Bad breath: Why should you care?
SOMETIMES we hear grandchildren complain about their smelly old grannies. There’s a distinct smell we associate with ageing and it can be caused by several factors. Malodour among elderly can either be from their body odour, odours from clothes that are not washed properly, odours from rubs or medicines, and malodour from the oral cavity.
Oral malodour or bad breath is associated with several factors such as gum disease, tongue coating, lack of saliva flow, abundance of dental plaque and poor denture hygiene. These are all oral problems generally found among the elderly.
As we grow older, loss of strength, mobility, manual dexterity and other functional loss become more common. Diseases associated with old age such as Parkinson’s Disease and arthritis may cause tremors and limit hand movement. A simple task like gripping a toothbrush becomes a challenge and that makes self-care difficult.
Elderly people suffering from dementia often forget to brush their teeth and may refuse help. Difficulties to perform simple day-to-day activities among bed-ridden or functionally-dependent elderly intensify their oral health problems.
Malodour from a functionally-dependent elderly’s oral cavity may hinder caregivers from taking proper care of his or her oral hygiene. Proper daily care of the oral cavity is important as oral health affects the general health, levels of daily living activities and wellbeing of the elderly.
Low saliva flow that is common among the elderly is reported to be associated with the accumulation of the tongue coating. Bacteria in the tongue coating and plaque are risk factors for diseases such as aspiration pneumonia (a disease that occurs when foreign bodies or bacteria enter the lungs via the mouth) and endocarditis (inflammation of the inner layer of the heart).
Tooth loss and pain make chewing, swallowing and talking difficult. They may lead to malnutrition and dehydration. Not being able to eat and talk properly, made worse by the presence of oral malodour may also deter the elderly from the pleasure of communicating with others, and may lead to social isolation.
Studies strongly support effective oral healthcare interventions for reducing the risk of pneumonia among the functionally-dependent elderly.
In Malaysia and most parts of Asia, the role of taking care of the elderly is often assumed by their children or members of the family. Some children who are too busy with work would hire helpers to care for their elderly parents. With the increase of life expectancy and shift in the socio-economic situation, the number of homes or care centres for the elderly is also on the rise.
Whoever the caregivers may be, it is important for them to have proper knowledge on how to care and to be able to perform it on a daily basis.
Here are some tips to cleaning the oral cavity of functionally-dependent elderly:
- Sitting position is recommended. However, if sitting is impossible, the elderly should lie on the side. When the elderly is lying on his left side, the right half of the oral cavity should be cleaned. Move the elderly to lie on his right side to clean the left half of the oral cavity. It is best to avoid the supine position to avoid accidental swallowing of debris. If unavoidable, raise the elderly’s head position by using either the caregiver’s lap or pillows and tilt the head to the side.
- Dentures, if wearing any, should be removed prior to cleaning the oral cavity.
- Use a clean soft sponge or gauze dipped in clean water and gently remove food debris on the teeth or on the buccal mucosa (surface inside of the cheek).
- Brush each tooth surface carefully to remove the plaque. Pay attention to fissures, pits and gum lines. Interdental brush could be used in between the teeth, where appropriate.
- Clean the tongue by lightly scrubbing from back-to-front using a tongue brush. A small-headed toothbrush could be used if a tongue brush is not available. Be careful not to brush too strongly and harm the tongue.
- Dip a soft sponge or clean gauze with ample water and rinse the teeth, mucosa and tongue. Repeat this step a few times. Use a mouthwash to replace water in the last step but avoid using mouthwash containing alcohol or peroxide as they may dry up the mouth. Ask the elderly to gargle if they can. Be careful to avoid accidental swallowing.
- If the elderly wears dentures, it should be removed and cleaned every day. Do not let the elderly sleep wearing their dentures. Apart from bad breath, unclean dentures are also associated with candidiasis, a form of fungal infection.
- Arrange for a professional dental examination once or twice a year.
Having a clean and healthy mouth improves not just the elderly’s general health, but also their social interactions as there is no bad breath to worry about!
Dr Haslina Rani is a lecturer in the Department of Dental Public Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia.