Stroke, diabetes, hypertension can lead to dental issues


MANY older adults suffer from multiple chronic illnesses like hypertension, diabetes mellitus, coronary heart disease and stroke. Coupled with the medications taken, chronic diseases can affect the oral health of older adults.

As we know, poor oral health may lead to restricted food choices due to chewing disability, as well as problems with communication and low self-esteem.

Some oral complications in older adults with chronic diseases include:

  • Dry mouth (xerostomia). This condition is an abnormal dryness of the mouth due to decreased secretion of saliva. It also can increase the pathogenic bacteria in the oral cavity predisposing the person to bad breath (halitosis), dental caries, gum disease and oral mucosal lesions. Some hypertensive and cardiovascular disease medications may cause dry mouth.
  • Gum or periodontal disease. Poor oral hygiene combined with dry mouth can lead to inflammatory gum disease caused by bacteria in dental plaque. Also, the enlargement of the gum is one of the side effects of some medications used to treat hypertension.
  • Dental caries. One of the roles of saliva is to balance the pH of oral cavity through its buffering effect of carbonates and phosphates. Reduced salivary flow due to the medications taken may increase the risk of developing dental caries among older adults with chronic diseases.
  • Oral mucosal lesions. Several hypertension, diabetes mellitus, and cardiovascular disease medications can cause mucosal lesions like lichenoid reactions. For this, the elderly are recommended to have frequent visits to the dentist.
  • Fungal infections. Inadequate dental plaque control plus reduced salivary flow can also lead to fungal infection in the oral cavity.
  • Burning mouth and taste changes. Some cardiovascular disease medications have side effects like burning of the mouth and taste changes.

Oral health recommendations:

1) Increase salivary flow

  • Drink water frequently so that the mouth is always moist.
  • Chew sugar-free chewing gum to stimulate salivary glands to produce saliva.
  • Eat fibrous foods.
  • Avoid drinks containing alcohol and caffeine.
  • Avoid using commercial mouthrinse that contain alcohol or peroxide that can further dry the mouth.

2) Remove dental plaque efficiently

  • Brush your teeth at least twice a day, preferably after every meal. Choose a proper toothbrush, for example, small head, soft bristles, finger grip handle.
  • Clean the interdental spaces by using floss or an interdental brush.

3) Increase fluoride intake

  • Use fluoride toothpaste to prevent tooth decay.
  • Alcohol-free fluoride rinse is also recommended after toothbrushing to help remineralisation of enamel.
  • Professionally-applied topical fluoride gel is also required in older adults with high risk of developing dental caries.

4) Diet control

  • Avoid eating too much sugary food and drinks to prevent dental caries.

5) Professional care

  • Visit the dentist frequently for oral examination and preventive procedures. The dentist can also emphasise and educate on good oral hygiene practices for maintenance of oral health.
  • Short dental appointments are also recommended in older adults with medical problems.

Special considerations

Older adults who have had a stroke are very susceptible to oral diseases due to impaired manual dexterity. Inadequate dental care combined with the side effects of drugs like dry mouth may lead to fungal infection, dental caries, gum disease and eventually tooth loss.

For those who have suffered a stroke, an electric toothbrush or a toothbrush with a modified handle is recommended.

Similarly, older adults with osteoarthritis are also recommended to use an electric toothbrush or dental floss with a long handle to facilitate better oral hygiene.

In diabetes patients, it is important to have good oral hygiene habits for prevention of periodontal diseases. Severe periodontal disease will affect diabetes control.

Dr Tanti Irawati Rosli is a senior lecturer at the Department of Dental Public Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia.

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