| Physical Limitations Can Affect Oral Hygiene
Today, 54 million people who live in the United States, that is, one in five, have at least one disability that reduces their ability to perform everyday tasks or activities. Some of these people were born with their disabilities, some may have become disabled due to an illness or an accident, while others might have developed the disability as they aged.
Aging and developing a disability do not necessarily go hand in hand, but as people grow older, the possibility of their becoming disabled increases. In the United States, almost 50% of people who are 65 to 69 years old have some form of disability, while more than 70% of people 80 years old or more are disabled in some way.
The most common physical problems older Americans have to deal with involve a change in their ability to see, hear, move and talk. Older people also can have problems with their sense of smell and taste, as well as difficulties chewing and swallowing. Many of these common, age-related impairments can have far-reaching health consequences, including harmful effects on oral health.
Visual limitations are the second most common impairment in people over 65. Nearly half of adults over 75 have some form of visual problems. Visual impairments include:
- Diabetic retinopathy
- Glaucoma
- Cataracts (very common)
- Macular degeneration
- Deterioration of motion perception and detection
- Age-related loss of visual sharpness
Vision changes can result from the natural aging process, or from other medical problems, such as diabetes, certain types of high blood pressure, atherosclerosis, Sjögren's syndrome and others.
People who are visually impaired generally have difficulty reading, preparing meals, doing housework, shopping, driving, and walking independently. A vision limitation does not have any direct effects on oral health, but it can make it difficult for a person to maintain a balanced diet, visit his or her dentist, evaluate his or her oral hygiene, or to notice oral problems at an early stage. As a result, people with visual limitations may wait until they are in pain to seek dental treatment.
Suggestions
- There is a wide range of visual impairment and as a result, it is not always obvious that a person is visually disabled. Make sure that the dental staff are aware of your disability.
- Ask that someone guide you from the dental waiting area into the operatory. 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 are aware that the furniture has been moved and that there are new obstacles to avoid.
- Ask the dental clinician to face you when he or she speaks and to keep you informed of each upcoming step, for example, when water or air will be used.
- Ask for instructions to be written in bold, large print and read to you before you leave.
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The gradual hearing loss that occurs as a person gets older is a common condition. Nearly one-third of Americans older than age 60 and about half of those older than 85 have a hearing impairment. Doctors believe that exposure to loud noise over the years is a major contributing factor to hearing loss.
A loss of hearing can make it difficult to understand what people are saying, and this can be a frustrating and embarrassing experience for many. In addition, because of the breakdown in communication, people with hearing loss often are thought to have impaired intellectual abilities, even when they do not, leading to further embarrassment.
Impaired hearing has no direct effect on oral health, but it does complicate communication between patients and caregivers. These complications can result in poor oral hygiene at home, inadequate care after dental procedures, and fear and anxiety in a dental office.
Suggestions
- If you use a hearing aid, make sure that you wear it to your dental appointment and that it is working properly. In addition, you may want to adjust the volume or turn it off since the sound of some dental instruments may cause you some discomfort.
- If you read lips or have partial loss of hearing ask your dentist and other personnel to face you when they speak, and to speak slowly and clearly. If you use sign language, arrange for an interpreter to come to the dental appointment with you.
- Ask that any background noise such as a radio or the suction be turned off when your dentist and / or the dental personnel are speaking to you.
Orthopedic problems are the third most common physical limitation in people over 65. Twenty percent of older adults experience these problems, which include arthritis, back pain, deformities of the back, legs and arms, loss of legs or arms, and osteoporosis.
Arthritis can cause changes in the jaw joint, or temporomandibular joint (TMJ), which can change chewing and sleep patterns, cause pain, and lead to changes in diet that can cause nutritional and oral problems. Treatment for arthritis often includes immunosuppressive drugs, which can increase the risk of oral infection.
Unlike arthritis, many orthopedic problems do not have direct effects on oral health. However, they can make it more difficult to get around and to handle a toothbrush or floss. This can make oral hygiene and visits to a dental office more difficult. Oral-hygiene devices are available that can help a person with pain or movement limitations care for his or her mouth and teeth. These include toothbrushes with enlarged handles, electric toothbrushes, devices to clean between teeth (floss, special brushes), and oral irrigators.
Suggestions
- Ask for and accept assistance with your oral-hygiene habits.
- Ask your dentist for recommendations for special devices that can help.
- Ask for and accept transportation to the office and assistance to the dental chair.
- Shift your position often during treatment and ask to keep the appointment as short as possible.
Older people often report chewing problems, even people who still have all of their natural teeth. Losing teeth can further reduce a person's ability to chew efficiently. People with chewing problems may alter their diets, which can lead to nutritional shortages and affect a person's overall health, oral health and quality of life.
Swallowing problems can increase the risk of choking or inhaling food into the breathing passage (aspiration). Stress or other medical problems can make swallowing problems worse. The most common causes of swallowing problems are neurological and cerebrovascular disorders. Parkinson's disease can slow the tongue and cause a loss of coordination when chewing and swallowing. 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, as do the shape and function of the tongue. However, normal aging should not significantly alter speech.
Many elderly take multiple drugs. One side effect of taking many drugs can be a condition called tardive dyskinesia, which can involve repeated tongue and mouth movements. This can cause frustration and make people less likely to visit a dentist.
Suggestions
- It is important that an older person continue to visit his or her dentist a regularly. Regular visits will give the dentist a chance to evaluate any dentures or partials to make sure they are fitting correctly and adjust them if needed. Also, regular checkups give your dentist a chance to detect tooth decay at an early stage, which allows you to avoid extensive dental work or losing teeth. Oral hygiene is very important to avoid periodontal (gum) disease, and keep your teeth. During regular visits, your dental hygienist or dentist can check the health of your gums and teeth, and can give you tips for dealing with problem spots.
- Ask your dentist or dental hygienist for suggestions about ways to improve your nutrition if you are having trouble eating certain foods.
- Brush and floss your teeth daily to help maintain the health of your teeth.
- Tell physician or dentist if your difficulties are hindering your ability to breath, swallow, eat or speak. A change in your medications could 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 are taking medications that affect taste and smell. Oral problems such as periodontal (gum) disease, fungal infections, dry mouth from medications or a decrease in the ability of salivary gland to produce saliva, and trauma also can alter taste and smell. If your mouth is constantly dry, it not only is uncomfortable, but it can lead to more tooth decay.
Suggestions
- Check with your physician and see if any of your medications might be causing dry mouth (xerostomia) and whether they can be changed.
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Use an over-the-counter oral moisturizer or saliva substitute.
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Drink water frequently to keep your mouth moist. Carry water with you to sip throughout the day, and keep water by your bed at night.
- Suck on sugar-free hard candies, ice chips or sugar-free ice pops.
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