15 March 2023

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Oral health management in old age

Gianna Maria Nardi

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The clinical observation of the signs and symptoms of the patient is the starting point for preparing a preventive therapeutic plan that can ensure the quality of the services and standards of efficacy of dental-periodontal health. The correlation of oral cavity conditions with systemic health must lead the clinician to interface in an interdisciplinary way to manage the changing needs of the individual, especially for patients in the senior age group. 

In prevention protocols, it is essential to receive the exact diagnosis of clinical situations with careful consideration, in the presence of systemic pathologies, of the side effects that some drugs cause in the oral cavity.

In terms of effects on the population, for example, allergies caused by pollen, according to WHO data, affect between 10 and 40% of the population. When people take antihistamines, this decreases salivary activity and inhibits the protection it carries out on the tissues of the oral cavity, causing dry mouth. The same symptomatology occurs with decongestant drugs and painkillers.

Society ages and the burden of chronic-degenerative diseases becomes increasingly relevant with multiple chronic conditions affecting 1 out of 4 elderly people. In Italy there are an estimated 17,177 elderly people, 83% of whom are women (Istat 2021).

To alter the eubiosis of the oral cavity, the intake of diuretics, drugs to control blood pressure and antidepressants should be considered and discussed with patients. 

The most common chronic pathologies are heart disease (27.8%), chronic respiratory disease (20.3%), diabetes (19.7%), tumors (12.5%), stroke or cerebral ischemia (8.4%) and renal insufficiency (8.1%). 

This data helps us reflect on the need to be prepared to deliver operational home hygiene protocols that can respond to the need to promote appropriate management. This could include providing advice on the choice of technologies that can help oral health management, considering the critical issues due to the age of senior care recipients such as reduced manual dexterity. Elderly patients may have implants or mobile prostheses, so it is necessary to fully explain the need for chemical and mechanical control of the perceived bacterial biofilm.

The latest generation manual, sonic or electric toothbrushes facilitate effectiveness because they have delicate filaments, suitable for the delicate mucous membranes of senior patients. For the interproximal spaces, rubber brushes with dynamic shapes (GUM Soft-Picks Advanced) ergonomically facilitate the effectiveness of brushing.

The chemical control of bacterial biofilm is appropriate to improve social life in order to fight not only the bacterial insult on the tissues of the oral cavity, but also the age-old problem of halitosis.

The mouthwash must therefore be super-moisturizing and delicate (Ialozon) to allow for daily use and relieve the perception of soreness. The prosthetic product must be brushed with a special brush which must be sanitized often.

Ergonomically, the use of spray solutions of ozonized olive oil, cetylpyridinium chloride and sodium bicarbonate (Ialozon-Clean) can be easily sprayed at a distance of five cm from the prosthesis. Clinicians and hygienists should explain to elderly patients how to control the malodor of the prosthesis itself.

Scientific evidence has confirmed the usefulness of considering the use of probiotics for their antagonistic effect towards pathogens, also associated with the influence of the local and systemic immune response as an independent factor, responsible for the reduction of inflammation and tissue destruction.

The technologies dedicated to oral care must facilitate, in the case of frail seniors assisted by caregivers, home management, and the possibility of remote oral hygiene consultation is a great opportunity to consider.

It's also a reminder to all of us healthcare professionals that we need to implement oral health management skills at a certain age.