Looking after your mouth in later life

What actually changes with age

The teeth themselves usually stay put; what changes is everything around them. The gum edge creeps slowly downwards, saliva thins out, and the hand and shoulder no longer turn as easily. Put the three together and the brushing habit of thirty years no longer cleans the way it did. The mouth has changed, so the care has to change with it.

The root surface a receding gum exposes

When the gum pulls back, the root beneath it comes into view. There is no enamel on a root surface, only a much softer tissue in its place. Root decay therefore spreads faster than decay on the crown of a tooth, and it often grows without any pain at all. Sensitivity to hot and cold can be a first warning, though decay also advances with no sensitivity whatsoever. A fluoride toothpaste is one of the practical ways to protect that surface.

Brushing when the hands are less steady

When finger joints stiffen or grip weakens, the problem is not unwillingness; the brush simply no longer sits at the right angle in the mouth. The first places to be missed are the inner surfaces of the back teeth and the gum line, and those are exactly where decay and gum inflammation tend to start. Thickening the handle or changing the brush brings most people back to the cleaning they managed before.

• A thicker handle: if a slim handle is hard to hold, a length of foam pipe insulation slid over it does the job, and a home-made fix is quite good enough.
• An electric brush: the head moves on its own, so the wrist does not have to twist, and resting the brush against the gum line is enough.
• An interdental brush: when holding floss taut with both hands becomes awkward, an interdental brush held in one hand cleans between the teeth more easily.

Dry mouth and the medicines behind it

Saliva rinses the teeth, dilutes acid and helps repair the enamel. Many medicines for blood pressure, depression, allergy, bladder problems and Parkinson's reduce the flow, and taking several of them together adds the effects up. A dry mouth means decay moves faster, a denture stops sitting properly, and swallowing and speaking become harder. Never stop a medicine on your own; tell the doctor who prescribed it that your mouth is dry. Sipping water through the day, chewing sugar-free gum and switching to an alcohol-free mouthwash bring relief for most people.

A denture does not belong in the mouth overnight

If a denture stays in overnight, the gum underneath is under pressure around the clock, which is why redness and fungal inflammation are so common. The denture comes out in the evening, gets cleaned with a soft brush and sits in water, because it can distort if it dries out. Ordinary toothpaste is not used on it: the abrasive particles scratch the acrylic and bacteria cling more readily to a scratched surface. Even with a full denture, the gums, palate and tongue still need wiping every day.

When someone else does the brushing

Keeping a mouth clean protects more than the teeth: it lowers the number of bacteria swallowed or breathed into the airway, and that carries real weight for anyone confined to bed.

Brushing another person's teeth is nothing like brushing your own. Standing to the side or slightly behind, rather than face to face, puts your hand at the right angle. Have the person sitting rather than standing, with the head tipped gently forwards so that foam does not run towards the throat. Use a small amount of toothpaste and wipe the mouth out with damp gauze instead of asking for a rinse.

• Say what you are about to do before you start, and put the brush in the person's hand first, with your own hand resting over theirs.
• If the mouth will not stay open, place a bite block or the handle of a second brush between the teeth, never your finger.
• With dementia, pick the calm hour of the day, since someone who gets restless in the evening is easier to brush in the morning.

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