Elder Dental Care Webinar with Dr. Nicholas Tong

Inspire Dental Group hosted an in-depth patient education webinar on the topic of oral health for older adults, bringing together two leading voices in dentistry to share the latest knowledge on maintaining a healthy mouth at every stage of life. Moderated by Inspire Dental founder Dr. Wilson J. Kwong and presented by Dr. Nicholas Tong — one of Canada’s foremost specialists in geriatric dentistry — the session covered everything from daily home care routines to the clinical concept of oral frailty and its impact on overall health. Whether you are an older adult looking to protect your teeth, a caregiver supporting a loved one, or a dental professional seeking practical guidance, the webinar offers valuable, evidence-based insights that are both accessible and actionable.

Meet the Speakers

The Changing Landscape of Elder Dental Care

Dental care for older adults has shifted dramatically over the past few decades. While previous generations often lost their teeth entirely by their senior years, today’s older adults — particularly Baby Boomers — are keeping their natural teeth well into their 70s, 80s, and beyond. In fact, less than a quarter of older Canadians are now fully edentulous (toothless), and the average older adult retains nearly 20 natural teeth.

This is great news — but it also means that dental care in later life has become more complex. With more natural teeth come more opportunities for decay, gum disease, and other issues that require ongoing, attentive care. Canada’s growing population of adults aged 85 and older only makes this more urgent.

Understanding the Spectrum of Older Adults

Not all older adults have the same dental needs. Dr. Tong describes three broad groups:

1. Functionally Independent (approx. 70%) — These individuals live in the community, manage daily tasks on their own, and are largely capable of maintaining their own oral hygiene with guidance.
2. Frail (approx. 20%) — Living at home with some assistance from family, friends, or caregivers. May need support with oral care routines.
3. Functionally Dependent (approx. 10%) — Dependent on others for activities of daily living. Often reside in long-term care or assisted living, requiring significant caregiver involvement in oral hygiene.

Understanding where a patient sits on this spectrum is essential for tailoring dental treatment plans and hygiene recommendations appropriately.

What Is Frailty — and Why Does It Matter for Dental Care?

Frailty is not just a vague sense of being “old and tired.” It is a clinically measurable syndrome defined as an increased vulnerability resulting from age-related decline in physiological reserve across multiple systems, making it harder to recover from everyday stressors — including dental procedures.

Signs of frailty include:

• Unintentional weight loss in the past year
• Weak grip strength
• Slow walking speed
• Low physical endurance or energy
• Reduced physical activity

If a patient shows at least three of these five characteristics, they are considered to screen positive for frailty. Dentists may also use the Rockwood Clinical Frailty Scale (ranging from 1 = very fit to 9 = terminally ill) to assess a patient’s overall status and inform treatment planning.

Why does this matter for dentistry? A dental infection or even a lengthy appointment can be a meaningful physical stressor for a frail patient. Recognizing frailty helps dental teams plan accordingly — keeping visits manageable, procedures appropriate, and treatment plans realistic.

Aging Well: The AVOID Framework

For patients and caregivers wondering what they can do to support healthy aging and reduce the effects of frailty, Dr. Tong recommends the AVOID Framework from the Canadian Frailty Network:

• A — Activity: Regular physical exercise, especially weight-bearing movement, supports strength and overall health.
• V — Vaccinations: Stay up to date on immunizations in consultation with your family doctor.
• O — Optimize Medications: Work with your pharmacist and physician to review and reconcile your medication list regularly.
• I — Interaction: Social engagement with family, friends, and community supports cognitive function and mental well-being.
• D — Diet & Nutrition: A balanced, nutritious diet is foundational to healthy aging.

These lifestyle factors can meaningfully mitigate the progression of frailty and help extend your “health span” — the years lived in good health and independence.

Essential Home Oral Hygiene for Older Adults

Good oral hygiene is one of the most powerful tools for preventing dental disease at any age. Dr. Tong outlines the following core routine for older adults:

• Brush teeth twice daily with a fluoride toothpaste
• Clean between teeth with floss or interproximal (interdental) brushes at least once a day
• Use fluoride toothpaste — fluoride helps remineralize early cavities and arrest decay
• Consider high-fluoride toothpaste (e.g., Prevident 5000) for patients at high cavity risk, such as those with a history of decay or significant gum recession — ask your dentist
• Limit sugary and acidic foods and beverages, focusing on frequency as well as quantity
• Visit your dentist and dental hygienist at least twice a year — or more frequently (every 3–4 months) if you are at high risk

Caring for a Loved One’s Teeth: Tips for Caregivers

Caring for someone else’s oral health — especially a parent or spouse with dementia or Alzheimer’s — presents unique challenges. One common issue is care-resistant behavior, where the person may close their mouth, push the caregiver away, or refuse oral care altogether.

Practical tips for caregivers:

• Use interproximal brushes instead of floss. These small, pipe-cleaner-style brushes are easier to maneuver and are gentler for cleaning between teeth, under bridges, and around implants. They come in different widths — ask your dentist or hygienist which size is right.
• Be consistent and gentle. Brushing another person’s teeth takes practice; routine and patience go a long way.
• Consult the Canadian Dental Association’s Alzheimer’s resources. Their website (search “Canadian Dental Association Alzheimer’s”) includes practical guides for caregivers.
• Prepare early. If a loved one has a dementia diagnosis, begin involving family members in oral care routines before it becomes necessary — the earlier the better.

Denture Care: What You Might Not Know

Many older adults still rely on partial or complete dentures, and proper care is often misunderstood.

Key denture care guidelines:

• Clean after every meal using hand soap and water — not toothpaste, which can scratch and damage the acrylic resin
• Avoid whitening toothpaste entirely on dentures — the abrasives will degrade the material over time
• Use an alkaline peroxide-based cleaning tablet as needed for deeper cleaning
• Never sleep with dentures in — always remove them at bedtime
• For healthy, independent older adults: Soak dentures in clean, fresh water overnight, changing the water daily
• For frail or long-term care patients: Store dentures dry overnight — research from UBC found this reduces fungal colonization compared to water soaking, particularly when water isn’t changed regularly

A Note on Dry Mouth and Swallowing Difficulties

Dry mouth (xerostomia) significantly increases the risk of cavities and gum disease. It is a common side effect of many medications taken by older adults, making medication reviews especially important.

Dysphagia (swallowing difficulties) — often caused by stroke or neurological conditions — is also common in older adults. Patients with dysphagia should generally avoid fluoride mouth rinses, as accidental swallowing or aspiration poses a risk. Speak to your dentist about alternative fluoride delivery options that are safer for patients with swallowing challenges.

A Note on Dry Mouth and Swallowing Difficulties

Dry mouth (xerostomia) significantly increases the risk of cavities and gum disease. It is a common side effect of many medications taken by older adults, making medication reviews especially important.

Dysphagia (swallowing difficulties) — often caused by stroke or neurological conditions — is also common in older adults. Patients with dysphagia should generally avoid fluoride mouth rinses, as accidental swallowing or aspiration poses a risk. Speak to your dentist about alternative fluoride delivery options that are safer for patients with swallowing challenges.

Oral Frailty: The Mouth-Body Connection

Emerging research — much of it from Japan — highlights a concept called oral frailty: a gradual decline in oral function that is linked to broader physical frailty, sarcopenia (muscle loss), and malnutrition.

Signs of oral frailty include:

• Difficulty articulating words clearly
• Slight choking or coughing while eating
• Food spillage from the lips while eating
• Increasing difficulty chewing hard, sticky, or crunchy foods
• Dry mouth
• Tooth loss

As oral function declines, patients may unconsciously shift to a softer, higher-sugar diet — which further increases cavity risk. Research shows that patients with high levels of oral frailty have significantly poorer survival outcomes than those with healthy oral function, underscoring the deep connection between oral health and overall health.

The good news: frailty is potentially reversible or mitigable with appropriate intervention. This may include visits to speech-language pathologists, dietitians, physiotherapists, and occupational therapists — all working alongside your dental team.

How Dental Teams Approach Frail and Aging Patients

For dentists working with frail or dependent older patients, Dr. Tong emphasizes a values-based, patient-centred approach:

• Present options clearly — explain the risks and benefits of all pathways and let patients and families make informed decisions.
• Simplify treatment plans where possible — for patients on a declining trajectory, the goal is comfort, function, and dignity, not perfection.
• Prioritize pain-free and inflammation-free oral health over complex restorative procedures when appropriate.
• Update your dental team on any changes to your medical history or medications — your dentist needs this information to care for you safely.

As Dr. Tong puts it: “Don’t let the perfect be the enemy of the good.”

Key Takeaways

• Older Canadians are keeping their teeth longer than ever — and that means ongoing, attentive dental care matters more than ever.
• Frailty is measurable and can inform how dental care is planned and delivered.
• A consistent home care routine — brushing, interdental cleaning, fluoride, and a healthy diet — is the cornerstone of long-term oral health.
• Caregivers play a vital role and can access specialized resources to help with the oral care of loved ones with dementia.
• Oral health and overall health are deeply interconnected. Your dental team is part of your broader healthcare circle.

The following article is based on a patient education webinar hosted by Inspire Dental Group, featuring one of Canada’s leading experts in geriatric dentistry.