Mouth, Teeth and General Health in Older Adults

How the mouth affects the rest of the body

• Nutrition: missing teeth, painful gums or loose dentures make chewing hard, so people avoid fruit, vegetables, nuts and meat and rely on soft, low-protein food, which leads to weight loss and weakness; see teeth, dentures and eating well in later life and malnutrition in older adults: signs and prevention.
• Diabetes: gum disease and high blood sugar worsen each other; treating gums can help sugar control; see diabetes after 60: a home care guide.
• Heart: severe gum disease is associated with higher heart disease risk; the link is not fully understood, but oral care is sensible for people with heart conditions; people with certain heart valve problems or implants may need special advice before dental procedures; ask the cardiologist.
• Lungs: bacteria in saliva can be inhaled, particularly when swallowing is poor or the person is bedridden; see preventing aspiration pneumonia in frail older adults.
• Cognition and mood: poor oral health has been linked to cognitive decline, and pain and embarrassment can lead to withdrawal; see loneliness and isolation in older adults.
• Medicines: many cause dry mouth, which raises the risk of decay and infection.
• Cancer: persistent mouth sores can be early signs; tobacco and betel quid chewing are major risk factors in India.
• Bone medicines and jaw health: tell the dentist about osteoporosis treatment; see osteoporosis medicines and supplements: questions to ask.

Common problems in later life

### Tooth decay

Decay occurs at the gum line (root decay) as gums recede, in people with dry mouth, sugary snacks, sipping sweet tea through the day, and poor brushing. Signs include dark spots, holes, sensitivity, pain and bad taste.

### Gum disease

Red, swollen, bleeding gums, bad breath, receding gums, loose teeth or pus. It is caused by plaque and is worsened by smoking, diabetes and poor hygiene. It is usually painless in early stages, so regular checks matter.

### Dry mouth

A sticky, dry mouth, difficulty swallowing dry food, cracked lips, burning tongue. Causes include medicines (many), mouth breathing, dehydration, diabetes, some conditions and radiotherapy. Ask the doctor to review medicines without stopping any yourself; see medicine side effects families should watch for.

### Ill-fitting dentures

Dentures may become loose as gums and bone change, causing sores, poor chewing, difficulty speaking and embarrassment. Dentures should be checked every year or two, and relined or remade if loose. Do not use home glues or modify dentures yourself.

### Mouth infections and ulcers

White patches that scrape off may be thrush (common with dentures, inhalers and diabetes). Ulcers lasting more than two to three weeks, red or white patches, lumps or unexplained bleeding need prompt examination to rule out mouth cancer.

### Tooth loss

Loss of many teeth reduces food choices and confidence. Options such as partial or complete dentures, bridges or implants depend on health, bone and cost; the dentist will advise.

### Tobacco and betel

Chewing tobacco, paan, gutka and smoking greatly raise the risk of mouth cancer and gum disease. Help is available to quit; ask the doctor or dentist.

Daily mouth care for those who can manage themselves

• Brush twice a day for two minutes with a soft brush and fluoride toothpaste (a pea-sized amount); brush all surfaces and along the gum line gently. Rinsing lightly rather than a large rinse after brushing leaves fluoride on teeth.
• Clean between the teeth daily with interdental brushes or floss, as advised; a dentist can show the right size.
• Brush the tongue gently.
• Choose tools to suit the hands: a brush with a thick handle, an electric toothbrush, or a handle grip for arthritis; see easy-grip cutlery guide, arthritis daily living gadgets and grip strength and hand exercises.
• Good light and a magnifying mirror help with poor eyesight; see magnifier lamp guide.
• Limit sugary snacks and drinks, especially between meals; sip water instead of sweet tea.
• Drink water, and chew sugar-free gum if suitable, to stimulate saliva (check with the dentist if there are jaw problems).
• Do not smoke or chew tobacco.
• Visit the dentist at least once a year, or more often if problems exist; see common dental problems in the elderly and best tips to maintain dental health for seniors.

Mouth care for people who need help

For frail, bedridden or dementia patients, a caregiver should do the mouth care; see oral care for frail older adults and denture hygiene.

• Wash your hands and wear gloves.
• Position the person upright (sitting or semi-upright), with the head slightly forward, to reduce choking; for someone lying down, turn the head to the side.
• Use a small soft brush and a smear of toothpaste, brushing gently on teeth, gums, tongue and inside cheeks; do not use much water or large amounts of toothpaste, to avoid inhaling; wipe out the mouth with a clean damp cloth or a foam swab.
• Do it twice daily, morning and night, even if the person is not eating.
• Be gentle and respectful, explain what you are doing; see dignity and consent in care and dementia communication tips. If the person clamps the mouth, try again later or use a calmer approach; ask the dentist or nurse for advice.
• Check the mouth daily for sores, white patches, red or swollen gums, loose teeth and food pocketed in the cheeks.
• Moisten dry lips and mouth with water sips or the advice of the dentist or nurse.
• Report pain, refusal to eat, bleeding, bad smell, swelling or ulcers.

Denture care

• Remove and clean daily: brush dentures with a soft denture brush and mild soap or denture cleanser, over a towel or a basin of water to avoid breakage if dropped. Do not use hot water, which can warp them, or toothpaste which can scratch.
• Take them out at night, after cleaning, and keep them in clean water or a cleanser as advised, in a labelled container.
• Clean the gums and tongue with a soft brush or cloth each day.
• Rinse after meals.
• Do not use dentures that are cracked or loose, and avoid homemade adhesives.
• Have them checked regularly; if they are lost in hospital, label them with the name.
• For weight loss and hospital stays, dentures may stop fitting; get them adjusted.

Eating and nutrition

• Choose soft, nutritious foods if chewing is painful: eggs, dal, curd, paneer, fish, soft vegetables, soups, porridge and well-cooked rice; see soft and pureed diets and how much protein do older adults need.
• Do not give up fruit and vegetables; cook, mash or grate them.
• Fluids for dry mouth; see hydration for older adults: how much and how to remember.
• Protein supplements only if advised; see protein powder for older adults: who needs it and how to choose.
• If swallowing is difficult, see swallowing problems (dysphagia) in older adults.

Finding dental care in India

• Family dentist or dental college hospitals often offer lower-cost, thorough care, with supervised students; check availability in your city.
• Government hospitals and some charitable clinics provide basic services.
• Mobile dental units and senior health camps may be organised by local bodies and NGOs.
• Ask about costs in advance, treatment options and phased plans; see care costs in India: budgeting and health insurance for senior citizens in India.
• Tell the dentist about all medicines, especially blood thinners, bone medicines, diabetes and heart conditions; do not stop any medicine before dental work unless the doctor or dentist instructs, and ask the doctor for advice on blood thinners well in advance; see atrial fibrillation and blood thinners: a family guide.
• Mobility problems: ask about ground-floor access, a wheelchair-friendly clinic or a home visit.
• Anxiety: bring a trusted person, ask for breaks, and speak up about pain.

Warning signs

See a dentist or doctor soon for: - A mouth ulcer, red or white patch, or lump lasting more than two to three weeks. - Bleeding gums, loose teeth, bad breath that does not go away. - Pain on chewing, or refusing food. - Swelling of the gum or face, with fever. - Dry mouth that is severe or persistent. - Sore patches under dentures. - Difficulty or pain on swallowing, or a change in voice lasting weeks. - Numbness of the lip or chin.

Call 112 or go to hospital for: swelling of the face or neck that makes breathing or swallowing difficult, a high fever with a swollen face, uncontrolled bleeding after dental work, or sudden chest pain or breathlessness.

When to ask a professional

Ask a dentist for a full check, a hygienist or nurse for mouth care teaching, a doctor to review medicines that cause dry mouth, and a dietician for nutrition. Seek urgent help for emergencies.