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Getting to the Root of Dental Problems
As we get older, we’re likely to experience more problems with our teeth and gums. However, this is not just an issue with discomfort; dental issues can lead to serious problems with general health. The remedy is routine check-ups as well as regular brushing and flossing. Click here to view article.
If you thought the worst problem with ignoring your teeth might be a cavity down the road, you should think again. As we get older, poor dental health can lead to a host of serious problems.
Researchers have found that issues with the teeth, gums and tongue can lead to many diseases in the rest of the body, including heart or liver disease, eating disorders, diet deficiencies, anemia, diabetes, arthritis, HIV, osteoporosis and even some autoimmune diseases.
For example, recent studies show a correlation between gum disease and heart disease. One study suggests that people with severe periodontal (gum) disease face double the risk of fatal heart disease, and other studies have found a link with higher rates of stroke. In certain circumstances, a tooth infection has the potential to cause bacterial endocarditis—an infection of the heart’s inner lining or the heart valves. Bacteria in the bloodstream can stick to the heart’s valves or damaged tissue and damage or even destroy the heart valves (“Senior Dental Problems and Taking Care of Elderly,” April 4, 2013, A Place for Mom).
“General health can affect oral health and oral health can affect general health,” says William Bailey, U.S. Public Health Service chief dental officer and acting director at Division of Oral Health National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (“Older Adults and Oral Health: Inspiring Community-Based Partnerships for Healthy Mouths,” Cross-Federal Initiative: Expanding Access for Older Adults, May 15, 2013 webinar, Administration on Aging).
For example, “People who have significant tooth loss may either limit their intake of food or choose other types of food, so tooth loss has been associated with both weight loss and obesity,” he says. ”We also know that extensive and complete tooth loss may restrict social contact, inhibit intimacy and that tooth loss can affect speech which in turn limits social interaction and detracts from physical appearance and lowers self-esteem.”
Dental Changes to Expect from Aging
Several factors associated with aging can increase the risk for tooth decay. For example, medications such as antidepressants, antipsychotics, beta blockers and antihistamines increase the likelihood of dry mouth, which reduces saliva. Without saliva, mouth and gums aren’t lubricated, which promotes bacterial growth and prevents minerals such as calcium, phosphate and fluoride from remineralizing the surface of the tooth when decay begins.
As we age, our mouth’s soft tissues (gums and cheeks) lose their ability to stretch, and muscles become soft and weak. Further, with less saliva, chewing becomes more difficult, and your mouth becomes more easily irritated and heals more slowly than when you were younger.
Other changes are associated with aging (from “Basic Dental Health for Older Adults,” University of Missouri Extension):
Tooth decay: The rate of decay can increase as you age, especially if the amount of saliva is reduced. In older adults, tooth decay appears most frequently at the gum level. When exposed, the root portion of a tooth is especially subject to decay. Gumline or root decay is difficult to restore with fillings, because decay often recurs around this type of filling soon after it is placed.
Periodontal disease: Generally found in varying degrees in older adults, this disease becomes more destructive if not treated. In the elderly, periodontal disease is a primary cause of tooth loss. Watch for red or swollen gums that bleed with the slightest irritation. Pockets often develop between teeth and gums and can pack or trap food debris.
Brittleness: As we age, our bodies supply less blood and nerve tissue to teeth, causing tooth pulp to gradually shrink and teeth to become more brittle and susceptible to chips or breaks.
Teeth wear: Because of the grinding action of chewing, tooth enamel becomes thinner. In severe cases, the hard enamel covering completely wears away, exposing a softer part of the tooth (dentin), which acidic oral fluids can dissolve. Teeth with only a fragile enamel shell are easily chipped or broken.
Drug therapy: Medications used for diseases that can affect older adults, such as heart disease, high blood pressure, depression and Parkinson’s disease, often have side effects that decrease the amount of saliva.
What You Can Do
The best way to prevent tooth problems is to do what our dentists (and parents) always told us: brush your teeth and floss regularly. Getting rid of food debris, plaque (a white residue adhering to the teeth) or calculus (solidified plaque) decreases the rate of tooth decay and gum disease.
The University of Missouri Extension recommends a medium soft brush and dental paste. For those incapable of gripping the handle, a rubber strap can be fastened to fit snugly around the hand. Brush teeth, gums and tongue at least once a day. Other steps to take include:
Rinsing: Decreased saliva means food particles adhere more easily to the teeth and gums. To resolve, you can rinse with warm water to dislodge any particles. If you use mouthwash, be aware that it can irritate dry tissue because of its high alcohol content. If used, dilute it with water.
Wiping with gauze: If you’re unable to brush or rinse because of physical issues, you can wipe your teeth and gums with a wet piece of gauze to remove debris.
Dental aids: For seniors with limited movement, the larger handles of electrical tooth brushes can be held more easily than non-electrical, and the mechanical movement of the brush aids movement. Also, water irrigators can be useful in removing particles from between teeth. Interdental cleaners, handles with small changeable brushes, can clean between teeth, which is especially helpful when the gums have receded, creating large spaces between the teeth.
Oral lubricants. Glycerin, flavored with a few drops of lemon, can provide a lubricating effect to help treat problems created by dry mouth. Several prescription medications can stimulate saliva production or act as a saliva substitute.
Good News about Dentures
In the future, fewer seniors are going to need dentures because today’s older adults are keeping their natural teeth longer. According to a recent survey by the National Institute of Dental and Craniofacial Research, the rate of toothlessness in individuals aged 55 to 64 has dropped 60 percent since 1960. This is due to scientific developments as well as better oral hygiene practices (“Frequently Asked Questions About Senior Dental Care,” WebMD).
If you do need dentures, an alternative is dental implants, which replace tooth roots and provide a strong foundation for fixed (permanent) or removable replacement teeth that match your natural teeth.
Paying for Dental Care
The bad news for seniors is that Medicare doesn’t pay for routine dental care, so many older adults don’t get check-ups that help identify problems before they become serious.
“We know that older adults have more difficulty in assessing effective interventions to prevent and control diseases than younger adults, and one of those barriers is lack of insurance,” says Bailey of the U.S. Public Health Service. “For persons aged 75 and older, only about 14 percent of costs are covered by private insurance and . . . we know that it’s harder and harder for some older adults to come up with the resources they need. So some choose to forego treatment or choose lower-cost treatment options such as tooth extraction rather than a root canal and a crown.”
If you are a senior on a limited or fixed income and can’t afford regular dental care, many dentists offer their services at reduced fees through dental society-sponsored assistance programs. Other resources are available (see sidebar).
Dental Resources
Dental schools: These can be a good source of quality, reduced-cost dental treatment. For a complete list of schools, visit the American Dental Association. To locate dental hygiene schools, go to the American Dental Hygienists’ Association website.
Health centers: The Bureau of Primary Health Care, a service of the Health Resources and Services Administration, supports federally funded community health centers across the country that provide free or reduced-cost health services, including dental care. To obtain a list of centers in your area, call toll-free at 1-888-Ask-HRSA (1-888-275-4772) or visit http://findahealthcenter.hrsa.gov.
Medicaid: Most states provide limited emergency dental services for adults, while some offer comprehensive services. Visit the website or call 1-877-267-2323.
Local resources: Programs in your area may offer free or reduced-cost dental care. Call your local or state health department to learn more about their financial assistance programs. In many states, you can also call 211 to find services in your area.
United Way: The nonprofit may be able to direct you to free or reduced-cost dental services in your community.
Source: National Institute of Dental and Craniofacial Research
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