Dental Care for Older People: A Guide for Families and Carers

What are the most common mouth problems in older people?

Ageing alone does not mean losing teeth, but some changes make the mouth more prone to problems:

• Root decay: as the gums recede, the roots become exposed. They are softer than enamel and decay faster.
• Dry mouth: often caused by multiple medicines, it increases decay and makes wearing dentures and swallowing harder.
• Gum disease: which can lead to loose and lost teeth, and is linked to harder-to-control diabetes.
• Denture problems: sores from loose dentures, and fungal infections under dentures worn at night.
• Worn teeth and broken old fillings.
• Changes in the tissues of the mouth that need checking, especially in smokers.

How can you help an older person clean their teeth?

First encourage them to do as much as they can themselves, and step in only where help is needed. Practical ideas:

• An electric toothbrush or a brush with a thick handle makes brushing easier for people with weak hands or stiff joints.
• Use a fluoride toothpaste twice a day; the dentist may prescribe a higher-strength toothpaste for those with recurring root decay.
• Small interdental brushes are often easier than floss for older people.
• If you help with brushing, stand behind or beside them while they sit, support the head gently, and use good lighting.
• Offer water regularly, and cut down on sweets and sugary drinks between meals, especially sweetened tea throughout the day.

How do you care for dentures?

Dentures need daily cleaning just like natural teeth, because plaque and fungi build up on them:

• Remove the denture after meals and rinse it, and clean it daily with a denture brush and denture cleaner rather than abrasive toothpaste.
• Clean the gums, tongue and any remaining teeth with a soft brush.
• Take the denture out at night to rest the gums, unless the dentist advises otherwise, and keep it in water or a special solution so it does not dry out.
• Do not use hot water or bleach, which can warp or discolour the denture.
• Clean it over a basin of water or a towel so it does not break if dropped.
• A loose denture or one that causes sores needs adjusting by the dentist, not fixing with home glue.

Special tips for caring for older people with dementia

With dementia, a person may forget how to clean their teeth, or refuse help because they do not understand what is happening. Patience and routine are the most important tools. Clean the teeth at the same time and place every day, give short step-by-step instructions, or place your hand over theirs and guide it gently. It can help to brush your own teeth in front of them so they copy you, or to give them a brush to hold while you use another.

If they refuse or become upset, stop and try again a little later rather than insisting. Watch for indirect signs of pain, since a person with dementia may not be able to describe it: refusing food or chewing on one side, touching the face or jaw often, increased agitation, or repeatedly removing the denture. It helps to have the mouth checked in the early stages of dementia, to treat problems before cooperation becomes harder.

Why do regular check-ups matter in older age?

Even someone with no natural teeth needs regular check-ups to assess the fit of the denture and the health of the gums and mouth tissues. The dentist sets the right interval between visits for each case. Bring the full medication list and any reports on chronic conditions, and tell the dentist about blood thinners or osteoporosis medicines, as these affect the planning of some procedures.

Research also suggests that good oral care in frail and bed-bound older people may reduce the risk of chest infections caused by inhaling mouth bacteria. So cleaning the mouth is part of daily health care, not a cosmetic extra.