How to help your parent with dental care (you may have to pay for it)
Eight things you can do to help your parent with their oral health (and the critical reasons you should).
“Can you get me some pudding?” my dad asked as soon as I picked up the phone. “Chocolate, in the little cups? Ooh, and rice pudding?”
He was in a facility, ostensibly for rehab, after his appendectomy.
He often asked for little treats, fast food he saw on a commercial, or a sweet he couldn’t stop thinking about, but pudding was new.
“Sure,” I said, laughing. “That’s random.”
My dad was always asking for little things like that. When I was in a good headspace, I laughed them off as weird idiosyncratic bids for attention. When I was struggling, I felt resentful. What I wish I would have done is gotten curious.
When my dad started losing weight, complaining about his dentures, I realized the pudding request wasn’t random. He was asking for soft food because his mouth hurt.
Like so many other times during my caregiving journey, my heart squeezed with guilt. This was another thing I should have been watching and wasn’t.
“Dad,” I asked, suddenly panicked. “When’s the last time you had a dentist look at your teeth?”
He laughed. “Lauren, I only have two teeth. Your father’s a vampire, remember?”
My entire life, my dad had dentures. He had a bright, straight, white smile and no one realized it was mostly fake.
“Yeah, but you still need new ones occasionally, right? Like a fitting?”
“I guess so, sweetie, but it seems like small potatoes compared to everything else. I mean, I can’t walk, Lauren.”
If I could have smacked myself upside the head for not thinking of this earlier, I would have.
Dental care often slips among the elderly, despite being critically important.
Periodontitis (advanced gum disease) is a risk factor for dementia. Older adults who have lost more than one tooth due to gum disease have been shown to have an almost 50% higher risk of developing cognitive impairment and a 28% higher risk of being diagnosed with dementia. Research has also shown that gum inflammation (gingivitis) raises the risk for lung disease, heart disease, blood vessel blockage, and strokes.
Sometimes, when a researcher says one thing is a risk factor for something else, or is associated with something else, it’s just a statistical correlation. But when I talked to Dr. Shelly Cram, a periodontist in private practice in Washington, D.C. and a spokesperson for the American Dental Association, she said we actually know the biological chain of events that likely occurs to link poor dental hygiene with these other outcomes.
“If you have bacteria and inflammation in your mouth, it's not just staying in your mouth, it's getting in your bloodstream. The bloodstream goes where? Everywhere—your brain. We have studies that show people who have uncontrolled periodontal disease, an infection around the bone and gums, around their teeth. They have a much higher incidence of developing dementia or early onset Alzheimer's. We know that there's some studies that show bacteria in the mouth can actually get aspirated into the lungs, and it can cause a respiratory infection. It's called inhalation pneumonia, very common in assisted living places where people are laying on their back a lot, not getting their teeth brushed.”
Heart disease also can be caused by inflammation that starts in the mouth, narrows your blood vessels, and causes you to get less blood to the heart and the head, Dr. Cram told me. “And guess what happens? You get high blood pressure. You get heart attacks. You get a higher incidence of strokes.”
There are a number of reasons older people’s oral health declines. One is that they’re paying a lot less attention to it. If they’re feeling fatigued, perhaps it’s hard to motivate themselves to stand in the bathroom and brush and floss. Maybe they lack the manual dexterity or grip strength required to brush effectively.
As people grow older, they are often prescribed more and more medications. (My dad was on so many pills that he kept them in a bread box.) One of the most common side effects of medications is dry mouth. This might seem like a minor side effect, but Dr. Cram says it’s serious for the elderly.
“When you get dry mouth, it does several things. It's a reduction in the saliva in your mouth. When saliva is a very protective thing in our mouth, it has enzymes and things in it that help to kill bacteria that cause inflammation. And it also helps to lubricate our cheeks and our gums and under our tongue so that we can speak. So when you have deficient saliva, you're missing all those enzymes, and the bacteria tend to proliferate, especially the bacteria that cause tooth decay and gum disease. And so what we find in a lot of older adults with dry mouth is suddenly they go from having no cavities for the last 15 or 20 years to suddenly we see them at the next visit and, oh my goodness, they've got a cavity on every tooth at the gum line.”
Also, older adults, who are on Medicare, are less likely than those of working age to have dental insurance. Medicare doesn’t cover dental. States manage their own Medicaid dental coverage, (through private companies) and some, like Florida, only cover “emergency-based” dental services. This does include dentures, but not routine cleanings or exams. Some Medicare Part C (Medicare Advantage) plans cover dental, but not all.
My dad was on a Medicare Part C plan for years, but I have no recollection of him ever visiting a dentist. By getting curious about your parent’s dental health, asking simple questions about their insurance or their habits, you can prevent them from succumbing to gum disease and limit a huge risk for major health issues. (They may still ask you for pudding, though.)
Here are eight things you can do:
Ask your parent when was the last time they went to the dentist.
Check if your parent has Medicare Part C and see if it covers dental. If they have Medicaid, check if they’re enrolled in a dental plan. Keep up on this—if they enter long-term care, their eligibility for various plans and services may change.
Ask around to friends or in Facebook groups about dentists in the area that offer cleanings and exams at a lower cost.
Consider enrolling your parent in private pay dental insurance that covers preventative care. Two cleanings a year can prevent thousands of dollars of dental care down the line, and might prevent inflammation from spreading to the rest of the body.
If your parent is in rehab or a nursing home, check on how the staff manages dental care. Dr. Cram has worked with the District of Columbia Dental Society to produce on a series of free videos to help older people with home dental care and to help providers who assist others with dental care.
Consider whether your parent could use an electric toothbrush, water flosser, or other device to help them with their oral hygiene.
Talk to your parent about dry mouth, or check the side effects list on their medications to see if dry mouth might be on the list. If they experience dry mouth, talk to their doctor about ways to alleviate it.
Keep track of things you notice regarding your parent’s dental health. My free tracker can be useful for this. There may not be anything you need to do right away, but take notes as to when things change.