Dental Care for the Home-Bound
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.
Geriatric dentistry is not currently recognized as a specialty, but it definitely should be.
Dr. Joy Poskozim’s Dental House Calls Started With Her Grandma
My geriatric house-call dental career started with my grandma. She needed a new lower partial denture but had horrible sciatica going down her right leg, rendering her immobile. As long as she had her public television, her comfy chair, and her hot water bottle underneath her right tush, she was happy as a clam.
My aunts/her daughters cornered me fairly early on in my dental career after I had moved back to my hometown of Chicago from New York, where I had achieved my education, went through a hospital general residency program, and worked in Grammercy Park on the island of Manhattan. I had only recently bought an existing dental practice on the North Side of Chicago. Single, with no other commitments outside of my office, I had no problem going to Gram’s house, where she had chosen to stay in place. Only ten minutes from work, my dental assistant at the time and I went to take impressions and provide the palliative care she needed in order to make her the removable appliance – partial denture – she needed to eat and to smile.
Missing Teeth Can Make A Person Very Self-Conscious
When she talked, one only really saw her lower teeth, which made her self-conscious. She needed her partial by this particular Friday because that Sunday she had a senior ladies guild luncheon at her church, and she wanted to be there whole.
As the story goes, Gram gets rolled in by my Aunt Mary, and the other 120 or so senior women of her church immediately noticed the change in Gram’s smile. “Jeannette, you have new teeth!” To which Gram replied in a loud, clear voice, “Yes, because my daughter Joy Victoria is a dentist who makes house calls.”
Uh, no, I didn’t. Her daughters and I kinda white lied on the “fact” that I did this all the time, and I would simply be adding her to my docket. Gram never wanted to be a burden on anyone, or for anyone to go out of their way for her. Completely lucid until her death, she fortunately never knew that she was my first at-home dental patient.
That day, I got a frantic phone call from my Aunt Mary saying she must have given my work number to at least six families. I shrugged it off, thinking nothing of it, thanking her for doing so, but that it was no big deal. You see, geriatric dentistry wasn’t a thing when I graduated from NYU College of Dentistry in 1999. Now there is a one-week program where senior dental students do a mini-rotation of a local nursing home, providing dental care outside of a dental office. This was 2007.
Geriatric Dentistry Is Not A Specialty, But It Should Be
Geriatric dentistry is still not a specialty, even though it has been brought to the American Dental Association four times, at the writing of this article in 2024.
When the first one called – and they all called for help – I didn’t know what to bring or what to charge. But, I felt if I could at least provide some info and/or knowledge that could help the oral health of their loved one, I could be that dentist.
Since then, I now am the dentist for sixteen nursing homes and go all over Chicagoland to those that have chosen to stay in place.
Those that have chosen to stay in place are living with family members – the sandwich generation – where parents are also taking care of their parent(s).
It’s Important to Know What Medications People Are Taking
It’s Important to Know What Medications People Are TakingI always need to know what medications my patients are on, so I truly appreciate the Directors of Nursing sending me their residents’ Face Sheets that include not only the meds that they are on, but also what they are allergic to, as well as who is the Medical and/or Financial POA (power of attorney).
I look to see if they are allergic to any antibiotics, such as Penicillin/Amoxicillin/Keflex.
I look to see if they are on any blood thinners, such as Eliquis, Heparin, or Warfarin, which can alter the quality of gums – especially when I clean them. This info is also important if I need to remove an infected or mobile tooth. A written conversation needs to be had in the form of a Medical Clearance on how long one needs to be off their blood thinners, and when 
to be put back on. Communication is so important between their prescribing physician that I subscribe to, along with the dispensing nurses at their home, as well as the family, so all are on board for the surgery.
Also, over 85% of medications for chronic conditions cause a condition called dry mouth or xerostomia. Xerostomia is the subjective condition where one feels like they have chronic oral dryness. Dry mouth can occur in the form of poor quality of saliva or poor quantity. It’s the quantity that is most common and which most complain about.
Over-The-Counter Dry Mouth Products Can Really Help
Fortunately, there are plenty of over-the-counter dry mouth products out there that are safe 
and effective – as long as they are being used just like their meds. These products must be utilized consistently and at least daily to have any kind of positive effect. All of them are topicals and will never affect or harm whatever other meds they are taking.
As you can tell from these images, the choices could be overwhelming. Let’s break it down:
Dry Mouth Mouthwashes: Biotene can be swallowed to help lubricate the back of the throat as well as the mouth to help protect the mouth as well as aid in swallowing.
ACT Dry Mouth Mouthwash has Fluoride in it to help keep the teeth healthy as well as to lubricate the mouth, but it must be spit out or it may cause tummy problems.
Mouthwashes should ideally be used after brushing teeth after breakfast and immediately after dinner to avoid sundowning. Rinse, spit, and wall – or roll – away to allow the astringents in them to do their jobs. I recommend drinking or rinsing with water first and 
then using the mouthwash to help keep the water/moisture in the mouth for as long as possible.
The Oral Sprays Are Also Beneficial
The oral sprays are also very beneficial for those who are too afraid to drink water – and then have to pee 20 minutes later – especially in the middle of the night. I recommend keeping them on their bedside table to use when the head hits the pillow and then again immediately upon waking. The great thing about all of these OTC products is that you can’t OD on them. The more often they are used, the better they work. The sprays are great to travel with and to carry in a purse. Before meals are wonderful to help with swallowing.
The oral tablets are thought to be more long-lasting. I don’t have a lot of patients who use them, but they are there for a reason. I always include them as a possible adjunct to help 
control dry mouth and bad breath.
Dry mouth gum made by ACT is great, but can only be used for those who don’t have dentures. If not, then chewing gum helps to prevent cavities since it tricks the salivary glands that one is eating, therefore stimulating more saliva production. Studies have shown that those who chew gum, especially after meals for about twenty minutes, greatly reduce the possibility of dental decay.
For those who cannot chew gum, I recommend the dry mouth lozenges. Lozenges also trick the major salivary glands to produce saliva when being sucked on. The more often, the better. And, these are sugar-free, so they are not like regular store-bought candies.
Finally, I recommend Dr. John’s Candies for all nursing home Activity Directors. I get frustrated when I see store-bought candies used for Bingo prizes. Bad for our diabetics, bad for all of our teeth.
Dr. John is a retired dentist based in Michigan whose daughter is Type I Diabetic. As such, she could not eat the candies her friends could, so her dad created this business to make healthy sweets. I have tried them all and they are amazing. Here is his website: Dr. John’s Healthy Sweets | Delicious Sugar Free Xylitol Candy & More (drjohns.com)
His lollipops were the first candy as they were his daughter’s favorite. They are great to suck on to help produce saliva as well as the ones aforementioned.
NOTE: I HAVE NO AFFILIATIONS WITH ANY OF THE PRODUCTS DESCRIBED
Questions/concerns/comments? Never hesitate to contact Dr. Joy Poskozim!
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.
