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Caring for the Older Adults

Healthy Smiles Rely On Consistent Dental Care

Older adult uses electric toothbrush.

By Holly Carlson MS, RN, CCRN

October is dental hygiene month which gives us an opportunity to reflect on how we are supporting the people we care for in maintaining good oral hygiene. In our blog Prioritizing Oral Health we shared the health consequences of poor oral health. Helping seniors with maintaining their oral health can be a challenge in any care environment.

The basics of a good regimen do not change throughout everyone’s lifespan. Everyone should make sure the following are completed regularly:

  • Brush morning and night for 2 minutes.
  • Floss at least once a day.
  • Use fluoridated toothpaste or mouthwash with oral care.
  • Schedule dental cleanings every 6 months.

Four steps to good oral health seems so simple, yet it is neglected regularly. Oral health neglect is even more prevalent when people experience either cognitive or physical barriers. Barriers usually require caregivers to assist with the care employing different strategies to accomplish the task.  Anyone who cares for another person who struggles with oral hygiene understands that successful strategies are far from one size fits all. It is important to look at the oral care process from all angles especially if it is an ongoing struggle.


  • Is there enough light where oral care is completed?
  • Is there an alternative location to complete the care, like the kitchen, particularly if a person frequently falls in the bathroom?
  • Use environmental queuing for example: turn down lights in the evening, use essential oils to create a queuing scent, or play certain music.
  • Brush while bathing.
  • Allow for enough time to complete the task.


  • Use respectful non-threatening language. Scolding or shaming has never accomplished anything productive.
  • Use the same verbiage each time to minimize confusion and anxiety.
  • Prompt the person you’re helping one step at a time. For example: Let’s go to the sink. Turn the water on. Pick up your toothbrush.
  • Provide verbal distractors for people who have memory impairment, or who have oral aversion or trauma associated with oral care.


  • Explore bristle firmness. Gums thin as we age, soft bristles are kinder to delicate tissue. There is also
  • Consider using a silicone bristled tooth brush for tender gums or oral aversion.
  • Use a toothpaste that the person can tolerate. Taste buds and sensitivity changes with age, some toothpastes are just flat out too hot to the tongue.
  • If toothpaste is the barrier to brushing, try brushing without using a fluoridated mouthwash after.
  • Change the water temperature.
  • Use flossers or flossing brushes instead of flossing thread.

Dr. Jason Van Wagenen DDS from Denver, Colorado recognizes the challenges of oral health as we age. Dr. Van Wagenen recommends using an electric toothbrush because it has a large handle and has an integrated two-minute timer. He states, “electric toothbrushes eliminate many of the barriers to good oral care by shear design.” He also recommends high fluoridated toothpaste and notes they come in neutral flavors such as vanilla. At the end of the day if oral care is a persistent issue, he recommends more frequent dental visits which could occur at 4, 3, or 2 month intervals to maintain a reduced plaque burden.

Dr. Van Wagenen also addressed the importance of and brushing dentures every day. He noted the porosity of the denture material which harbors bacteria and fungus. These organisms cause infections in the mouth and can cause pneumonia. It is important to remember people who wear dentures can still get gingivitis, an infection of the gums, even when they don’t have teeth. Gingivitis is the origin for where oral bacteria enters the body and causes long term health problems like cardiovascular disease and Alzheimer’s. So even if people do not have teeth good oral health continues to be really important for sustained health.

Dr. Jason Van Wagenen D.D.S is a dentist from Denver Colorado who has cared for the elderly and underprivileged populations for over 20 years. His is an expert in individualizing treatment plans that are affordable without compromising care outcomes.

Holly Carlson MS, RN, CCRN is a freelance writer and owner of HDC Consulting.  Holly is a registered nurse with 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes direct care, organizational leadership, facility management, and organization culture development.


Phone: (541)419-4036