Management of Altered Taste and Sensitive Teeth in Elderly Patients
Use herbs and spices instead of salt to enhance food palatability, limit cariogenic foods (sugars, refined carbohydrates, sticky foods), ensure adequate hydration, and treat sensitive teeth with potassium nitrate-containing toothpaste applied twice daily for up to 4 weeks. 1, 2
Addressing Altered Taste (Dysgeusia)
Flavor Enhancement Without Salt
Replace salt with herbs and spices to improve food palatability while keeping salt intake below 6 g/day. 1 This is critical because elderly patients commonly increase salt use to compensate for diminished taste, which significantly increases hypertension risk—affecting over 50% of older adults. 1
Avoid salt substitutes in patients with diabetes, heart failure, or hypertension due to high potassium and sodium content that can worsen renal function. 1
Do not use flavor enhancers as routine intervention—evidence does not support their systematic use according to the American Society for Nutrition. 3
Dietary Modifications for Dental Health
Reduce frequency of snacking and eliminate cariogenic foods including sugars, refined carbohydrates, sticky candies, crisps, and biscuits. 1 These foods are particularly problematic because they are difficult to clear from the mouth and directly contribute to chronic dental disease, which is highly prevalent in elderly patients with reduced manual cleaning ability. 1
Provide specific dietary counseling for edentate (toothless) older adults, as their nutritional needs and food texture requirements differ substantially. 1
Hydration Management
Ensure women consume at least 1.6 L of fluids daily and men consume at least 2.0 L daily. 1, 3 This is essential because aging dampens thirst sensation and impairs kidney concentration ability, while adequate hydration maintains saliva production necessary for taste function. 1
Water, milk, tea, coffee, and unsweetened fruit juice all contribute to fluid intake. 1
For underweight or frail patients, recommend milky drinks that provide energy and protein alongside hydration. 1
Managing Sensitive Teeth (Dentinal Hypersensitivity)
First-Line Treatment
Apply at least a 1-inch strip of potassium nitrate-containing toothpaste onto a soft bristle toothbrush and brush thoroughly for at least one minute, twice daily (morning and evening), ensuring all sensitive areas are brushed. 2 This is the most inexpensive and efficacious first-line treatment for most patients. 4
Minimize swallowing and spit out after brushing. 2
Continue treatment for up to 4 weeks. 2
When to Escalate Care
- Stop use and refer to a dentist immediately if pain or sensitivity persists after 4 weeks or if the problem worsens. 2 Persistent sensitive teeth may indicate serious underlying pathology requiring prompt professional care. 2
Dental Hygiene Counseling
- Provide advice on proper dental hygiene techniques, as reduced manual cleaning ability in elderly patients substantially increases risk of chronic dental disease. 1
Critical Assessment Considerations
Medication Review
Review all medications, as drug use is the most common cause of taste disorders in elderly patients (21.7% of cases). 5 Acetylcholinesterase inhibitors and anticholinergic medications specifically worsen taste perception through multiple mechanisms. 3
Periodically reviewing pharmacological therapies is essential because drugs used to treat chronic diseases typical of the elderly are also potential causes of taste disorders. 5
Screen for Nutritional Deficiencies
- Assess for B vitamin deficiencies, particularly B12 and folate, as these are essential in at-risk elderly populations. 3 Zinc deficiency accounts for 14.5% of taste disorders in older adults. 5
Evaluate for Systemic Disease
Screen for diabetes mellitus, chronic kidney disease, GERD (affects 8-19% of adults), and other chronic conditions that directly impact taste function. 3
Assess for neurological symptoms including bradykinesia, tremor, cognitive changes, or prior stroke, as progressive neurologic diseases cause taste alterations through direct neural pathway damage. 3
Common Pitfalls to Avoid
Do not allow patients to compensate for taste loss by increasing salt intake—this creates a dangerous cycle of hypertension risk in a population where cardiovascular disease is already a major modifiable risk factor. 1
Do not overlook oral and dental pathology—chronic dental diseases, atrophic glossitis, and oral infections directly impair taste receptor function and are extremely common in elderly populations. 3
Do not dismiss sensitive teeth as trivial—they may indicate serious underlying dental pathology requiring professional evaluation, particularly in elderly patients with high susceptibility to chronic dental disease. 2
Do not forget that taste disorders often go unrecognized or underestimated in elderly people—assessing gustatory function should be part of comprehensive geriatric assessment, especially in patients who are malnourished or at risk of malnutrition. 5