Apr 182012

Good mouth care is extremely important in the elderly for prevention of respiratory infections as well as overall health. Unfortunately, the mouth is often the most neglected area of care for those who cannot do it themselves.

Caregivers may be afraid of being bitten, they could just not know what to do with someone who is unable to rinse and spit or because the person no longer has teeth, or it does not occur to them to clean the mouth. Even professional caregivers tend to neglect this area, giving only the most cursory of swipes with toothettes and lemon-glycerin swabs. I must admit that I have not always been as diligent as I should have be when it comes oral hygiene. Mainly because I had not realized that good oral hygiene can be essential to the overall health of those we look after.

It all started when another nurse and myself were advocating for a patient’s right not to have a feeding tube inserted, though the doctor was insisting on it (the doctor’s heart was in the right place). The patient however was loudly proclaiming he wanted to eat and refusing a tube. My coworker bravely fired off an e-mail and a committee was formed.

You see, the concern was that the patient was inhaling food into his lungs causing Aspiration Pneumonia. While swallowing studies were being done and speech therapy was working for the patient, we were researching the problem. That is how I learned that studies were showing there was no evidence to prove that tube feeding prevented aspiration.

What the studies were showing, among other things, was that bacteria from the mouth were getting into the lungs and causing pneumonia. We also discovered that a significant number of people with feeding tubes died of aspiration pneumonia. This was obviously the opposite of what we, and many other healthcare professionals, had always been told.

Before you pull the tube though, please realize there are times when feeding tubes are necessary and appropriate. But before one is inserted caregivers should do their research, including talking with the doctor and speech therapists, and also try something as simple as cleaning the mouth better if pneumonia is a reoccurring problem.

It is estimated that approximately fifty percent of the healthy adult population inhales their own saliva when asleep (brush your teeth before bed)! Normally, we cough and clear the lungs. In those with a depressed cough reflex the saliva and bacteria stay in the lungs and can lead to infection. So you can see how important cleaning your mouth can be.

While sharing this information with someone, they pointed me to an article they just recently read about the relationship between not cleaning your teeth and heart attacks. I do not know about you, but I’m starting to take my dentist a lot more seriously!

Unfortunately, not everyone is able to brush their own teeth, or swish and spit if someone else brushes for them. Dementia, confusion, (and sometimes just plain meanness), can cause people to bite down on a toothbrush too hard to make brushing a viable option. What to do?

Toothettes and lemon-glycerin swabs are good alternatives to a toothbrush and toothpaste. If there is concern about the person biting or clamping their teeth together, a bite stick can be used to keep the mouth open while performing care. Gauze squares or a wash cloth moistened with cranberry juice and mouthwash can be effective especially for cleaning the tongue, as can a Tongue Scraper

One of the interesting things I recently discovered are Finger Tooth Brush. I was working at a mental health institution and residents are known to swallow things like toothbrushes. So we give them these finger brushes. They are marketed for pets and toddlers but they would also work on the elderly who still have their teeth.

For those who do not have teeth, lightly brushing the gums and tongue twice a day is just as important. It will not only keep your parent’s healthier, their breath will smell better.

Resources: Complications of Enteral Feedings, Aspiration Pneumonia, Tube Feed or Not,
Bacteria in Saliva