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November 21, 2008

Dental professionals alleviatethe shame of being a denture wearer

On Jan. 1, 2008, Kathleen Casey-Kirschling — who was born one second after midnight on Jan. 1, 1946 — became the first baby boomer eligible to file for Social Security benefits. Over the next two decades, an estimated 10,000 baby boomers will become eligible each day.

Profound changes in the demographics of this country will be apparent. Are you prepared to treat the overwhelming number of baby boomers in your office?

The Denture Stigma

Studies show that health-care providers sometimes have negative attitudes toward older patients, including misconceptions that they are too ill, too old, or unable to pay for dental services. The mouth plays an important role in appearance, speech, communication, and intimacy. The impact of poor oral health on these functions can lead to poor self-esteem, social isolation, and depression. Adults who are depressed or disengaged may neglect their oral hygiene, thus contributing to poor oral status.

Most tooth loss is caused by two preventable diseases: dental caries and periodontal disease. Missing teeth can have a profound effect on both oral and systemic health. Tooth loss, even when replacement prostheses are worn, can affect an individual's quality of life, as dental prostheses are imperfect replacements for teeth and may affect an elder person's social interactions, facial esthetics, chewing, swallowing, and speaking.

Patients facing the reality of dentures may feel ashamed and embarrassed about their poor oral health care, even if tooth loss was inevitable. Mostly, they are scared of the unknown, fearing a loss of independence or the possibility of drawing negative attention.

Dental professionals are essential advisors during the denture process. The hygienist can allay fears through patient counseling, and discussing such issues as preparing to become edentulous and what procedures will follow. The hygienist can calm patients' fears by teaching them and their caregivers how dentures can augment their life, either by giving them a stronger bite force so food is more enjoyable, or by increasing the vertical dimensions of their face to make them more esthetically pleasing.

Hygienists must help patients understand the importance of denture care and denture plaque control. They should recommend specialty products that promote oral hygiene and proper denture care. For example, denture adhesives can enhance and stabilize a proper-fitting denture. Daily cleansing products can facilitate easy cleaning habits to help remove bacterial plaque, odor-causing film, and food particles.

Ongoing Care

At every visit, dental professionals provide patients with home-care instructions for the care of natural teeth, and discuss disease prevention and health promotion. The amount of time dental professionals spend educating patients on denture care pales by comparison. Dentists, hygienists, and dental assistants should take time to educate patients about the importance of good oral and denture hygiene to maintain a properly fitting, well-functioning, clean denture. Total cleanliness of the oral cavity for the health of the teeth and supporting structure involves specific procedures for the care of the natural teeth and all replacements, both fixed and removable.

Poor denture care can lead to larger health issues. Patients' daily care program should include soaking with an overnight effervescence tablet. As the amount of plaque and calculus in the mouth increases, patients' oral mucosa can become damaged and oral candidiasis can occur, leading to mouth odors, infection, and diseases.

Dental professionals should not recommend that patients brush their dentures with an abrasive toothpaste. This may damage the denture by causing surface roughness that can lead to increased bacteria. Instead, they should suggest a cleansing product specifically designed for dentures, such as Polident® (GlaxoSmithKline), which contains no abrasive ingredients, causes no surface wear over time, and kills 99.9% of odor-causing bacteria.

Adhesives are another important part of patients' daily denture care program, actually improving their quality of life. Social situations are particularly worrisome for denture wearers, as they are self-conscious about speech clarity, dentures slipping, or food getting trapped under their dentures. However, studies have shown that more than half of denture wearers report improved speech and chewing, as well as increased confidence, with the use of adhesives.

Help patients by recommending an adhesive such as PoliGrip® (GlaxoSmithKline Consumer Healthcare) to enhance and provide stability for their already properly fitting denture. The use of adhesives can improve bite force, giving patients the freedom to eat a wider variety of foods, which may lead to better nutritional habits. Adhesives can also be useful for special needs patients, including those with poor neuromuscular control or who suffer from dementia.

The presence of well-fitting dentures is associated with higher and more varied nutritional intake and greater dietary quality. Good health, including nutrition, is necessary for patients who wear dentures. Painful or ill-fitting dentures can become a factor in malnutrition. Encourage your patients to visit the office for regular check-ups, or as soon as they experience pain or a loose fit.

Meeting Needs

By being sensitive to denture patients' needs, you can help them feel more comfortable with their oral health care experience and give them the tools necessary to preserve their independence and practice proper oral and denture care.

The success of geriatric oral health care depends on a team-centered approach, where patients understand the importance of maintaining their independence and raising their quality of life.

About the Author

Lisa Stefanou, RDH, BS, MPH, is assistant director of dental hygiene programs and associate professor at New York University College of Dentistry, New York. She practices clinical dental hygiene and especially enjoys working with pediatric patients. In addition to her teaching and clinical work, she has contributed to dental hygiene textbooks.

Preparing Your Office for the Older Patient

Older adults highly value maintaining a clean mouth, reporting that good oral hygiene makes them look better, feel more comfortable, and feel healthier. Keep your older patients coming back time and again and ensure your office can accommodate them appropriately by offering:

• Well-lit treatment rooms with climate control. Blankets or pillows can increase comfort while older patients sit and wait.
• Slow and clear speech, and looking directly at them while you speak. If possible, remove your mask to allow for lip reading.
• Educational material with pictures to assist those patients who may be hard of hearing but haven't disclosed that fact to you.
• Kind reminders for patients to turn off their hearing aids before you begin using high-pitched tools.

In addition, increase the probability of oral hygiene compliance by explaining pertinent information to patients' caregivers, when appropriate. Make it a habit to legibly write down hygiene instructions so patients and their caregivers can review them at home. 1

1 DeBiase CB, Austin S. Oral health and older adults. J Dent Hyg 2003;77(2):125-143

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