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  Your grandpa, in his late 70's, has suffered a stroke. He has been a diabetic for several years and there is an underlying cardiac condition. He is being looked after with the best of medicines and quality health care. He is confined to be most of the day and walking even a few steps to perform daily tasks requires support. There is not much muscle control and gargling or rinsing the mouth is difficult.

Medical history findings include congestive heart failure, diabetes and a depressed mood. He is taking digoxin daily and chlorthiazine, aspirin and an assortment of vitamins.

How can you help your grandfather to maintain oral hygiene? The dental care of the elderly, the sick and the debilitated is a matter of great importance. Everyone needs to know why.

Older people and people with chronic illness tend to have the following major problems in maintaining mouth hygiene: Lack of dexterity and skill to co-ordinate hand movements to brush effectively; A moderate to severe drying of the mouth due to reduced salivary flow and or long-term medication.

The mouth is a repository for millions of bacteria, as is well known. When the saliva flow is reduced, food particles tend to stick on or between tooth surfaces. Stagnation occurs due to lack of proper flushing out of food remnants.

Add to that the difficulty in gargling and you have a scene where gum disease and dental decay take over.

Gum disease is a source of septic focus of infection and can have far reaching effects on the body like fatigue, debility, uncontrolled diabetic levels, plantar pain, knee and joint pain.

Dental caries attacks usually occur at the neck of the teeth and cause them to break off. Brittle fracture of the teeth is very common.

As people age, over a period of years many teeth would probably have been lost. Missing teeth also makes for poor chewing abilities leading to poor digestion and subsequent gastric problems like constipation.

Since fibrous food is difficult to eat due to lack of teeth there is a tendency by the aged to opt for softer, non-fibrous food.

The care of aged dentition involves assessing needs and improving the quality of life. If it is possible to wheel him in to a dental office, an assessment will bring to light the difficulties faced. A general cleaning procedure, a check for dental decay and basic fillings can be done. Fluoride treatment can help to control decay and hypersensitivity. Dentures, which are basic but comfortable, can be fabricated in order to improve chewing and digestion. A quarterly recall would be very useful.

Home dental care: Brush with a standard brush or an automatic brush, if hand movements are restricted.

Gargling frequently after eating or drinking anything. If this is not possible, at least small sips of water to remove food particles are a must.

Mouth wash containing fluoride or anti-plaque mouthwashes at least after major meals are recommended if the patient is able to spit normally.

Well fitting dentures to be worn only during the day, need to be carefully cleaned with suitable cleansers after every meal and kept aside, soaked in antiseptic-laced water overnight.

Drinking water and eating fibrous food is planned by serving balanced meals.

In the elderly and the debilitated it is seen that there is often a dulling of the senses and a general lack of personal interest. It is for the family who care about their well being to help.

Good dental care, along with large doses of love and encouragement, can provide total care for someone you love totally!

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