Don’t forget your teeth!

Sin­ga­pore­ans are not tak­ing care of their teeth accord­ing to a sur­vey and this could spell prob­lems in later years

BY: Eleanor Yap

Sin­ga­pore­ans are not doing a good job in car­ing for their teeth, accord­ing to nine in 10 den­tists sur­veyed by oral care brand Lis­ter­ine. This includes reg­u­lar and proper brush­ing, floss­ing and rins­ing with a mouth­wash, in between reg­u­lar den­tal check-​ups. This may lead to declin­ing gen­eral health and qual­ity of life in later years.

The sur­vey find­ings also found that 84 per­cent of den­tists who par­tic­i­pated in the sur­vey said that seniors (aged 55 years and above) require the most atten­tion in den­tal care and also they are the ones most sus­cep­ti­ble to oral prob­lems. For instance, seniors, who suf­fer from dis­eases like Parkinson’s dis­ease, visual impair­ment and res­pi­ra­tory dis­ease, are also most likely to suf­fer oral prob­lems such as peri­odon­tal dis­ease, den­tal caries/​tooth decay and gin­gi­val bleed­ing. This could be partly due to neglect of proper oral hygiene as a result of their illness.

Age­lesson­line queries Dr Kuan Chee Keong, a den­tist in pri­vate prac­tice and who serves as the act­ing hon­orary gen­eral sec­re­tary of the Sin­ga­pore Den­tal Asso­ci­a­tion (SDA), to find out about some com­mon oral prob­lems affect­ing seniors and how to pre­vent them:

What kinds of com­mon oral prob­lems do seniors face?

Some of the com­mon oral prob­lems among seniors are loss of teeth (and thus loss of func­tion), increas­ing inci­dence of root caries (decay that forms on the root sur­faces of the teeth), and wear and tear of den­tal sur­faces at coro­nal (these are sur­faces above the gum­line where the tooth­brush bris­tles come into con­tact) as well as root sur­faces, which result in sensitivity.

Seniors are also more likely to expe­ri­ence dif­fi­culty in clean­ing due to decreas­ing dex­ter­ity or phys­i­cal impair­ment, and are more prone to oppor­tunis­tic infec­tion like fun­gal or peri­odon­tal infec­tion due to sys­temic dis­eases (that affects the body as a whole). Another com­mon oral prob­lem among seniors is a decrease in sali­vary out­put due to sys­temic diseases.

So sen­si­tiv­ity to both hot and cold is a com­mon prob­lem for seniors? What is the cause and treatment?

Yes, sen­si­tiv­ity to hot and cold is a com­mon prob­lem for seniors. There are sev­eral rea­sons for this. The sen­si­tiv­ity among seniors is usu­ally caused by nat­ural gin­gi­val reces­sion due to age­ing, attri­tion of the enamel due to eat­ing and grind­ing, abra­sion of enamel and den­tine due to brush­ing improp­erly and too vig­or­ously, patholo­gies like cav­i­ties and frac­tures, and ero­sion of enamel and den­tine due to acidic food and beverage.

Drink­ing car­bon­ated drinks or juices using a straw is a good way to min­imise acid ero­sion. For tea and cof­fee, there is not much acid ero­sion prob­lem as com­pared to exter­nal stain­ing. Rins­ing after any drinks or food is def­i­nitely a good idea even just sim­ply rins­ing with plain tap water. The prac­ti­cal­ity of such an advice is another matter.

Treat­ment will depend on the cause of sen­si­tiv­ity. A com­plete mouth­wash with active ingre­di­ents such as essen­tial oils can help to keep germs in check, as well as zinc chlo­ride to pre­vent tar­tar buildup and sodium flu­o­ride to strengthen teeth against cav­i­ties. This will greatly reduce the inci­dences of plaque, tar­tar, cav­i­ties and gin­givi­tis, and pre­vent lead­ing oral dis­eases as well as other health prob­lems that may be caused by oral bacteria.

Are seniors more at risk of oral cancer?

No, there is no evi­dence to sup­port this. 

So is age in and of itself a dom­i­nant or sole fac­tor in deter­min­ing oral health?

No. Oral health is depen­dent on oral hygiene habits. A reg­u­lar holis­tic oral care régime con­sist­ing of proper brush­ing, floss­ing and rins­ing with a com­plete mouth­wash, and reg­u­lar den­tal check-​ups, will help to pro­mote good oral health. This will then reduce the inci­dences of plaque, tar­tar, cav­i­ties and gin­givi­tis, and pre­vent lead­ing oral dis­eases as well as other health prob­lems that may be caused by oral bacteria.

Since cer­tain con­di­tions like arthri­tis in the hands and fin­gers can make brush­ing and floss­ing dif­fi­cult and hence gum dis­ease and tooth loss, or even mild demen­tia, what advice would you give those suf­fer­ing from those conditions? 

For patients with phys­i­cal and men­tal impair­ment whereby self-​cleansing is impos­si­ble, it is impor­tant to instruct their care­givers. Patients who are phys­i­cally, not men­tally impaired should try using an elec­tric tooth­brush, inter­den­tal tooth­brush, a floss­ing aid and a com­plete mouth­wash with active ingre­di­ents such as essen­tial oils, zinc chlo­ride and sodium flu­o­ride. They should also visit their den­tists more reg­u­larly, about every two to three months every year.

Can med­ica­tions also affect oral health? Such as what?

Almost 80 per­cent of the most com­monly pre­scribed med­ica­tions lead to a dry mouth. Saliva helps to main­tain the health of the soft and hard tis­sues by remov­ing waste prod­ucts and pro­vid­ing disease-​fighting sub­stances through­out the mouth, offer­ing first line pro­tec­tion against micro­bial inva­sion or growth that might lead to disease.

Oral bis­pho­s­pho­nates are given to treat osteo­poro­sis. There is a link to an uncom­mon com­pli­ca­tion called osteonecro­sis of the jaw, which is a rare but poten­tially seri­ous con­di­tion that can cause severe destruc­tion of the jaw­bone. How­ever, given the risks asso­ci­ated with osteo­poro­sis and the proven ben­e­fits of oral bis­pho­s­pho­nate ther­apy, patients are advised not to stop tak­ing these med­ica­tions before dis­cussing the mat­ter fully with their physician. 

Can you share some oral hygiene tips for seniors? How often should they visit a dentist?

Seniors should fol­low a reg­u­lar holis­tic oral régime, con­sist­ing of proper brush­ing, floss­ing, and rins­ing with a good anti­sep­tic mouth­wash, com­bined with reg­u­lar vis­its to the den­tist every six months (more fre­quent if oral care is poorer). A good mouth­wash is par­tic­u­larly impor­tant for seniors as some of them may not be able to brush or floss prop­erly as they tend to lose teeth as they age.

Again look for mouth­washes with active ingre­di­ents such as essen­tial oils, zinc chlo­ride and sodium fluoride.

How do you choose the right floss or tooth­paste? Is whiten­ing tooth­paste a solution?

All floss and tooth­paste sold in Sin­ga­pore except those by grey importers are gen­er­ally effec­tive. Choos­ing a rep­utable man­u­fac­turer and those with endorse­ment such as the SDA Seal or ADA (Amer­i­can Den­tal Asso­ci­a­tion) Seal would be best.

In my opin­ion, whiten­ing tooth­paste is not an effec­tive method of bleach­ing. Whiten­ing is a cos­metic treat­ment and the most effec­tive (rel­a­tively speak­ing) is bleach­ing using hydro­gen per­ox­ide. I am not aware of effec­tive bleach­ing using tooth­paste, so I don’t advo­cate bleach­ing. [How­ever in say­ing this] I would not sug­gest bleach­ing for seniors. 

Can you explain denture-​induced stom­ati­tis? So how can seniors pre­vent such a prob­lem or what is the proper care for dentures?

Den­tures ought to be re-​based or re-​lined, or com­pletely changed with time. Oth­er­wise ill-​fitting den­tures can cause stom­ati­tis, which is when the area under the upper den­ture becomes inflamed or swollen. Other causes include lack of main­te­nance like clean­ing the den­tures reg­u­larly, and pro­longed wear­ing of den­tures, which can cause infec­tion of the soft tissue.

Chang­ing ill-​fitting or old den­tures, and clean­ing den­tures reg­u­larly can pre­vent stom­ati­tis. You can soak them in water or den­ture cleanser and this will keep infec­tions at bay.

If a senior has prob­lems chew­ing and swal­low­ing cer­tain foods, what advice can you give her?

See a den­tist to diag­nose the cause of this prob­lem. It could be due to a vari­ety of rea­sons, includ­ing a lack of saliva, ill-​fitting den­tures or den­tal caries. I can’t stress enough – to improve oral health, seniors should fol­low a reg­u­lar holis­tic oral régime, con­sist­ing of proper brush­ing, floss­ing and rins­ing with a good anti­sep­tic mouth­wash, com­bined with reg­u­lar vis­its to the dentist.

(PHOTO CRED­ITS: TOOTH PASTE 02 © Rewat Wan­na­suk | Dream​stime​.com and Listerine)