Best Oral Care Products As We Age
Submitted by Dr. Joy Poskozim DDS FSCD CDP
Founder of Joyful Dental Care – House Calls, Advocate, & Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
Having provided oral care for the geriatric community for over fifteen years, Joy understands medical conditions – and the subsequent issues revolving around them – supersede oral care.
As our bodies change, so do our reactions to what we are using to keep our bodies clean and healthy. This includes oral hygiene products.
Do we really need to bother with different toothpastes or mouthwashes as we get older?
For some, no. Using the same type of mouthwash that their parents used and what their kids are using now works and it is what they are used to. Why rock the boat? For most, however, as our bodies change, so do our reactions to what we are using to keep them clean and healthy. This includes oral hygiene products. Certain body parts start to slow down, or even dry up, unfortunately. Our salivary glands are a good example of this. We have three major salivary glands in our mouths: one on the upper right between our first molar when we got at 6ish and our inner cheeks; one on the upper left same place, and one below our tongues. We also have minor salivary glands throughout our mouths, but they don’t matter much as we age. It’s our major salivary glands that we have to worry about. Why?
Let’s learn what our saliva does for us:
- Helps lubricate our tongues to speak
- Helps lubricate our mouths to break down foods and swallow
- Helps keep bacteria and other microorganisms from sticking to our teeth, causing cavities and/or gingivitis.
As we age, all glands begin to slow down, and our salivary glands are no different. Some begin to produce the same amount of saliva, but it begins to get thicker and ropey. Others make the same quality of saliva (thin and clear), but the quantity is reduced. Either way, our mouths begin to suffer from this, either by feeling dry, or acquiring bad breath, or not being able to chew and/or swallow foods we used to be able to do all the time when we were younger. The biggest culprits are sticky, chewy foods like peanut butter, caramels, and dried fruits.
As our mouths become dryer, alcohol-based mouthwashes may start to feel too strong to be used. I have found some of my older patients will continue to use the mouthwash (because they truly don’t know that others can be different) and start to dilute the one they are using to taste and feel better.
Our mouths also can become dryer from the more medications we begin to take.
Our mouths also can become dryer from the more medications we begin to take.Approximately 85% of all medications taken for chronic conditions like high blood pressure, diabetes, and COPD can cause dry mouth the longer being taken and as the dosages are raised. Alcohol is a drying agent, which can perpetuate the dryness feeling. “Alcohol-free” mouthwashes use hydrogen peroxide as their base, thereby feeling gentler to teeth and gums. When one of my patients is on the market looking for a new mouthwash, I always recommend an alcohol-free mouthwash, regardless of age.
Going even further, some people start to have a difficult time swallowing.
My mom did because after she fell and broke her leg she was too nervous to get up to even go to the bathroom. How to prevent the need to go to the bathroom? Stop drinking water! Her swallowing muscles stopped working because she was not consuming enough to keep them in good working order. Those living with any of the dementias also start to have a hard time swallowing as well.
I have only found two mouthwashes Over The Counter that are safe to consume
I have only found two types of mouthwash Over The Counter that are safe to consume if your loved ones no longer follow the directions to spit out mouthwash: Dr. Brite and Biotene. There are several dry-mouth mouthwashes on the market, and they are all good. It really comes down to which one they think tastes the best. The most important thing is consistency. All mouthwashes should be used twice daily after brushing. They are wonderful astringents but also need time to permeate the gums and teeth. So, I always recommend rinsing, spitting, and then walking away. Do not rinse with water after.
By the way, ALL Biotene products are swallowable. They are pH neutral so will not hurt the tummy. These include their toothpaste, spray, and gel.
Those things in the image between the toothbrushes? Tongue scrapers!
Those things in the image between the toothbrushes? Tongue scrapers!Some people swear by tongue scrapers, but as we get older, our tongues can become dryer, making these scrapers sometimes a little hard to use.
I recommend using a separate soft toothbrush to brush the tongue daily, and in only one direction: back to front. We don’t want to push food particles and other things we can’t see further down in between our tastebuds. Also, it is better to use a toothbrush for our tongues when wet, either with water or with a mouthwash of your choice. That being said, if you choose to use a mouthwash, it’s better to spit it out and walk away than to rinse it out with water.
Ah, yes, I am constantly being asked which toothbrush to use.
Ah, yes, I am constantly being asked which toothbrush to use.And my answer is: SOFT! I don’t care what the bristles are made of: bamboo or nylon; or the shape of them: curved or flat; as long as it is being used twice daily after meals for TWO MINUTES! This is what the American Dental Association recommends in order to hit every tooth and every tooth’s surface the most effectively. However, if you are using a medium toothbrush and you like the feeling of a harder bristle, then an electric toothbrush is the way to go. The bristles are soft, but because they are motorized, they give the impression of being harder.
I also recommend electric toothbrushes that are in the shape of a manual toothbrush as they can cover more surface area and are more user-friendly than spin brushes. When I was in dental school over 25 years ago, we were taught brushing with the manual toothbrush got rid of 70% of the gunk, and flossing got rid of the other 30%. With the advent of the electric toothbrush, these types of brushes get rid of 85% of the gunk, and floss 15%. Needless to say, we still need to floss our teeth….
Unfortunately, those living with one of the dementias begin to not only become apathetic to brushing their teeth but also become intolerant of toothbrush vibrations. Moving back to a soft, or an ultrasoft brush can be more comforting, even if only the front of the teeth can be brushed. Something is better than nothing.
Bottom line: change the brush (or electric brush head) every three months.
I change my brush head and the batteries of my electric brush at the same time. AND toothbrushes should be kept at least 6 feet away from the toilet. What we have also learned post-COVID is to change ALL toothbrushes when someone is sick in the house, not just for the sick person. This is simply safer to do to prevent the continuation of infection, as well as cross-contamination in the bathrooms. This last part is kinda hard to do when living in a community, and keeping a toothbrush in a drawer may create an “out of sight, out of mind” condition if not being reminded to brush.
As a caregiver, putting a toothbrush “away” doesn’t necessarily mean they don’t want to brush anymore. As a family member, please remind the caregivers where you have put the toothbrush and toothpaste in order that they will do so.
Flossing teeth
Flossing teethFlossing teeth – either with traditional waxed floss or the pre-strung floss – is crucial for all gums. Remember the old expression, “Only floss the teeth you want to keep”? Still holds true today. There is no toothbrush that has bristles that can get between the teeth to get rid of bacteria that cause cavities in between teeth. A lot of the older population never truly grasped the need to floss, and, as such, have partial dentures and complete dentures to prove it.
Women are 5 times more likely than men to lose teeth in their lifetimes, and lose oral bone (jawlines) at a 20% faster rate. Both percentages are usually pre, peri, and post menopause, but the sooner we start on a regular basis, the longer we will keep our healthy smiles intact.
Back in the day, floss really didn’t exist, and the harder the toothbrush bristle the better.
We didn’t know what we didn’t know! Not only can harder toothbrushes cause toothbrush abrasion, where the tooth enamel has worn down over time, but also hypersensitive gums due to gums receding away from the teeth, exposing more of the root.
Toothpaste for sensitive teeth are not a marketing ploy – the American Dental Association AND the FDA are our watchdogs. They actually have a buffer in their ingredients – an added salt – to raise the pH of the toothpaste to be more neutral/less acidic.
Once again, when I was in school, we learned that the negative fluoride ions bonded to the positive calcium ions in our teeth, preventing bacteria from penetrating them and causing cavities (bacterial infections).
Now we also know that fluoride also prevents the leaching out of micronutrients in our teeth: magnesium, manganese, etc., keeping our teeth mineralized. All toothpastes mineralize our teeth, not just the ones that say so on the tube.
The last oral care product to discuss is the almighty waterflosser.
Yes, they are amazing in helping prevent plaque buildup. Over time, though, they may collect more and more dust.
As a geriatric house-call dentist, I am more concerned about brushing and mouthwashing. I want to make sure we are mechanically getting rid of the plaque/tartar/calculus that causes tooth loss with a product that covers the most surface area as possible.
Waterflossers are very technique-sensitive and can be quite messy. I personally like the ones that are waterproof that can be used in the shower.
Questions/concerns/comments? Never hesitate to reach out to me!
Submitted by Dr. Joy Poskozim DDS FSCD CDP
Founder of Joyful Dental Care – House Calls, Advocate, &Presenter
Geriatric House Call Dentist for over 15 years, Dr. Joy Poskozim speaks to Long-term Care Facility Administrators, Nursing Staff, Caregivers, and loved ones on the importance of oral health care as we age. Her goal is to share as much dental information as possible, thereby making it easier to communicate to traveling dentists on what oral health problems residents may have.
