One need only look around the majority of long term care facilities to see the prevalence of women residents. As women age, by age 85, they outnumber men at least two to one. Aging accounts for the loss of social support—including spouses, partners, friends, and family members—which may result in the need for help with daily care, including oral care. With aging comes a higher risk for oral diseases, regardless of gender.

Men, Women Differ In Needs

Clinicians know that increased medications often mean a decrease in spit or saliva. Most people don’t realize or value the important role that saliva plays in protecting their teeth and mouths. Various chronic diseases, such as arthritis or stroke, can make it more difficult for elders to clean their mouths. These chronic diseases may result in residents needing assistance with their daily oral hygiene care.
There are subtle differences in oral health between men and women as they age. Men have slightly higher levels of active oral disease, such as cavities (dental caries) and gum (periodontal) disease, when compared with people under the age of 65. However, the amount of dental care men and women receive over a lifetime is about the same. This mirrors the medical fact that in most studies, older women may have better health outcomes than men, even when treatment was the same or less.
Women as a group, especially older women, make up the majority of adults living in poverty. Older women’s loss of social support combined with poverty may result in their entering long term care with poorer oral health. It is also important to know that most women, whether they have worked outside the home or not, have been called upon to be caregivers at some point in their lives. This role may spill over into how they choose to care for themselves and their oral health.
Research shows that women are more likely to prefer prescription drugs over invasive treatment, and though the reasons are not clear, it suggests they may be making less stressful, less invasive choices in order to accommodate their daily lives.

Providers Should Encourage Daily Care

There is a definite improvement to be seen in quality of life with a fresh, clean, and pleasant-smelling mouth. Women are more likely to embrace preventive and proactive care than men. This concept can be used to encourage patients or their loved ones to participate in daily care of the mouth.
The benefits may have to be experienced for a resident to become a believer. And, frankly, it might have been a long time since someone has pointed out the needs and benefits of this often-missed daily ritual.
Late-life depression is more common in women than in men in long term care facilities. Although this may superficially appear to have little to do with poor oral care, it can be a factor.
If people do not have the energy or drive, and cannot see the benefits to cleaning their mouths every day, it can be an easy thing to forget to do. As people get older, this lack of daily care can actually increase oral disease even faster than in a younger person.
Decreased saliva and recession of the gums that leads to more exposed tooth roots are more common in the elderly and can accelerate cavities and periodontal disease. Positive feedback regarding all the benefits of daily oral care is not only helpful, but it also provides encouragement for the woman who may be resistant.

Be Mindful Of Meds

Since women are more likely to have osteoporosis, they may be taking bisphosphonate medications. These medications (such as Fosamax), which are often used to treat osteoporosis, can also increase the risk of causing a non-healing bone lesion to form in the mouth.
These bone lesions, which are painful, open wounds in the mouth, are more likely to occur if invasive treatment like a tooth extraction is done.
Dentists always need to know what medications a patient is taking prior to providing any dental treatment to avoid this possibility.
Likewise, an intravenous form of the bisphosphonate drugs is sometimes used during the treatment for breast cancer and some lymphomas. Therefore, it is very important for women to tell their dentists if they have had treatments for cancer in the past and, if possible, supply the dentists with a list of the medications, even if the treatment occurred years earlier.
Teeth were designed to last a lifetime, and many more adults are entering their senior years with the expectation of keeping their natural teeth for a lifetime. Older women benefit from good oral health through improved chewing, speaking, swallowing, and smiling, as well as enjoying the social benefits of good oral health.
Regular dental exams and daily oral care remain vital pieces of a preventive strategy to maintain good health and function whether older women reside at home or in a long term care facility.
Gretchen Gibson, DDS, MPH, is director of Oral Health Quality Group, VA Office of Dentistry and VA Health Care System of the Ozarks, Fayetteville, Ark., and Linda C. Niessen, DMD, MPH, is vice president and chief clinical officer, Dentsply International; and clinical professor, Department of Restorative Dentistry, Texas A&M University, Baylor College of Dentistry, Dallas.