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Dental hygienist explains how to care for the oral health of the elderly

Various over-the-counter mouth care products. (Mainichi)

The oral health of the elderly is said to be closely tied to their risk of suffering strokes, pneumonia and other diseases. The Mainichi Shimbun recently spoke with Hiroe Nishima, a certified dental hygienist and care manager from the Nihon Houmonshika Kyokai national dentist society about how to keep the mouths of elderly people in good form.

    When speaking of oral hygiene, the first thing people think about is brushing their teeth, but this is only one part of proper hygiene.

    "The teeth only make up just 25 percent of the mouth. Even if you perfectly brushed your teeth, only 25 percent of your mouth would be clean," says Nishima. It is also important to clean the inner part of the cheeks, the top and bottom of the tongue and the roof of the mouth. Whitish matter on the tongue should be gradually removed over the course of a few days, so as not to damage the taste buds. The patient should tuck in their jaw, sit up straight and have their feet firmly planted on the floor while having their mouth cleaned.

    Very important is that the removed bacteria and unclean matter be expelled from the mouth. In the case of the elderly, the bacteria-laden saliva can easily enter their windpipe and cause aspiration pneumonia. To correctly expel the removed matter, the patient should when possible be made to gargle and spit at least six times.

    Age reduces the production of mouth-cleaning saliva. To stimulate the production of saliva, one can put the hands on the face, hook the thumbs behind the ears and apply pressure with the entire palms, then push with the thumbs from directly below the chin up to below the ears.

    To prevent aspiration pneumonia, Nishima says that practicing pronunciation of words with sounds like "kah" in them is effective.

    Patients with dementia may not warm to oral care and refuse to open their mouths. In such cases, the caretaker should start by making the patient aware of their presence. For patients who are often asleep, use a wadded up, cool and wet cloth to pad their face until they wake up, then talk to them while looking at them. Next touch the patient on the hands, arms, shoulders, cheeks and lips. If you are able to put your fingers in their mouth without them complaining, slowly begin the oral care. If they bite, reprimand them with short phrases, like, "That hurts, stop it."

    Nishima says that sometimes if a patient starts resisting while their mouths are being cleaned, she will stop midway. "The point is to not be hasty, and to go forward step-by-step. It's important to think of the patient while interacting with them."

    Nishima also says that early intervention by a dentist is important to ensure elderly patients who need nursing care can continue to eat by themselves into their final years. In particular, she says, dentists should always be invited to conferences held by care workers and occupational therapists about how to handle elderly patients who have been returned home after being hospitalized for strokes or pneumonia and need care. Nishima has seen a number of cases where she felt "if a dentist had gotten involved sooner, this patient could have kept eating normally."

    Nishima says, "Oral care goes beyond cleaning the mouth. I think of what care I can give to make the patient's life more fun, while observing their health and lifestyle. For the first step, please have patients seen by a dentist."

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