The oral health of frail older New Zealanders has been declared an urgent clinical problem that "is only going to get worse", in an extensive world-first study.
Otago University has surveyed the oral health of 987 people living in aged residential care and found those with dementia, and older men in general, have dirtier and more decayed teeth.
Lead author of the study, Professor Murray Thomson, describes poor oral health as one of the "geriatric giants", that is predominantly caused by the higher rates of cognitive and physical impairments found among older Kiwis.
"Neither the aged care sector nor the dental profession, in most countries, is prepared. Not only do we have more and more older people every year, but more and more people are entering old age with their own teeth, rather than full dentures, as was the situation just a couple of decades ago," Professor Thomson says.
"In some ways, dentistry has been a victim of its success – we have long emphasised the idea of 'teeth for life' without much thought to what happens towards the end of life.
"We also now know that half of those in old age will end up in residential aged care, and that more and more of those will have some form of dementia."
Another alarming finding form the study was that "slow progress" was being made in the area of geriatric oral health.
"It's a very complex situation involving a lot of players – the aged care sector, the Ministry of Health, the dental profession, and the public. An encouraging sign is the inclusion of oral health in New Zealand’s Healthy Ageing Strategy. That’s a starting point, but there is a lot of work to be done," Professor Thomson says.
Of those examined in the study (representative of the more than 14,000 New Zealanders living in aged care), recently published in the journal Gerodontology, about half had severely impaired cognitive function, and more than a third required fillings or extractions.
Those with severely impaired cognitive function had greater numbers of decaying teeth. They also had higher oral debris scores, reflecting poorer daily oral hygiene care.
Professor Thomson says greater rates of tooth decay can lead to dental and facial infections, poorer quality of life, malnutrition and communication difficulties.
The researchers also found that even the most cognitively impaired participants were able to be examined fairly easily, and regular, routine removal of oral debris by carers should not be a difficult task.
"The issue that we currently face is that much of that debris removal is not being done, and this, along with frequent exposure to sugary, over-processed meals and snacks, and poor salivary function, is enabling plaque and dental caries to flourish in aged residential care populations," Professor Thomson says.
For those wanting to improve or maintain their oral health, Professor Thomson has some simple advice: brush twice daily with fluoride toothpaste; clean carefully between the teeth at least two to three times per week; avoid having sweet drinks or snacks between meals (and that includes sugar in tea or coffee – it takes only a couple of days to get used to not having it); and avoid smoking.
"For people who have poor oral health in middle age, it is not going to be any better in old age, and an honest, open conversation with a dentist about the options, which may include complete extraction, may be a very good idea," Professor Thomson says.