Question: My 84-year-old mother suffers from mid-stage dementia. For the last year and a half, my five siblings and I have helped pay for a caregiver to take care of Mom during the day. We “kids” – now from 49 to 62 years of age – take turns sleeping over at Mom’s each night. Recently, Mom was rushed to the hospital to be treated for pneumonia, which flared up fairly quickly.

While she was recovering, I talked to a nurse who told me that Mom’s gums and teeth were not being properly cared for, and that, according to recent studies, there is a link between bacteria in the mouth and upper respiratory problems, including pneumonia. I thought you might like to pass this on to your readers, as I had never heard this before.

Answer: Neither had we. So we called Dr. Barbara Resnick, a professor at the University of Maryland and a Baltimore-area nurse practitioner, who is a member of the American Geriatrics Society. Resnick confirmed that yes, indeed, there is relatively new research that links bacteria in the mouth to pneumonia and other upper respiratory difficulties.

“The mouth is a place that is often overlooked by seniors and their caregivers,” explained Resnick, “and it’s not seen as a priority because of other looming health problems. While other problems are easier to see because they are visible, because problems in the mouth are hidden, they are not so obvious. But these oral problems are just as important, if not more important, to treat as are other ailments.”

Resnick, who teaches geriatric nurse-practitioners and also does clinical work at a Baltimore continuing care retirement community, told us that good oral hygiene is a “critical, critical area in long-term care for older adults,” particularly if they are institutionalized, but also if, like your Mom, they live at home.

Early diagnosis can help prevent more serious health problems caused by poor oral hygiene, such as the pneumonia that struck your mother, not to mention gingivitis, an inflammation of the gums surrounding the teeth.

According to the American Geriatrics Society, here are some key signs caregivers should watch for as indicators that a trip to the dentist is necessary:

• Growth, patches, or lesions in the mouth could be signs of malignancies and should be brought to the attention of a health care provider immediately.
• Broken or missing pieces on dentures, or dentures that no longer fit. Because older adults often lose body fat, the way in which dentures fit changes. This can cause mouth pain and discomfort.
• Dry mouth. As we age, saliva production lessens and causes dryness and discomfort of the mouth. Dry mouth is also a common side effect of many medications.
• Bad breath. While this is often an embarrassing topic for many people to address, it can serve as an indicator for more serious health problems.

As adults age, it’s often more difficult for them to brush or floss due to physical and cognitive changes. But, says Resnick, there are products available for seniors and their caregivers---- such as electric toothbrushes and toothbrushes with larger handles for easier gripping -- that make brushing and flossing easier for people who suffer from conditions likes arthritis. You can also buy longer toothbrushes or extenders that you pop onto the end of the regular toothbrush to make it longer. And there are also floss holders to make flossing easier.

Some additional tips from the American Geriatrics Society to ensure good oral hygiene for seniors include:
• Use an oral rinse -- such as water or a salt solution, using one teaspoon of salt to one quart of water -- instead of mouthwashes with alcohol, which tend to dry out the mouth.
• Take special care of dentures to avoid infections. Thoroughly brush and clean dentures after each meal, in addition to soaking them overnight.

One last tip for caregivers from Dr. Resnick: Keep a close watch on the feet. “Feet are often neglected,” she says, “because you don’t always see them.” But feet that are ignored can lead to major medical problems, particularly for seniors with conditions such as diabetes.