Practice question

Why is oral hygiene important to older people’s health?

Research shows poor oral health in older people can cause a range of health problems.

If the oral health problems of older people are left undetected or untreated, their physical, psychological and social health can deteriorate (Public Health England (PHE) 2015).

cleaning teeth
Good oral hygiene can prevent older people from experiencing a variety of health issues. Photo: iStock

Improving older people’s oral health is essential to active ageing (World Health Organization (WHO) 2002), but living with one or more long-term conditions results in higher rates of severe dental caries, periodontal (gum) disease and untreated oral pain (National Audit Office 2014).

Malnutrition risk

Physical problems affecting dexterity and mobility make self-care difficult and older people are more likely to have tooth loss, adversely affecting dental function. Research shows 75%-95% of older patients are unable to eat properly (Peltola et al 2005) and the resulting malnutrition can increase risk of infection, falls and pressure ulcers.

Despite these risks to health, improving/maintaining oral care is a low nursing priority and nurses lack the knowledge to provide evidence-based interventions (Preston et al 2006).

Oral health and oral hygiene are not the same. Oral health is freedom from mouth and facial pain, periodontal disease and disorders that affect the oral cavity. Oral hygiene is the practice of keeping the mouth and teeth clean to prevent the onset of dental problems (WHO 2002).

Top tools for teeth

Oral health is improved by effective oral hygiene and making oral healthcare a nursing priority. Interventions such as using a soft, small-headed toothbrush to access all areas of the mouth or to remove plaque from the gums of edentulous patients are effective if carried out over at least 3 minutes.

Powered toothbrushes increase the effectiveness of teeth cleaning as more plaque is removed than by manual toothbrushes. They are also easier for some older people to use independently (Robinson et al 2005, Sharma et al 2005).

Foam swabs are not effective in reducing plaque (Rawlins and Trueman 2001) and their use has been discontinued in several clinical areas because of choking risks. Additional aids include artificial saliva and mouth washes, modified brush handles and floss brushes for people with poor dexterity.

Referral and assessment

Good oral hygiene is the first step to good oral health, but without an oral health assessment there is incomplete information about required interventions. A responsive, integrated and person-centred approach to dental care for older people requires timely referral (PHE 2015) and nurses must develop robust screening and assessment practices for older people in diverse care situations. Areas for assessment include:

  • Personal perception of oral health.
  • Oral mucosa, gums, lips and saliva.
  • Swallow and voice.
  • Dexterity and self-care ability.
  • Cognition and physical health.
  • Tooth health and prosthetics.
  • Dentures – appearance and fit.
  • Medication.

Oral hygiene is vital to maintaining general health. Nurses should prioritise assessment and support person-centred planning for oral health. They must be prepared to improve their knowledge of dental-related conditions and use effective treatment interventions in all settings.


References

National Audit Office (2014) Adult Social Care in England: Overview. www.nao.org.uk/wp-content/uploads/2015/03/Adult-social-care-in-England-overview.pdf (Last accessed: 13 September 2016.)

Peltola P, Vehkalahti M, Simoila R (2005) Oral health-related well-being of the long-term hospitalised elderly. Gerodontology. 22, 1, 17-23.

Preston A, Kearns A, Barber M et al (2006) The knowledge of healthcare professionals regarding elderly persons’ oral care. British Dental Journal. 201, 5, 293-295.

Public Health England (2015) What is Known About the Oral Health of Older People in England and Wales. PHE, London.

Rawlins C, Trueman I (2001) Effective mouth care for seriously ill patients. Professional Nurse. 16, 4, 1025-1028.

Robinson P, Deacon S, Deery C et al (2005) Manual versus powered toothbrushing for oral health. Cochrane Database of Systematic Reviews. Issue 2.

Sharma N, Goyal C, Qaqish J et al (2005) Single-use plaque removal efficacy of three power toothbrushes. Journal of Dentistry. 33, Suppl 1, S11-S15.

World Health Organization (2002) Active Ageing: A Policy Framework. http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf (Last accessed: 13 September 2016.)


Lindsay Dingwall is a clinical academic nurse consultant (older people) at Ninewells Hospital in Dundee

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