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Seniors -- Age Brings Changes In Dental Care Treatment

It's an indisputable fact - our bodies change as we get older and so does our need for dentistry. These changes take different forms in different people, depending on our inherited physical traits, our lifestyle and nutritional habits, and our medical conditions.

Age brings changes in oral health and your need for dental care, too. There are some specific areas where seniors need to pay close attention to protect and extend their oral health.

• Tooth Color: Plaque is an invisible layer of bacteria that forms on our teeth, and can trap stains at any age. But as we get older, plaque builds up more quickly and is harder to remove. At the same time, the tissue that lies underneath the tooth enamel, called "dentin," is changing, and those changes can make teeth appear darker. Finally, decades of consuming coffee, tea, or tobacco leave stains that build up over time.

Daily brushing and flossing are important, particularly first thing in the morning and just before bed, to combat the plaque that builds up overnight. You may also want to consult your dentist about using commercial rinses that remove plaque.

• Dry Mouth: Many seniors experience a reduced flow of saliva, sometimes as a side effect of medications such as painkillers or decongestants. For some, the lack of moisture inside the mouth can lead to sore throats, a burning sensation, hoarseness, or difficulty swallowing. In addition, if you leave dry mouth unattended, it can damage teeth, since saliva's natural rinsing keeps bacteria washed away from teeth and gums. Sugar-free chewing gum and hard candy will stimulate natural saliva, and artificial saliva and oral rinses will provide much-needed relief. Ask your dentist which commercial products are the best for you.
• Cavities: If your gums begin to recede, the portion of the tooth that used to be below the gum line is now exposed. Roots are softer than tooth surfaces and are susceptible to decay; they are also likely to be sensitive to hot and cold beverages and food. Most people over age 50 suffer from some form of dental care disease. Make sure you take good care of teeth and gums with daily brushing and flossing. A word of caution: your gums may be starting to thin. Brush thoroughly but gently to keep from tearing your gums.
• Fillings: Your fillings are getting older, too. They can weaken or crack, or your tooth may decay around the edges of the filling. As a result, bacteria can seep into your tooth, causing more decay. Regular check-ups will give your dentist the chance to keep an eye on your existing fillings.
• Gum Disease: Daily cleaning and good nutrition are critical for healthy gums. When gums become infected and diseased, they set off a chain reaction that can result in losing teeth or weakening the jawbone. Either condition creates more problems for your health and increases your medical costs. Contact your dentist if your gums become red or you have bleeding gums.
• Good Nutrition: What you put into your mouth has a direct impact on the health of your mouth -- and the health of the rest of your body. As you age and your lifestyle changes, keep your nutritional goals in mind. Balanced meals are one the best ways you can contribute to your own good health.
• Regular Exams: The dentist will check your mouth, teeth, and jaw for any problems. You should also mention any sores, swelling, or pain you might be experiencing or if you have diabetes or other medical conditions. Regular checkups enable the dentist to spot problems early. Early resolution of problems will help you keep your natural teeth.

Good dental care, regular check-ups, and good nutrition are the keys to really keep you smiling in your golden years!

By Brian J. Gray, DDS, MAGD, FICO

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The Effects Of Aging And Tooth Loss On The Mouth

Tooth loss is not part of the normal aging process. In fact, tooth loss is declining among older adults. Aging is not a general of cause oral diseases, according to dentists and other dentistry professionals, yet oral diseases such as tooth loss are more prevalent with age due to changes in the oral soft tissues, a depression of the immune system, an increase in the number of systemic diseases, a decreased ability to perform adequate oral hygiene and self dental care secondary to stroke, arthritis, Parkinson's disease, dementia, or Alzheimer's disease, and dry mouth due to greater use of prescription and over-the-counter medications.

With age, teeth become less white and more brittle; however, oral hygiene habits and use of tobacco, coffee, and tea also will affect tooth color. Teeth also can darken or yellow due to the thickening of the underlying tooth structure (dentin). Brittle teeth tend to be susceptible to cracks, fractures, and shearing. Over the years, the enamel layer (outer tooth layer) is subjected to wear due to chewing, grinding, and ingestion of acidic foods. In severe cases, the enamel is completely worn away and the underlying dentin is worn down as well. Inside the tooth (pulp), the number of blood vessels and cells decrease and fibroses increase with age; thus, capacity to respond to trauma may also decrease.

The fiber content and number of blood vessels of the periodontal (gum) tissues decrease with age. However, periodontal disease represents a pathologic or disease change and is not due to just age. The loss of bone and gum attachment (receded gums) associated with periodontal disease is collective and therefore greater in older adults. An outcome of periodontal disease is exposed root surfaces. Exposure of the root in older people probably gave rise to the term "long in tooth". Oral hygiene practices and certain medications affect the health of gum tissue. Receded gums and exposed root surfaces put older adults at high risk for dental decay (caries) on the relatively soft root surfaces. Dental caries on root surfaces is a disease that is common among older adults. Dry mouth and a diet high in sugars and fermentable carbohydrates greatly increase the risk for root caries. Dental caries are a major cause of tooth loss in older adults.

Studies show some reduced chewing effectiveness, decreased tongue strength, and increased swallowing time with age; however, the studies do not indicate that there is any real change in the ability to swallow with age.

The number of cells that produce saliva decrease with age. However, healthy, unmedicated older adults do not have reduced saliva flow. This is because the salivary glands have a high reserve capacity. Usually when a decrease in saliva flow is noted, it is associated with medication use, illness, medical conditions, or their treatment.

The number of taste buds do not appear to change with older age; thus, the ability to taste does not change significantly with age. However, smell decreases with age. Since the ability to taste is closely related to smell, taste perception may be altered in older adults.

Soft tissues of the mouth become thinner and lose elasticity with age and promote tooth loss. Soft tissue lesions are more common in older adults. Chronic inflammation such as candidiasis (fungus growth) and denture irritation also occurs more often. Wound healing is decreased due to reduced vascularity (blood flow to the area) and immune response with age.

Oral and oropharyngeal cancer is the most serious disease associated with age. Oral and oropharyngeal cancer lesions usually are not painful. Oral and pharyngeal cancer may appear as a red or white patch, a sore or ulceration, or a lump or bump that does not heal within two weeks. Swollen lymph nodes of the neck, difficulty swallowing and speaking, and voice changes also may be signs and symptoms of oral and oropharyngeal cancer. The risk for oral and oral pharyngeal cancer increases with age, use of all forms of tobacco, frequent alcohol use, and exposure to sunlight (for lip cancer). See a dentist if any signs or symptoms of oral and pharyngeal cancer are present.

By Denise J. Fedele, DMD, MS