Mealtime Partners, Inc.

The Importance of a Healthy Mouth and Teeth to Enjoying Eating

Have you ever had a canker sore in your mouth? If you have, you will be aware of how difficult it is to enjoy eating when every bite that you take hurts. The same thing applies if you have toothache. It is almost impossible to enjoy a bite of food let alone a full meal if your mouth or teeth hurt. Common causes of a sore mouth are: a sharp or broken tooth, biting your cheek, tongue or lip, burning your mouth from hot food or drink, braces, or chewing tobacco.  

Many caregivers and healthcare providers overlook problems that might stem from a sore mouth. It is not uncommon to think that someone’s reduced appetite is directly related to their being ill, yet it might be because eating is painful. Before drawing conclusions about the cause of the reduced food intake, it is wise to check inside the mouth of someone who is unable to verbalize what is wrong, but who exhibits reduction in food consumption, behaves as if they are uncomfortable, or just seems not the same as usual.

Over time, poor oral health will lead to overall reduction in health. Lack of oral care can result in tooth decay, gum disease and other oral problems, including infection. In addition to the health issues associated with these conditions, when teeth are not brushed and flossed, the individual will develop bad breath that will lead to a negative reaction from those who are around him or her. This is damaging to self-esteem and social interaction.

Daily oral health care is extremely important for everyone, and includes brushing and flossing, and sometimes rinsing with fluoride or other rinses. For individuals with disabilities that are severe enough to make it impossible for them to brush their own teeth, oral care can be very difficult. This problem can impact people of all ages and for a wide variety of reasons. It is common for oral care and regular visits to the dentist to be of a lower priority than many other health issues and oral care is, therefore, sometimes neglected.

Parents of children who are born with, or acquire, severe disabilities, are confronted with an ongoing, extensive, level of care that they must provide for their child. In many instances the child has multiple health problems that must be addressed. Because of the level of care that is required, oral health is often overlooked as being less urgent or significant. Yet, it is beneficial, in the long run, to undertake some level of oral care from a very early age. Starting early makes the care become part of a familiar routine and removes some of the stress that can exist with oral care. For children who have serious aversions to being touched on or around their mouth, consult a speech pathologist, pediatric dentist, or other early intervention specialist for advice on how to desensitize the child’s mouth enough to enable daily brushing without it being a battle.

Beyond daily brushing and flossing, regular preventative care dental checkups are recommended to maintain a healthy mouth. There are two major difficulties that exist with undertaking dental care: 1. Finding a dentist who is qualified and comfortable with treating people with disabilities who might be difficult to work with, have involuntary movement, or are afraid, and therefore might need sedation for routine care; 2. Being able to afford dental care. Lida¹, et al., concluded that children who were screened as having several special healthcare needs were the most likely to have unmet dental care needs and the lowest rate of dental care use compared with children who did not have any special care needs. An article titled “Dental Care” provides insight into finding a dentist and the use of anesthesia to facilitate behavior control during dental treatment. Also, the Office for People with Developmental Disabilities in New York, through their Task Force on Dentistry, has a broad range of information which can be found on their website at www.opwdd.ny.gov/hp_dentistry_index.jsp.

For those who do not have dental insurance coverage, being able to afford dental care is in many cases prohibitive. The reimbursement rate for Medicaid recipient’s dental care is minimal to nonexistent and, therefore, it is difficult to find services for those individuals. Oddly, the movement in the United States to deinstitutionalize the care of adults with disabilities by moving them into community based living situations, has lessened the availability of dental care. Thirty years ago dentists were willing to provide dental care in a centralized setting (institutions), because they could treat many people in one location. Now, when people live in many different communities it is hard to find a dentist who is: willing to treat Medicaid patients because of the inadequate reimbursement rate; has training and experience treating people with disabilities; and, is willing to treat patients who might be difficult to work with, and require additional staff help and take much longer to treat².

The U.S. Census Bureau estimates that 20 percent of the population has some type of disability and 12 percent are severely disabled. More than a third of adults over age 65 are severely disabled. With our growing population of seniors, this special-needs population can be expected to increase, thus increasing the number of individuals whose dental needs will be unmet³. Many seniors have lost many or all of their teeth and/or have dentures. For some this does not present a problem but for others, ill-fitting dentures can cause a sore mouth, or can make chewing difficult. Dentures need regular cleaning and also gums should be regularly cleaned to prevent gum disease and bad breath.

The difficulty of affording and acquiring dental care reinforces the need for diligent daily care of both teeth and the mouth. The U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, publishes a document titled: Practical Oral Care for People With Developmental Disabilities, Dental Care Every Day: A Caregiver’s Guide. It stresses that “A healthy mouth helps people eat well, avoid pain and tooth loss, and feel good about themselves.” The guide provides an overview of how tooth brushing, flossing and dental visits can be accomplished. However, it does not provide details or recommendations for dealing with difficult circumstances. 

There are several organizations that can assist with finding appropriate dental care. They include the American Academy of Developmental Medicine and Dentistry and the American Association of Geriatric Dentistry. The University of Florida, College of Dentistry⁴ at www.dental.ufl.edu/faculty/pburtner/scdlinks/ provides an extensive list of resources that can be useful.

In conclusion, regardless of the age of the individual, everyone should receive regular dental care, but the principal barriers to care are limited public and private dental insurance and the limited number of dental professionals who are qualified to treat those who have severe disabilities. Without dental care, problems with teeth and mouth will occur and this will remove the enjoyment of meals and may lead to weight loss and ill health. Therefore good oral care is extremely important.