitute.
- Drink water often to keep your mouth moist. Carry water with you to sip throughout the day. Keep water by your bed at night.
- Suck on sugar-free hard candies, ice chips or sugar-free ice pops.
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