Singaporeans are not taking care of their teeth according to a survey and this could spell problems in later years

Singaporeans are not doing a good job in caring for their teeth, according to nine in 10 dentists surveyed by oral care brand Listerine. This includes regular and proper brushing, flossing and rinsing with a mouthwash, in between regular dental check-ups. This may lead to declining general health and quality of life in later years.

The survey findings also found that 84 percent of dentists who participated in the survey said that seniors (aged 55 years and above) require the most attention in dental care and also they are the ones most susceptible to oral problems. For instance, seniors, who suffer from diseases like Parkinson’s disease, visual impairment and respiratory disease, are also most likely to suffer oral problems such as periodontal disease, dental caries/tooth decay and gingival bleeding. This could be partly due to neglect of proper oral hygiene as a result of their illness.

Agelessonline queries Dr Kuan Chee Keong, a dentist in private practice and who serves as the acting honorary general secretary of the Singapore Dental Association (SDA), to find out about some common oral problems affecting seniors and how to prevent them:

What kinds of common oral problems do seniors face?

Some of the common oral problems among seniors are loss of teeth (and thus loss of function), increasing incidence of root caries (decay that forms on the root surfaces of the teeth), and wear and tear of dental surfaces at coronal (these are surfaces above the gumline where the toothbrush bristles come into contact) as well as root surfaces, which result in sensitivity.

Seniors are also more likely to experience difficulty in cleaning due to decreasing dexterity or physical impairment, and are more prone to opportunistic infection like fungal or periodontal infection due to systemic diseases (that affects the body as a whole). Another common oral problem among seniors is a decrease in salivary output due to systemic diseases.

So sensitivity to both hot and cold is a common problem for seniors? What is the cause and treatment?

Yes, sensitivity to hot and cold is a common problem for seniors. There are several reasons for this. The sensitivity among seniors is usually caused by natural gingival recession due to ageing, attrition of the enamel due to eating and grinding, abrasion of enamel and dentine due to brushing improperly and too vigorously, pathologies like cavities and fractures, and erosion of enamel and dentine due to acidic food and beverage.

Drinking carbonated drinks or juices using a straw is a good way to minimise acid erosion. For tea and coffee, there is not much acid erosion problem as compared to external staining. Rinsing after any drinks or food is definitely a good idea even just simply rinsing with plain tap water. The practicality of such an advice is another matter.

Treatment will depend on the cause of sensitivity. A complete mouthwash with active ingredients such as essential oils can help to keep germs in check, as well as zinc chloride to prevent tartar buildup and sodium fluoride to strengthen teeth against cavities. This will greatly reduce the incidences of plaque, tartar, cavities and gingivitis, and prevent leading oral diseases as well as other health problems that may be caused by oral bacteria.

Are seniors more at risk of oral cancer?

No, there is no evidence to support this.

So is age in and of itself a dominant or sole factor in determining oral health?

No. Oral health is dependent on oral hygiene habits. A regular holistic oral care regime consisting of proper brushing, flossing and rinsing with a complete mouthwash, and regular dental check-ups, will help to promote good oral health. This will then reduce the incidences of plaque, tartar, cavities and gingivitis, and prevent leading oral diseases as well as other health problems that may be caused by oral bacteria.

Since certain conditions like arthritis in the hands and fingers can make brushing and flossing difficult and hence gum disease and tooth loss, or even mild dementia, what advice would you give those suffering from those conditions? 

For patients with physical and mental impairment whereby self-cleansing is impossible, it is important to instruct their caregivers. Patients who are physically, not mentally impaired should try using an electric toothbrush, interdental toothbrush, a flossing aid and a complete mouthwash with active ingredients such as essential oils, zinc chloride and sodium fluoride. They should also visit their dentists more regularly, about every two to three months every year.

Can medications also affect oral health? Such as what?

Almost 80 percent of the most commonly prescribed medications lead to a dry mouth. Saliva helps to maintain the health of the soft and hard tissues by removing waste products and providing disease-fighting substances throughout the mouth, offering first line protection against microbial invasion or growth that might lead to disease.

Oral bisphosphonates are given to treat osteoporosis. There is a link to an uncommon complication called osteonecrosis of the jaw, which is a rare but potentially serious condition that can cause severe destruction of the jawbone. However, given the risks associated with osteoporosis and the proven benefits of oral bisphosphonate therapy, patients are advised not to stop taking these medications before discussing the matter fully with their physician.

Can you share some oral hygiene tips for seniors? How often should they visit a dentist?

Seniors should follow a regular holistic oral regime, consisting of proper brushing, flossing, and rinsing with a good antiseptic mouthwash, combined with regular visits to the dentist every six months (more frequent if oral care is poorer). A good mouthwash is particularly important for seniors as some of them may not be able to brush or floss properly as they tend to lose teeth as they age.

Again look for mouthwashes with active ingredients such as essential oils, zinc chloride and sodium fluoride.

How do you choose the right floss or toothpaste? Is whitening toothpaste a solution?

All floss and toothpaste sold in Singapore except those by grey importers are generally effective. Choosing a reputable manufacturer and those with endorsement such as the SDA Seal or ADA (American Dental Association) Seal would be best.

In my opinion, whitening toothpaste is not an effective method of bleaching. Whitening is a cosmetic treatment and the most effective (relatively speaking) is bleaching using hydrogen peroxide. I am not aware of effective bleaching using toothpaste, so I don’t advocate bleaching. [However in saying this] I would not suggest bleaching for seniors.

Can you explain denture-induced stomatitis? So how can seniors prevent such a problem or what is the proper care for dentures?

Dentures ought to be re-based or re-lined, or completely changed with time. Otherwise ill-fitting dentures can cause stomatitis, which is when the area under the upper denture becomes inflamed or swollen. Other causes include lack of maintenance like cleaning the dentures regularly, and prolonged wearing of dentures, which can cause infection of the soft tissue.

Changing ill-fitting or old dentures, and cleaning dentures regularly can prevent stomatitis. You can soak them in water or denture cleanser and this will keep infections at bay.

If a senior has problems chewing and swallowing certain foods, what advice can you give her?

See a dentist to diagnose the cause of this problem. It could be due to a variety of reasons, including a lack of saliva, ill-fitting dentures or dental caries. I can’t stress enough – to improve oral health, seniors should follow a regular holistic oral regime, consisting of proper brushing, flossing and rinsing with a good antiseptic mouthwash, combined with regular visits to the dentist.

(PHOTO CREDITS: TOOTH PASTE 02 © Rewat Wannasuk | Dreamstime.com and Listerine)

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