Oral health and the older patient

No matter your age, the nasty side effects of chemotherapy are the same for everyone. Unfortunately, they do tend to be exacerbated in elderly patients because their bodies aren’t as strong.

Mucositis (sore mouth) and gingivitis (gum disease) are the most common oral side effects of chemotherapy. This involves painful, bleeding and burning gums, sores in the mouth and a swollen or burning tongue. Xerostomia (dry mouth) is another side effect and is prevalent in older patients, as they are predisposed to this condition due to their age.

A dry mouth is a serious problem as there is less saliva, or an altered consistency of saliva in your mouth. Saliva is required for normal swallowing, speech and taste. Speech and swallowing can be affected due to decreased lubrication and your lips may become dry and cracked with secondary fungal infections. If the volume or consistency of your salvia changes (reduced volume and thicker consistency) you become prone to developing cavities and gum disease. Saliva contains numerous antibodies dedicated to protecting your teeth and gums and maintaining bacterial homeostasis. The body will resort to extracting minerals from your teeth in an attempt to attain homeostasis in the mouth. This will lead to weak and brittle teeth, as well as the inability of the saliva to redeposit minerals onto the tooth surface.

However, xerostomia and mucositis is manageable. If you suffer from mucositis you should avoid crunchy, sharp and spicy foods. It’s of the utmost importance to maintain excellent oral hygiene by brushing and flossing your teeth every day. A soft toothbrush may be required as the gums can become extremely tender. Mucositis usually resolves as soon as the chemotherapy treatment stops.

Xerostomia can be successfully managed during treatment but can persist as a chronic condition once chemo has been completed. Saliva substitutes and synthetic saliva solutions are available from your dentist, or pharmacy. Chewing gum containing Xylitol, sucking on ice and drinking lots of water will help keep the mouth moist, lubricated and healthy.

For patients who wear dentures, xerostomia is a problematic side effect. Xerostomia affects the retention of the dentures in the mouth, as well as normal speech and swallowing. Secondary fungal infections are common (denture stomatitis) in patients affected by xerostomia. During xerostomia it’s challenging to keep dentures from loosening (due to the loss of the suck-down effect created between the denture, saliva and palate) and the dentures become difficult to wear as there is usually a thinning of the mucosa, resulting in sores. A saliva substitute lubricant or synthetic saliva agent will help with speech, swallowing and retaining the dentures to a certain extent. A denture fixative (Corega) can be applied to the fitting surface, which will help keep the denture in your mouth.

Dentures tend to loosen and fit poorly with age and prolonged wear. This is due to the resorption (destruction) of the bone in the mouth. When a tooth is removed, the bone is unsupported and it starts to resorb three dimensionally from the jaw. Once a denture doesn’t fit properly ,you have one of two ways to improve the situation. You can either invest in new dentures or opt for dental implants or bridges. These fixed restorations dramatically improve the patient’s life. Dental implants have revolutionised dentistry. Dentists can provide toothless people with a full set of fixed teeth within a couple of days! Partial dentures can be replaced with one or two dental implants in the affected area.

Poor oral health is another cause of bone loss, which leads to gum recession as the gum follows the bone. Unfortunately, your gums do recede with age and it is very important to keep this recession to a minimum. This can be achieved by maintaining excellent oral hygiene (brushing twice a day and flossing once) and having the correct tooth brushing technique (no scrubbing).

Written by Dr Carina van der Linden