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Q: Dad, who has had several small strokes, seems to need a lot of help with many things. I noticed he doesn’t brush his teeth much and they look neglected. Should I bother with this or let them be?
A: Oral health is an important part of all our overall health needs and if not properly maintained, can end up causing a lot of pain and discomfort and affect our speaking ability, chewing, swallowing and digestion. These problems can arise from certain medical conditions or from age-related changes.
Oral health can also impact your dad’s nutrition, interpersonal relationships and sense of self-esteem.
A person with missing teeth, ill-fitting dentures, cavities or gum disease may not be able to eat the diet necessary for their well-being. They are usually unable to manage raw vegetables, salads and many fresh fruits. This may result in poor nutritional intake.
Many older adults often take a variety of medications. It is not unusual that some of these may have negative effects on teeth and oral health. Medications that treat blood pressure, diabetes and depression as well as cholesterol can result in reduced saliva production and a dry mouth. This, too, can affect chewing, speaking and swallowing and increases the risk of cavities.
A dental visit is important to evaluate the gums, teeth and soft tissues and to ensure that other health issues are detected. It is also helpful to make sure that the dentist can provide instruction on how to handle care at home. It is still critical to have a dental checkup at least once a year.
Your dad has had strokes which can also affect his ability to manage his oral needs. Some individuals with strokes, dementia and other cognitive issues have difficulty with “how to use a brush.” This can be due to a condition called “apraxia,” whereby the brain cannot perform or co-ordinate the complex motor components to do the activity, even though the ability to move is present.
Other individuals may also not remember to brush regularly since they are forgetful. Putting your hand over dad’s hand and guiding him with the movement may be all that is needed to get him to brush. Sometimes just putting the brush in his hand may help him do this activity more easily, as he will automatically start to use it properly.
Use a soft brush and do the best you can to have dad remove as much plaque and food matter as possible. You can also try brushing with a bowl and brush while seated if that helps. Dr. Bonnie Chandler explains: “If he is not effective in brushing, a caregiver should be brushing and flossing for him. Flossing wands are easier to use than regular floss.
Some people are resistant at some times of the day, so experiment with another time. Time of day is not as critical as actually doing it.
Talk to your dentist about mouth swabs and rinses that can help reduce bacteria. Keeping dentures clean by brushing them well can help limit the risk of infection. Have the dentist check the fit of prostheses, as weight changes can affect fit and comfort and as a result, function.
Perform regular mouth checks and see if anything out of the ordinary is noted (e.g. lumps, colour changes or sores.) Make an appointment to check any irregularity you find.
Some cognitively impaired individuals are not able to reliably tell you if they have pain, so a regular checkup with a dentist who understands these issues is key.
Although it is yet another caregiver responsibility, taking care of oral health is indeed an investment in your dad’s overall health.
This article was written by Nira Rittenberg for Toronto Star
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