Seniors and Oral Health
Good Oral Hygiene
More and more people today are avoiding the need for dentures, bucking the notion that false teeth are a normal part of growing older.
In fact, there’s usually no reason for you NOT to keep your teeth your entire life, providing you maintain a healthy balanced diet and practice good oral hygiene.
Another desirable side effect of good oral hygiene: avoiding more serious problems such as hypertension, cardiovascular disease, diabetes, and even stroke. Indeed, medical research shows that a healthy mouth equates to a healthy body.
Who knew? The mouth is a part of the digestive system of the body. Without a functioning masticatory (chewing and initial breakdown of food) system, the rest of the digestive system is challenged. Your stomach, intestines and excretory system have to work much harder to break down larger and more fibrous pieces of food to access nutrients and rid waste. This additional hardship can lead to digestive problems such as indigestion, irritable bowel syndrome (IBS), limiting foods containing certain supplements and nutrients (i.e. not eating fiber-loaded apples because you can’t chew them), Gastroesophogeal Reflux Disease (GERD), etc. AND because most people in this age group are also on medications which cause xerostomia (dry mouth), the system is already compromised even if you have all of your teeth.
Another thought to keep in mind is that aging takes a general toll on our bodies. You cannot maintain some of the activities you are used to enjoying. Many times, social festivities as we mature include more eating out, or going to a friend’s or neighbor’s house for dinner, having people over for cocktails and hors d’ouevres; in other words, eating is involved in your social hour. If you cannot eat easily, or enjoy eating whatever you want, you limit yourself in these activities.
And just because you’re getting older doesn’t mean you can relax on your daily routine. This means brushing twice a day, flossing, and rinsing.
Dexterity and Arthritis
Your dexterity has changed. Think about signing your name. Does it look the same as it did 5-10 years ago? You are not doing anything differently, but the way you sign your name changes as dexterity changes. People who suffer from arthritis or other problems have more difficulty and even painful to practice good oral hygiene.
Thankfully, industry has responded with ergonomically designed devices such as toothbrushes and floss holders that make it easier to grasp and control. Mechanical tooth brushes and proxa brushes are the best.
You can also use items around the house to help you. Inserting the handle of your toothbrush into a small rubber ball, or extending the handle by attaching a small piece of plastic or Popsicle stick may also do the trick.
Floss can also be tied into a tiny loop on either side, making it easier to grasp and control the floss with your fingers. You can also choose to use the flossers with the plastic handles available at drugstores.
One popular flossing adjunct is called a water pick, or irrigator.
Water picks use powerful tiny bursts of water to blast away food particles and other debris in hard-to-reach areas of your mouth. Dentists use professional-grade water picks when preparing a tooth for restoration, or in general cleaning and exams.
Having to wear dentures is one of the risks of poor oral hygiene. Older adults also may be at risk for such oral problems as:
- Gingivitis – a condition that occurs when bacteria and plaque invade below the gum line, causing inflammation of the soft tissues and, sometimes, bleeding. Advanced gingivitis can lead to formation of a substance called tartar (also called calculus), which is a hard and crusty coating that can usually only be removed by scraping.
- Periodontal (gum) disease – Usually the advanced stages of gingivitis, gum disease begins with infections in the gums that can spread to the teeth and bones. Advanced forms of gum disease can lead to a host or problems that can only be treated by extreme measures such as extraction. Click here for more information on periodontitis.
- Dry mouth – Older adults sometimes experience diminished production of saliva and a condition called dry mouth, which leads to problems such as swallowing or speech difficulty. Certain kinds of medications and even cancer treatment can cause dry mouth. One of the more serious consequences of dry mouth is greater susceptibility to cavities and other oral problems because saliva acts as a natural rinsing agent in the mouth. This can also cause your denture to rub or fall out since there is less saliva for suction and lubrication.
- Oral cancer – Older adults are more prone to certain kinds of oral cancer. Head and neck cancer in 2012 was reported as the sixth most common cancer. The five-year survival rate (the percentage of those with oral cancer who will still survive after five years) is 81% when detected early, but drops to 42% if larger when detected and treated, to a low of 17% when there is metastasis. If your dentist identifies something suspicious, and recommends a biopsy or a second opinion, it can save your life. If you decide not to follow the recommendations, the consequences are sometimes harsh. Early signs of oral cancer are unusual lumps, patches or lesions, as well as unexplained or chronic bleeding or areas which have trouble healing.
- Root surface cavities – With recession or cavities which already invade the area below the gums comes cavities on root surfaces. Under bridges and adjacent to teeth which hold partial dentures are other areas you commonly find these cavities. Fluoride varnish (applied by your dentist or hygienist) and high fluoride toothpastes (prescription) are helpful in fighting these cavities and even strengthening the root surface. These are both low-cost ways to help prevent costly dental work, or the cost of losing and replacing a tooth.
- Compromised digestion – The digestive system is set up to accept food which is properly broken down first by the teeth, and the digestive salivary enzymes (amylase). If the teeth are not functional or there are fewer teeth to accomplish the task, there is compromise, and the extra load is placed on the rest of the digestive system.
- Recession – Recession is when the gums recede revealing a weaker root surface of the tooth. The root surface of the tooth was never meant to withstand the acids and attacks from bacteria caused by normal every-day eating and digestion. Enamel is strong, and cavities can form on enamel, they can form much easier on the root surface. The root surface is also more porous than enamel, so there can be tooth sensitivity associated with recession. When recession of the gums occurs, it means that some gingiva (gum tissue) is now missing. With this loss of gum tissue, bone loss occurs simultaneously. Loss of bone and tissue means loss of the very structures which hold teeth in place. A fourth consequence of recession is that because the gums no longer fill the areas between your teeth, more food and debris is caught between the teeth and remains there. This causes cavities in these areas, many times under existing dental work such as crowns, bridges or fillings. Treatment for recession can be as simple as utilizing a desensitizer, or changing the way you clean your teeth, to periodontal surgeries or grafting to prevent tooth loss.
- Cracked teeth – Over time teeth will show signs of wear. Many times, they fracture. Even a person who has had no cavities can fracture a tooth and require support such as a crown. Teeth with large fillings can last many years without requiring any intervention, but when they do start to breakdown, it is often a crown which is required to preserve the tooth. Because the crown encircles the tooth, it prevents opening of the fracture and further splitting when the tooth is used for chewing. If a tooth splits too far down the root, there is no long-term solution for keeping the tooth, and removal is usually the only option. Cracks are not always visible on radiographs or when visually observing the tooth. Sometimes your symptoms, if any, are the only way to diagnose a fracture.
Overall, we age, period. Our teeth age as well as our bodies. The better we take care of them, the longer they last. Dr. Michaels often asks patients if they are proactive or reactive. No matter which you decide, teeth will require more maintenance as they have endured more years of use. Dentistry has advanced along with medicine, and the options to help you keep your teeth for a lifetime are readily available.