Oral hygiene for institutionalized seniors who require high levels of care has been a research focus for dental professional Shirley Gutkowski, RDH. She said numerous studies have shown that poor oral hygiene among institutionalized seniors is a critical and worsening issue. Patients who are suffering from dementia, paralysis or various forms of palsy may have trouble keeping their mouths, gums and teeth free of food debris. Relying on poorly trained and poorly paid nursing assistants to do this for them has proven repeatedly to be a nonstarter, Gutkowski said.
Gap in oral care
“I’m always looking at how to do things better to reduce the amount of decay in my patients. Dental hygienists have thousands of hours of training in how to properly clean someone’s teeth,” Gutkowski told NutraIngredients-USA. “Nursing assistants get a week of training at best. And then they practice on each other.”
In addition to more training, dental hygienists working in dental offices can rely on a fairly high level of patient compliance. In other words, the patients understand why certain operations are being performed on their teeth and will cooperate in the treatment. No so in long term care facilities, Gutkowski said. It makes for a highly challenging work environment to say the least.
“All the studies that have been done on trying to get nursing assistants to do long term oral care have shown that it just doesn’t work. They get bitten; they get spit upon. Nursing assistants are just not equipped to deal with this,” she said.
Gutkowski said the extremely poor level of oral hygiene that results can start a cascade of health consequences that can end up causing accelerated periodontal disease and can even be lethal. Gutkowski said there is a ‘big gun’ wide-spectrum antibiotic approach available, but it’s not clear how effective it can be in this particular setting.
“Chlorhexidine, applied with a sponge, is one strategy but it is associated with staining, alters the taste buds and it is not clear how it mixes with other medications,” she said. “Plus, chlorhexidine has never been studied in this population, and it is difficult for it to penetrate the immense of amount of build-up on their teeth.”
How cranberry might help
This is where the cranberry can be effective, she believes. Cranberry when taken orally in shot form can both coat the teeth and soak into any food debris that might be present. The ingredient has demonstrated ability to interfere with the ability of pathogenic bacteria to adhere to surfaces. This can interrupt the formation of extensive biofilms in which an excreted carbohydrate matrix allows the organisms to shield themselves from the body’s natural defenses.
“Swishing with the shot would be ideal but in this patient population is probably impractical. But with all of the debris in their mouths this will kind of quickly soak in. That’s how I envision this working,” she said.
At the upcoming Supply Side West trade show Canadian cranberry supplier Fruit d’Or will be highlighting its organic cranberry powder formulated into a prototype shot delivery form of the sort advocated by Gutkowski. Business development director Stephen Lukawski said the shot could be sweetened with xylitol, which has oral health benefits of its own, and in any case the company has been working to control the tartness of its ingredient. The formulation gets around one of the criticisms of cranberry juice cocktail, that being that those products are mostly water and sugar, with enough juice added in to provide the flavor.
“In our process we are trying to limit the pH, and we’ve been successful at that. This is where the proanthocyanidins in cranberry really provide the benefits. We have an ingredient with standardized levels of PACs,” he said.
Supply Side West
Fruit d’ Or will be exhibiting at Supply Side West in booth No. MM121.