Caring for the Aging Population’s Oral Health

By Thu-Nga Ortega, DDS

In the United States, 1 in 6 people are over the age of 65—a number that continues to grow rapidly as the baby boomer generation ages (U.S. Census). As this population segment expands, so does the need for comprehensive strategies to address their unique healthcare needs, particularly in dental care.

Maintaining oral health in older adults—especially those living with dementia, Alzheimer’s, or multiple chronic conditions—can be complex. These patients often require specialized care from dentists trained in geriatric dentistry who possess the patience and experience necessary to manage their specific needs. Many older adults reside in nursing homes, assisted living facilities, or live at home under the care of family, and as they lose the ability to care for themselves, oral hygiene often suffers.

Dental care for the elderly significantly differs from the general population. Their extensive medication lists and complex medical histories must be factored into treatment planning. In most cases, conservative treatment is preferred over complex procedures. The length of time a patient can tolerate in the dental chair, their physical and cognitive condition, and the potential risks associated with treatment must all be considered.

Routine cleanings, regular evaluations for infections or new pathology, and maintaining basic oral hygiene are essential. In some cases, broken teeth at the gum line may not cause acute pain, making a “watch-and-monitor” approach more appropriate than surgical intervention. Surgical extractions, for instance, carry risks such as bone loss, poor healing, and increased susceptibility to complications—especially in patients with conditions like diabetes or those taking medications such as blood thinners and cardiac drugs.

Before performing invasive procedures, physician consultations may be necessary. Temporarily discontinuing medications like anticoagulants for dental surgery can pose significant risks, including strokes or cardiac events. In many cases, the risk of complications may outweigh the benefits of extraction, especially when broken teeth are asymptomatic.

Patients with Alzheimer’s or dementia present additional challenges. They may be unaware of post-treatment numbness, leading to accidental injuries such as biting the tongue or cheeks, which can result in severe bleeding. All potential risks and benefits should be carefully weighed before proceeding with treatment for these patients.

Preventive care remains the cornerstone of geriatric oral health. Cleanings every six months—or more frequently, such as every 3–4 months for those with significant health issues or behavioral challenges—are recommended. Regular removal of plaque and biofilm from below the gum line is critical to preventing bacteria from entering the bloodstream, where it can exacerbate conditions like heart disease or dementia. Studies have linked gum disease with the progression of Alzheimer’s, emphasizing the importance of oral hygiene in overall health.

Dry mouth, a common side effect of many medications used to treat cardiac and blood pressure conditions, increases the risk of tooth decay. Additionally, diabetic patients often suffer from gum disease, making routine dental cleanings even more crucial to minimize tartar buildup and inflammation.

Some dentists now offer mobile services, visiting patients in their homes or care facilities to provide cleanings and limited treatment—a valuable option for patients with mobility or behavioral challenges.

In conclusion, preventive and conservative dental care is essential in maintaining the oral and overall health of the aging population. Prioritizing early detection of infections, use of fluoride treatments, and minimally invasive procedures helps ensure these patients can maintain a healthy diet, stable weight, and a better quality of life.