The same general advice as described for adults applies equally to older people. With some extra considerations as described below. As with adults the main problem is dental plaque and how it affects the teeth and gums. Dental plaque is a soft layer, composed mainly of bacteria, which forms on the teeth and is present in all mouths. Plaque will also form on dentures. There are a number of diseases that affect the gums and the surrounding tissues that support the teeth, but by far the most common are gingivitis and chronic periodontal disease.
Without adequate personal oral care, a second stage of gum disease, termed periodontitis can occur. In this stage, which can begin as early as adolescence, the tissues that support the teeth are progressively destroyed. The rate of destruction can vary greatly between and within individuals. This may lead eventually to loosening and finally loss of the tooth, although the process can be slowed by a combination of personal mouth care and professional treatment. To prevent gingivitis proceeding into periodontitis, effective plaque control must be achieved. This must be considered at two levels – what people can do for themselves on a daily basis, and what dentists and hygienists/therapists can do to eliminate plaque retention factors and to advise the individual on the most appropriate home care. The most important plaque control method is effective tooth brushing with a fluoride toothpaste. The precise technique is less important than the result, which is that plaque is removed effectively and daily without causing damage to teeth or gums. Gums should be cleaned with a tooth brush even if there are no teeth present. The roof of the mouth, the gum ridges and tongue should be cleaned daily with a soft brush to remove any food particles and plaque.
Older people can get decay on the roots of their teeth. This is called root caries (root decay). It is more common in older adults due to the presence of periodontal disease which can result in gum recession. Caries may then develop on the exposed root surfaces. This is often made worse by reduced salivary flow and difficulty in maintaining good plaque control, especially around lower front teeth. To keep teeth healthy people need to reduce their consumption and especially the frequency of intake of sugary foods and drinks or those with added sugar. Sugary foods and drinks should be consumed as part of a meal rather than between meals. Snacks and drinks should be free of added sugars wherever possible.
Denture wearers should use a small, soft brush and a denture cleaning paste or liquid soap to clean all denture surfaces before rinsing the denture and placing it in a hypochlorite-based soaking solution of the Steredent type. Hypochlorite is bactericidal and fungicidal and helps to break down the plaque that forms on dentures. Hypochlorite is not suitable for metal based dentures for which special soaking solutions containing alkaline peroxide are available. After soaking in either solution, the dentures should be rinsed and left in a container of water for safekeeping. With all cleaning and soaking agents, manufacturer’s instructions should be carefully followed. Ideally all dentures should be removed before sleeping to allow the soft tissues of the mouth to recover from the day’s denture use and to remove the risk of injury or Candida infection (thrush). Where this is not practical, they should be removed for at least four hours during the day.
You should visit a dentist at least once a year whether or not you have your own teeth. The period between oral examinations must be flexible and based on a professional assessment of the risk from oral disease. This period can be extended for adults with no evidence of dental disease, which are in good health and do not use tobacco and have a low and infrequent sugar and alcohol consumption. Dentists can provide a domiciliary (home visit) service to housebound clients. These should be arranged between patient/carer and their dentist.
Dental practices can take both NHS and/or Private patients. It is important when trying to find a dentist that you find out if the Practice is accepting NHS patients before joining or starting a course of treatment. NHS treatment is free to those who are eligible. If you feel you are eligible for free NHS treatment please check the NHS Choices website www.nhs.uk for details of eligibility.