Tremendous Teeth

Do you remember a time before you started to brush your teeth?

Do you remember your first toothbrush?

Did you have a favorite toothbrush?  Was it your favorite color or superhero?

Now, can you remember a time when you did not brush your teeth?

Has toothbrushing ever not been a part of your daily routine; not been a priority for your overall health and well-being?

My grandmothers were fortunate.   One was cared for daily by her youngest daughter with a full-time caregiver.  My other grandmother was witty and independent until the day she died.  But what about your aging parents or grandparents?  Did one live with you or is currently living with you?  And, if not, could you say for certain your loved ones’ teeth were being brushed daily, let alone twice daily?

For those who have chosen to stay at home or are living in a senior housing community of one type or another, ADL’s, or Activities of Daily Living are the base standards of self-care.  The term was created in the 1950s and is now used by  health professionals to determine a person’s ability or inability to perform certain criteria as a measurement of their functional status, particularly in regard to  after having suffered an injury, with disabilities and the elderly.

Basic ADLs consist of self-care tasks that include:

• Bathing and showering
• Personal hygiene and grooming (including brushing/combing/styling hair)
• Dressing
• Toilet hygiene (getting to the toilet, cleaning oneself, and getting back up)
• Functional mobility, often referred to as “transferring”, as measured by the ability to walk, get in and out of bed, and get into and out of a chair; the broader definition (moving from one place to another while performing activities) is useful for people with different physical abilities who are still able to get around independently.
• Self-feeding (not including cooking or chewing and swallowing)

As a dentist, I find the fact that oral hygiene (including brushing and flossing one’s teeth), and (not including…chewing and swallowing) not to be considered basic abilities to be alarming.  Chewing and swallowing are considered in the medical sense as unconscious acts.  Caregivers feed our elders when needed, but brushing their teeth after breakfast and before bedtime?  Unfortunately, oral care is not generally considered a need in even the nicest of communities I provide care.

So what exactly are we doing when we brush our teeth, and why is it so important?

We are brushing off plaque:  bacteria, bacterial waste, and excess food stuffs that do not get digested by our saliva.  Oral bacteria, otherwise known to our school-aged children, as “sugar bugs”, thrive on carbohydrates.  Carbohydrates start getting digested in the mouth, so that by the time they reach our stomachs, we get that almost-immediate energy boost.

Unfortunately, saliva has not kept up with our modern diets, so processed foods do not get broken down as well as simple carbs found in fruits and vegetables.  These food stuffs will tend to stick on and around our teeth.  If left long enough, bacteria will help to eat them, creating acidic waste like acid rain on our teeth, eroding enamel and inflaming gums.

Ever spilled orange juice?  An orange sticky coating immediately covers the countertop.  Imagine that sticky coating on our teeth.  Our oral bacteria will gravitate to our teeth, but will not stop at the sugary level.  They will continue to find a way to burrow into our teeth and homes for themselves, aka dental cavities.

Now imagine being on a medication for a chronic condition that causes dry mouth.  86% of medications taken long-term have dry mouth has a side effect.  And, as one continues the medication, the side effect gets worse.  Maybe it starts as generating poor quality saliva that is roapy, thick, and viscous.  Then, over time, the salivary glands stop making enough saliva to swallow or talk.  If we cannot swallow, we cannot eat.

The less saliva we have, the more opportunistic our oral bacteria become and the higher the chances for new dental decay.  Seniors’ teeth tend to have smaller nerves in their teeth so toothaches may not occur so the decay progresses.  “All of a sudden” a tooth breaks at the gumline and no one knows why.  The process of tooth decay can take months to years before this happens, but if proper dental hygiene is not consistently applied, this will happen.  I see it all the time.

Fortunately, the American Dental Association has come up with a recipe, if you will, for healthy teeth:

• Brush with a soft or electric toothbrush for 2 minutes 2 times a day.
• Floss or use a waterpik daily.
• Rinse with a mouthwash twice daily after brushing. Rinse, spit, walk away.

If we have something sugary, compensate for it by drinking water, chewing sugarless gum, or, brush and rinse, then do the same for the one you are caring for.  Safe, and effective.

In conclusion, in aging and in caregiving, our mouths must not be overlooked.  The good news is, we can always start again in taking care of our smiles.

Oral Care = Self Care.

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