Addressing oral health in the geriatric population

Lilia Kaur Prem discusses the oral health challenges affecting the geriatric population and how they can be addressed.

‘As I get older, I feel invisible.’ It was these few words from an elderly patient that ignited dental hygienist and therapist Lilia Kaur Prem’s interest in geriatric dentistry. ‘We’re all going to grow old and have family members who will, too. They deserve the same level of dental care as anyone else,’ she says.

She is right to emphasise this point. The population of individuals aged 65 and older is growing rapidly. In 2022, 19% of the UK population was 65 years or older, and this percentage is projected to rise to 27% by 2072 (Barton et al, 2024).

A study from King’s College London suggests the UK should adopt an ‘integrated healthcare model’ to address the oral health challenges that an ageing population will bring (Patel et al, 2024). This demographic shift necessitates urgent attention, the authors concluded.

A natural affinity

Lilia would agree. Studying dental hygiene and therapy at the University of Sheffield, she graduated in 2006. She began her career at Dental Perfection in Derby, where she utilised her full scope of practice and discovered a natural affinity for treating geriatric patients.

‘I did every bit of therapy and discovered a real liking for older patients. One gentleman arrived for his appointment, and I commented on how smart he looked. He was delighted with the compliment and said, “Nobody cares about you when you are old.” I have never forgotten this. None of us will be young forever, and the health of our ageing population matters greatly.’

While there, she was approached by an Oral-B representative to explore the effects of using electric toothbrushes on two patients. The results were promising: both patients exhibited a noticeable reduction in plaque accumulation and decreased inflammatory markers associated with gum disease – findings that Lilia later shared with care home staff as a dental volunteer.

Neglected oral health

Reading around age-related oral health issues, Lilia was alarmed by the statistics, particularly concerning elderly residents in care homes. In March 2023, the Care Quality Commission (CQC) conducted a follow-up review of its initial 2019 report on oral health in care homes (CQC, 2023).

Despite increased awareness of the NICE oral health guidelines, up to 40% of care home staff still lacked essential training. Providers also indicated that not enough dentists were able or willing to visit care homes.

Motivated by a desire to address these unmet needs, Lilia – who briefly practised in Oxford and is now settled at St Andrew Street Dental Practice in Hertford – continues to volunteer her time regularly.

She says: ‘Unfortunately, poor dental hygiene remains widespread in many residential facilities. The root causes are complex: care staff are often overwhelmed and may prioritise other immediate healthcare needs, while a lack of formal oral health training exacerbates the issue. When asked, staff often report that residents don’t receive oral hygiene because they are too busy getting them up and dressed for the day ahead.’

Tailored approaches

She says some care managers have even expressed concerns about’ failing their residents’.

‘There is no blame game, but we must ensure that elderly individuals receive the best oral hygiene possible. Caring for elderly patients with complex needs requires tailored approaches.

‘For instance, adaptive brushing techniques can improve independence for stroke survivors, who often have lax cheeks where food debris accumulates.

‘Similarly, choosing a calm moment for patients with dementia is the best time to address oral hygiene. Physiological factors, particularly glucose metabolism, significantly influence cognitive function, and these patients can be uncooperative upon waking, while medications can leave their mouths extremely dry.

‘They are often more settled later in the day, the pH in the mouth is lower and there are no staff changeovers to disrupt the moment.’

Powerful tools

Lilia’s experience highlights that, in all cases, an electric toothbrush is essential.

‘Electric toothbrushes are powerful tools for improving oral hygiene, especially for individuals with manual dexterity issues or cognitive decline. Oral health in degenerative conditions is a one-way street, but we still have a responsibility to care.

‘I teach caregivers brushing techniques using the Oral-B iO Test Drive. The oscillating-rotating technology provides a faster, more effective clean. The small brush head also makes brushing more comfortable for patients who may find it otherwise invasive.’

She adds: ‘The electric toothbrush can reach the nooks and crannies and provide a degree of interdental cleaning.

‘Switching to an SLS-free toothpaste like Oral-B Clinical Decay Control can also help improve residents’ comfort and compliance with medication-induced dry mouth. Encouraging regular water sipping helps maintain moisture and prevent root caries.

‘High-fluoride toothpaste, such as Oral-B which contains a unique Stannous Fluoride complex, offers added protection for vulnerable teeth, especially those with receding gums or a history of decay.’

Out-of-box thinking

‘I also show staff some simple ideas to help keep the mouth open – such as a mouth prop or getting the resident to bite down on the end of a chunky, inexpensive rubber toothbrush – a clever trick providing more access without fuss.

‘For bedbound residents, sometimes the best care is just a clean mouth. You don’t need to be at the sink for oral care. I encourage caregivers to sit them down with support and use a kidney dish under the chin.

‘Patients with strokes might still want independence, so we help them find ways, like strapping a toothbrush to their wrist. I always strive to keep the language straightforward, make it easy to understand and ensure it is non-intimidating. It’s all about simplicity and reducing stress.’

Coupons and goodies

Additionally, initiatives such as distributing Oral-B Exclusive Professional Coupons help promote better habits and facilitate access to high-quality products. Proceeds support Dentaid The Dental Charity, ensuring that the benefits of improved oral health extend even further into the community.

Lilia explains: ‘I take the Oral-B Exclusive Dental Professional Coupons into the homes I visit, and family members are always happy to buy a toothbrush for their loved ones. These coupons help patients purchase the right electric toothbrush at a reduced cost.

‘The coupons also provide an exclusive deal on toothbrush head refills, encouraging replacement every three months. I give staff enough free Oral-B toothpaste samples to gain their support. I believe it’s essential to arrive with something in hand – I never want to be without goodies.’

Proper denture care is another critical area. Many residents find adhesive products challenging, which can deter regular use. Training staff and patients on the correct application technique helps increase comfort and compliance. She also distributes free samples of Fixodent denture adhesive and shows caregivers how to apply it properly to improve the seal.

Culture of kindness

Currently studying for a Level 2 Principles of Dementia Care TQUK Certificate at Leicester College, Lilia is also a member of the British Society of Gerodontology, which is dedicated to improving the oral health of older people.

‘At a recent conference, a primary concern was the number of patients experiencing severe inflammation associated with implants. For patients without a ridge for dentures who have All-on-4 implants fitted, effective cleaning is crucial. I ensure the teeth are properly aligned and use the Oral-B interspace power tip to reach difficult areas. Gently pulling down the lip allows me to access better for thorough cleaning.’

She is magnanimous about her charitable work. ‘We must make people feel supported. It’s about creating a culture of kindness and acceptance. Explaining to caregivers how to use an electric toothbrush with their residents is a joy when you see the results. Not everything requires monetary compensation,’ she says.

References

This article is sponsored by Procter & Gamble.