We are delighted to have a guest blogger this month. Dr. Joy Poskozim has been making dental house calls for over ten years all over Chicagoland and Cook County.
Enjoy her article on CAREGIVING + ORAL CARE = A HAPPY MOUTH.
A home-bound patient’s daughter wanted me to make her mother a new denture. “My boys can’t stand to look at their grandma without teeth, and I want them to have a relationship with her.”
Maria had lost her last denture. Her family realized it was gone when they asked her caregiver to put her denture in for Sunday family dinner. They didn’t know Maria had taken it out at some point during the week and the caregiver had yet to find it. Taking care of Maria had its challenges. She had Alzheimer’s, was nonverbal, and was also diabetic. These medical conditions made it difficult to create a menu that was nutritious as well as easy to chew; healthy, but also low in carbohydrates and sugar. Her diet options would definitely increase with a full complement of teeth.
I examined Maria. She had a pleasant smile on her face, allowing me to see her entire mouth, lower teeth, and her tongue, which she easily stuck out for me upon command. She had minor dry mouth, a side effect of the medications she was taking. In fact, 85% of all medications for chronic conditions have dry mouth as a side effect, worsening the longer these medications are taken. Fortunately the caregiver and family were already on it, making sure she drank water from her sippy cup on a regular basis and with meals. I recommended adding an OTC dry mouth rinse that was pH neutral so it was swallowable, just in case she forgot she wasn’t drinking water. Dry mouth rinses/lozenges/sprays are great before meals to help with swallowing. I also encouraged using the dry mouth rinse at two important times of the day: before bed and when she woke. Before bed to help keep her saliva in her mouth and not evaporate, and then again as soon as she got up to jump-start her saliva production in the morning.
I then cleaned her lower teeth, noticing that she did not know what to do with her toothbrush at the end. Even with prompts, Maria would not put her toothbrush to her mouth to brush her teeth. This was discussed with the family and the caregiver, as I showed them how to brush her lower teeth. Teethbrushing seniors is exactly the same way we should brush our teeth: imagine the toothbrush cut in half length-wise. Half the toothbrush goes on the gums, half on the teeth. So we want to raise our toothbrushing higher for our upper teeth, dropping the brush for our lower ones. Why? All oral bacteria that causes gum disease (and tooth mobility and gum swelling and recession) live at the gumline between the teeth and the gums. Toothbrushing disrupts where they live, not allowing them to grow/multiply/divide/increase inflammation/decrease plaque. I also explained dry mouth + plaque (tartar) production = bad breath. Bad breath is a great sign for oral health neglect. The better and longer the brushing, the healthier our mouths. In fact, the American Dental Association trademarked “Two Minutes Two Times A Day” for how often we should be brushing our teeth. The average American only brushes for 42 seconds on average. As Maria’s disease moved along, it would become more difficult to brush her teeth for two minutes, which is why it was so important to put this method into place now while the caregiver and family still could.
Making a denture takes about five appointments, at which Maria was incredibly docile and helpful. I had noticed at about the third appointment that her mouth did not seem as dry as before. Sometimes the OTC dry mouth products do not work, so one has to be prescribed. The prescription saliva substitutes do not have generics since they are all still so new, so they get to be expensive. I also noticed the gum margins around her teeth were not as red or puffy, nor did she have any bad breath.
By the fifth and last appointment, Maria’s daughter and caregiver were there to watch me insert her new upper denture. It fit beautifully. Maria smiled and laughed in response to them applauding Maria’s smile. She then got up and started to walk around the living room. All three of us watched her as she saw balloons that were from Maria’s daughter’s birthday party. Maria instantly took out her upper denture, put it on the table, pick up the balloons, and brought them to me. “What just happened?” the caregiver asked. “Maria is offering me payment for her new denture. You will have to make sure she keeps it in during the day. I may need to come back to adjust the denture if she refuses to put them in. It may be her way of telling you that it hurts. There will probably be some kind of redness or sore showing me where to adjust. There is a topical medicine to help as well.” Both of them just nodded.
Maria was fortunate to have a family and full-time caregiver so willing and eager to help Maria with her mouth. They understood the need for oral care in order for Maria to thrive. Unfortunately, if they had dismissed the idea of getting her a new denture, they may also have missed the fact that she had plaque buildup, potentially causing severe dry mouth and an extreme possibility of additional tooth loss. The more teeth we have the better chance we have of surviving and thriving, due to a variety of foods that are so important in all human diets, no matter the age. Pureed foods are obviously necessary for those who can no longer swallow or have the capacity to chew. There are even cookbooks for pureed foods now! But there are plenty of studies that show the more teeth we have, the longer we live.
The bacteria that causes gingivitis -- porphyromonas gingivalis – has been shown to grow in plaque deposits in the brains of Alzheimer’s patients. More than half of bacteria that causes bacterial pneumonia is oral bacteria. The better we treat our and our loved ones’ mouths, the better we all live. Here’s to smiling!
Dr. Joy Poskozim has been making dental house calls for over ten years all over Chicagoland and Cook County. From oral hygiene visits to extractions – and everything in between – please contact Dr. Joy at (773) 736-7767 or www.joyfuldentalcare.com for all oral care needs.
If you or an aging loved one are considering Caregiver Services in Skokie IL, contact the caring staff at Gentle Home Services. Call today (800) 860-9823.