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As the Baby Boomer generation continues to age, it's important for hygienists to understand their role as caregivers.
“My grandmother and I were very close. It broke my heart the day I helped her move into a nursing home, but between her congestive heart failure, severe insulin-dependent diabetes and handicap from losing her leg to diabetic complications, her health conditions required her to have around-the-clock care. I could never get her to stop her smoking habit, though…”
I listened in awe as Sonya Dunbar, RDH, shared her freshly vibrant story of how she discovered her passion for gerodontics.
“My grandmother refused to let the nursing home staff clean her mouth because she knew I would visit her every day and clean her mouth. She liked having that attention from me. In the end, that’s all that most elderly people want: attention from their loved ones.”
Sonya lets in a deep breath as she relives her early moments in her career as a geriatric dental hygienist.
“Once I started cleaning my grandmother’s teeth, her roommate wanted her teeth cleaned. I slowly began cleaning everyone’s teeth in my grandmother’s hall, then in the next hall over. I had spent hundreds of dollars at the Dollar Tree on toothbrushes and had a line of wheelchairs around the corner to see me. I soon realized that I was so engrossed in what I was doing, I hadn’t seen my grandmother in a while.
“Turns out, she was offering up her granddaughter’s dental cleaning services in exchange for cigarettes,” Sonya laughs. “Grandma was sitting out in the courtyard enjoying her afternoon smoke while pimping me out to everyone in her assisted living home!”
We enjoy a casual conversation as Sonya shared that shortly thereafter, she lost her beloved grandmother. Nevertheless, she continued visiting the assisted living home where her grandmother had lived to be able to provide continued dental care to the residents of the home.
“Katrina, have you ever looked death in the face before?”
I remained silent.
Sonya recounts a beautifully touching story about how she experienced the peace of being present as one of her favorite residents passed away while in her mobile dental chair during her cleaning. No, this patient didn’t forget to take her premedication. She wasn’t overdosed on anesthetic or not cleared for dental care. She simply was “graduating.” Sonya has beautifully featured this and many other touching stories in her published book “Golden Nuggets of Life,” which recounts her experiences as the “geriatric tooth fairy.”
Of note, Sonya has created a flourishing career with her mobile dental company, which provides dental cleanings, extractions and denture services to the elderly in assisted living facilities. She also provides trainings to the nursing staff on proper oral care. She shares a wildly passionate and optimistic vision for optimal dental care for the elderly population, and this vision is continuing to drive her forward in her mission.
As we continued to revel in each other’s’ passions for dental hygiene, we also enjoyed some “shop talk.” Sonya shared ideas about the concerns with geriatric patient populations who present with unique challenges and special care needs. Of note, geriatric patients present with increased risk of xerostomia due to medications, systemic conditions such as Sjogren’s Syndrome, diabetes, digestive problems and liver disfunction, oral habits such as mouth breathing and dehydration, and reduced salivary gland function due to radiation therapies, to name a few.
As the Baby Boomer generation enters retirement and begins to age, our industry has grown in the products that are available to support dental professionals in the management of the dental needs of our geriatric patients. The following are a few of my favorite products.
Click through the slides to see the products.
SmileCo Moisture Pearls
Xerostomia creates a multidimensional concern to the overall health of the oral cavity. Saliva buffers the pH within the oral cavity, provides antimicrobial effects, lubricates the oral mucosa and provides amylase, the primary enzyme that begins the digestive process. In its absence, patients are at an elevated risk for caries and periodontal disease, may have difficulty swallowing, and could develop various oral lesions associated with mucosal trauma.
My patients have found relief from these symptoms through the use of SmileCo Moisture Pearls. Created and patent-pending by Alli and Becky (two fabulous dental hygienists, by the way), these pearls were originally designed for Alli’s mother, who was experiencing the negative effects of chemotherapy to manage breast cancer. Being the excellent hygienist she is, Allie placed her mother on xylitol products and began exploring alternative options once her mother experienced the negative side effects of xylitol products. What began as a small project to help her mom combat the side effects of cancer treatment has now flourished into a product shipped across the country to aid in the management of xerostomia.
Each moisture pearl is encased in a chewable vegan soft gel and contains a patent-pending combination of vitamin E oil, organic shea butter, extra virgin coconut oil and avocado oil and is flavored with gentle peppermint oil. Patients bite into the pearl, releasing the moisture fluid, which is then swished throughout the mouth to bring relief to the symptoms of xerostomia. I love sharing this product with my patients, as they find that the pearls are a fantastic way to manage their xerostomia throughout the day.
I’m humbled to know both Alli and Becky and blown away by the dedication and passion they have for improving the quality of life for patients who suffer from xerostomia-related lesions. I encourage you to visit their website and learn more about their products.
SalivaMAXTM & SalivaCAINETM
Despite our best efforts, our geriatric patients may experience advanced oral lesions due to cancer treatments, diseases or other causes. The engineers with Forward Science are working tirelessly to revolutionize the ways we manage the symptoms of xerostomia and oral mucositis.
SalivaMAXTM is an FDA-cleared prescription rinse for patients who experience xerostomia to oral mucositis. The product is a supersaturated calcium phosphate powder that’s applied to water to create a high concentration of electrolytes similar to that of natural saliva. SalivaMAX acts as an artificial saliva and has been proven to shorten the duration and severity of oral mucositis when utilized as a prophylactic rinse prior to undergoing cancer treatment as well as throughout cancer treatment. The rinse actively replenishes ions lost when patients experience xerostomia and therefore provides excellent relief for patients. Available by prescription only, SalivaMAX has a patient assistance program, which means many patients qualify for $0 out-of-pocket expense for the product.
As SalivaMAX gained popularity in the management of oral mucositis, the research and development team at Forward Science saw a need for additional pain management for patients who suffer from advanced lesions. SalivaCAINE™ integrates similar ingredients to SalivaMAX while providing pain relief with the addition of benzocaine. In addition, SalivaCAINE is provided as a free product for any patients who are currently utilizing a prescription for SalivaMAX.
In addition to directly addressing, treating and managing oral lesions, Forward Science has truly paved the way in oral cancer diagnostics through the use of OralID, a transillumination system that has had an incredible impact on the dental industry. The system itself is inexpensive, lightweight and easy to manage while providing clinicians with a tool to aid in the early detection of oral cancer. What I find most impressive, however, is the campaign that Forward Science has utilized to spread awareness about the importance of oral cancer screenings in the dental office. They’ve truly revolutionized the way dental providers identify, manage and treat oral lesions. Feel free to visit their website for information about their products.
If hygiene school drilled (see what I did there) anything into our heads, it was that our elderly patients may struggle with adequate home care due to dexterity issues. Between diminished motor skills and complications with arthritis, our elderly patients appreciate recommendations for oral hygiene products that accommodate their unique needs.
The Triple Bristle toothbrush, created by dentist, author and inventor Dr. Max Babiner, provides three sets of toothbrush bristles to provide a thorough mechanism of action. The electric toothbrush has bristles that seat onto the occlusal surface while another set of bristles adapts at a 45-degree angle to the buccal and another set of bristles adapts at a 45-degree angle to the lingual. In a fraction of the time of your typical Bass Method of brushing, the Triple Bristle toothbrush effectively debrides all accessible surfaces of the tooth structure with minimal effort.
Elderly patients love the thorough clean and ease with which the brush itself performs most of the work. I gave my 20-something-year-old brother a Triple Bristle brush and he loves it for the cleansing properties and the thorough cleaning he receives in a third of the time of traditional brushes.
Dr. Babiner has also created Triple Bristle brush heads that adapt to all Sonicare electric toothbrush models, allowing your loyal Sonicare users to experience the triple bristle action with their own brushes. Check out Dr. Babiner’s website for additional information about his brushes.
Dr B Dental Solutions
Pneumonia is the No. 1 killer of elderly patients in hospitals and nursing home facilities. It’s widely known that pneumonia is directly linked to poor oral health and that the effective management of hospital-induced pneumonia has been linked to the control of oral disease. Dr. Lorin Berland of Dr B Dental Solutions has dedicated his life’s work to understanding the relationship between oral disease and prosthetic devices.
Dr. Berland understands the delicate role that saliva plays in the oral health of geriatric patients who utilize oral appliances. In turn, his products aim to treat and prevent xerostomia through unique ingredients.
Dr B’s Adhesadent is the only denture adhesive that directly addresses xerostomia while holding the ADA Seal of Acceptance. His unique formula of aloe vera with vitamins A, D & E moisturize the gingival tissues while his copolymer adhesive provides a strong and long-lasting hold.
The Cleanadent Paste is a favorite of mine, as it’s the only cleansing paste safe for both gum tissues and dental appliances. Patients with full-arch bridges, all-on-four cases and partially edentulous sites benefit from this soothing paste, which doubles as an adhesive remover from dentures and gums. The paste is formulated with vitamins A, D & E, aloe vera, coconut oil and tea tree oil, which provide excellent moisturization to the gingival tissues. I use this paste as a refreshing and soothing way to freshen up the edentulous areas on my denture patients and safely use it in my prophy cup for all-on-four patients.
Dr B’s Cleanadent Liquid Crystal formulation is the only soak cleanser that instantly kills Candida, strep, staph and Actinomyces on removable appliances. In addition, these crystals remove heavy stain, provide disinfection and completely eliminate odor. Patients use these crystals for all types of removable appliances from dentures, partials, sleep apnea devices and night guards to retainers and aligners.
I’ve had the pleasure of sharing phone conversations with Dr. Berland and am in awe of the passion he has for providing products that benefit the geriatric population. If you believe your patients would benefit from using Dr B’s products, don’t hesitate to contact him (firstname.lastname@example.org) or visit his website as he is generous with samples and information to support your practice and patient needs.
As a hygienist with the country’s largest periodontal practice and clinical hygienist to many geriatric patients, I would be remiss to write an article about significant products and not include CloSYS. CloSYS is the magic rinse, the one-size-fits-all, the main attraction and the jack of all trades when it comes to dental products. It holds the ADA Seal of Acceptance and its Silver product line is specifically designed for the 55 and older patient population.
Doctors like CloSYS because it’s one product line that addresses countless oral conditions. CloSYS addresses mild to moderate oral sensitivity, mild to moderate xerostomia, halitosis, active periodontitis or peri-implantitis, patients who suffer from herpetiform aphthous ulcers and cancer patients undergoing therapy, to name a few. CloSYS is safe for patients from age 6 to age 100 and above.
Patients like CloSYS because it effectively manages their oral discomfort. The non-irritating solution provides an effective cleansing without the burn that other products deliver. Holistic patients appreciate the triclosan-free, sulfate-free and fluoride-free options available.
As a hygienist, I love recommending CloSYS as its patented ingredient, Cloralstan®, restores appropriate balance to the delicate oral flora by addressing the pathogenic bacteria while stabilizing the positive bacterial components in the oral cavity. I confidently provide the same CloSYS products to patients ranging from my adolescent orthodontic patients to patients in the healing or maintenance phase of their periodontal surgery to patients experiencing oral mucositis.
Of note, the developers with Rowpar are constantly evaluating how their products can benefit patients who suffer from various forms of oral disease. They’re beginning to discover significant improvements in the mucosa of patients suffering from erosive lichen planus. It’s my recommendation of choice for patients who are experiencing discomfort from oral lichen planus lesions and disruptive soreness from benign migratory glossitis as patients feel a relief from their transient pain within a few days of consistent use.
Additionally, CloSYS is an incredibly effective gingival irrigant and is my irrigant of choice following diode laser therapy, as it doesn’t inactivate fibroblasts unlike its “tasty” older brother, 0.12 percent chlorhexidine gluconate.
I encourage you to visit the CloSYS website to evaluate how this product line may directly benefit your patients.
I find it ironic that as I write this article, I’m on an airplane returning from a weekend in my hometown of Greendale, Wisconsin. In this small suburb, my Grampie resides in the home he and my late grandmother raised their children and grandchildren in. Despite being a decorated World War II veteran and patriarch of our family, Grampie’s health is rapidly declining, and I found it necessary to spend some quality time with him while I still have time with him. Grampie was once a strong, articulate man with wit and humor. He’s now a fragile man who refuses to wear his dentures, loves a good chicken pot pie (when we can get him to eat it) and spends his best days with his rescue Shetland Sheepdog, Daisy (who seems to enjoy most of Grampie’s pot pie these days).
I also had the opportunity to road trip through Wisconsin’s green highways to Oshkosh, Wisconsin, where my Grandpa Bob lives. Grandpa Bob is awaiting the sale of his condo on the golf course and was moved into a senior living community after a series of falls and pneumonia that left him requiring daily medical assistance. A beautiful black-and-white portrait of my late grandmother is prominently hung over his bed. Despite the cane he uses to walk, Grandpa Bob’s mind is just as quick and sharp as ever. We spent a beautiful afternoon exchanging stories, cracking jokes and enjoying each other’s company.
Nostalgia aside, it’s incredibly difficult boarding a plane and saying goodbye to Grampie and Grandpa Bob. The strong, heroic men who once carved the holiday turkey, helped decorate the Christmas tree, enjoyed our concerts and plays, taught me how to ride a bike without training wheels, spent the better part of the 1980s documenting my childhood with a camcorder on their shoulder, snuck me my first sip of beer, handed me that awesome check at graduation, and helped me fix my first car are the same men who are now widowers with frail bodies, declining health and around-the-clock care.
L-R: Katrina, Grandpa Bob, Elizabeth and Katrina's dadAs I sit on this plane somewhere over Iowa, I have to trust that my Uncle Russ will provide the care that Grampie needs to live his final moments in peace and with dignity, and that Grandpa Bob will be treated with respect and kindness in his assisted living facility by the nursing staff. Never forget that every geriatric patient you see is someone’s beloved Grampie or Grandpa Bob, deserving of the utmost in kind and empathetic support when entrusted to your care. As our geriatric patients enter the second half of their lives and find themselves becoming increasingly dependent and frail, it’s important that dental providers understand their role as caregivers with the ability to support their unique dental needs.
On a personal note: If you’re fortunate to have grandparents who are still alive, or elderly family members in general, consider giving them a call. Their worlds truly light up when they’re involved, when they know you’re thinking about them and when they feel loved.
This article is dedicated to my Grampie and Grandpa Bob, two strong men who have enriched my life so much.