Dental care is often thought of as the realm of the young. Kids are admonished to brush and floss regularly, skip sugary sweets and get braces all before entering high school. But maintaining good oral…
Dental care is often thought of as the realm of the young. Kids are admonished to brush and floss regularly, skip sugary sweets and get braces all before entering high school. But maintaining good oral and dental health is an important aspect of overall health that spans the lifetime, and for older adults, maintaining good oral health may be critical to overall wellness, quality of life and maintaining a beautiful smile.
“The first thing that older adults need to understand (about maintaining good oral and dental health) is that getting older does not mean having to lose your teeth,” says Dr. Rima B. Sehl, associate professor and director of health promotion and healthy aging at the NYU College of Dentistry in New York City. “Teeth are lost because of disease, not because we get old.”
“Having said that, as we get older, we become more susceptible to certain diseases, especially chronic diseases,” she says. These can range from simple cavities and gum disease to chronic diseases and cancer. “As we get older, we become more susceptible to these diseases because our body changes.”
Cavities are one particular area of concern. Again, cavities are often associated with children, but the American Dental Association reports that “even though it may have been years since you’ve had a cavity, your risk of cavities increases with age.” One reason why is because dry mouth can cause cavities, and dry mouth is a common side effect of many medications used to treat the chronic conditions associated with aging. “When patients have dry mouth, that increases the chances of getting decay and increases the chances of other conditions like fungal infection in the mouth and having difficulty swallowing because there’s not enough saliva to soften the food.” Sehl says you should ask your doctor whether any new prescriptions cause dry mouth so you can prevent problems before they start.
Dr. Stuart Frost, a Mesa, Arizona–based orthodontist in private practice and author of the book, “The Artist Orthodontist: Creating an Artistic Smile is More Than Just Straightening Teeth!” says that in addition to that increased risk of cavities, inflammation and infections, the structure of our mouths and teeth can change as we age, which can have a big impact on health and cosmetics. That’s because over time, the bony substructure of the mouth and face can shift and deteriorate as a simple consequence of gravity.
“As we age, gravity takes over and the skin in our faces tends to droop, the upper lip gets longer and the dental arches (the crescent shape) of the upper and lower jaw tend to crowd or narrow,” Frost says. “As the arches narrow, the teeth get more crowded and then we don’t have as much facial support.” He says this crowding process typically begins in our late 30s or 40s, and over time, it can lead to pain, difficulty cleaning the teeth and a change in the aesthetics of your smile. Stains, pits, cracks and chips caused by simple wear and tear and every cup of coffee you’ve ever drunk can also alter the beauty of your smile over time.
Gum recession is also a common problem among older adults, and the biggest reason gums recede is because of inadequate oral hygiene. Simply brushing with a soft bristle brush twice a day and flossing daily can reduce the changes of gum recession, Frost says, because if you don’t clean your teeth well enough, that can lead to a build-up of tartar under the gums, which in turn causes inflammation (gingivitis) and gum disease (periodontitis). These conditions can cause the gums to recede, or pull back from, the base of the tooth, exposing more of the root, which is more susceptible to decay than the rest of the tooth. Gum recession can be painful and is also the source of a common phrase. “When we say that people get ‘long in the tooth,’ or you see people with teeth that look longer,” that is due to gum recession, he says.
All of these problems are generally correctable, and Frost says an orthodontist may be able to widen, and broaden your dental arches, which can lead to a more youthful, aesthetically pleasing smile. “If patients want that better facial aging, they can go back to the orthodontist, widen and broaden their smile to create a more youthful smile. It also supports the face as the face ages.” Beyond just looks, making sure there’s enough room between the teeth to keep them clean means you may be able to hang on to your own teeth longer.
“The most important thing is for the public to understand that maintaining their general health is really part of maintaining their oral health and vice versa,” Sehl says. “The connection is very strong between the two and you can’t have one without the other, especially for individuals with chronic diseases.” For example, people with diabetes need to take special care of their mouth, because infections in the mouth can throw blood sugars out of balance and create other problems. “The relationship between those two diseases (oral health and diabetes) is bidirectional, so you need to keep control of one in order to control the other. In order for the diabetes to be under control, people with diabetes have to keep their mouths healthy and free of infection and vice versa. The best thing we can do is keep the mouth in check.”
This means frequent brushing, flossing, regular checkups and an awareness of your mouth and what’s going on in there. “Look in your mouth and check things that are unusual. If you see a lesion in there that wasn’t there before and doesn’t disappear in a week or two, have it checked. Most of the time it’s probably nothing, but if it isn’t, it could be caught at a very early stage and that’s very important,” Sehl says.
In addition to inspecting your own mouth, both Frost and Sehl say regular visits to your dentist are your best defense against age-related dental problems. “We need to catch things at the earliest stage possible because the agony of the disease itself and the management of the disease and the cost of the disease is much less when you catch it early,” Sehl says.
When it comes to brushing, “the general rule is to brush twice a day,” she says. “The most important brush is in the evening because when we sleep, our saliva is at its minimal,” so it’s not as able to clear away bacteria and plaque that may be present in the mouth and on the surface of the teeth and gums. “We need the plaque to be at the minimal as well,” so always brush before bed.
And even though you’ve likely heard it ad infinitum over the years, cleaning between the teeth really is important to overall oral health. For most people, this means flossing, but for some, floss picks, interdental brushes, water flossers, dental picks and other flossing tools might offer a better way to access those hard-to-reach spots. “Some people may not be able to use floss because of dexterity problems like arthritis,” Sehl says.
If you wear dentures, it’s important your clean them on a daily basis, too, with a cleanser made specifically for dentures, the ADA recommends. “Take your dentures out of your mouth for at least four hours every 24 hours to keep the lining of your mouth healthy. It’s best to remove your full or partial dentures at night.” And be sure to follow your dentist’s instructions for wearing and caring for your dentures.
Seeing your dentist regularly for cleanings and checkups is also important, Sehl says. “The rule of thumb is older adults should see the dentist more often. Insurance companies usually only pay for twice-a-year checkups, but depending on the risk of the patient we recommend even up to four times a year.” She encourages older adults to advocate for the inclusion of dental care into Medicare plans to help pay for these added visits. “Dental disease is common in older people — we’re living longer and keeping more of our teeth for a longer time. Therefore, we’re going to need more care. Unfortunately, dental care is costly and most older adults are on a fixed income. Most do not have dental insurance — after they leave their jobs, one of the first things to go is dental insurance. Therefore, dental care becomes a mainly out-of-pocket deal, and that’s a major obstacle to care. People just can’t afford the care they need,” Sehl says. She adds there’s no reason why the body and the mouth should be separated in terms of insurance coverage, and connecting the two will lead to better overall health outcomes for patients across the age spectrum.
The ADA agrees that regular checkups are important because “as you age, the nerves inside your teeth become smaller and less sensitive. By the time you feel pain from a cavity, it may be too late and you may lose your tooth.” A good dentist is also well trained to spot the signs of oral cancer and gum disease in their earliest stages, which may save you time, pain, health and money down the road.
Sehl says that depending on the risk of tooth decay, adding a fluoride product might help maintain dental health in older adults. Fluoride is a naturally occurring mineral that helps strengthen the outer surface of your teeth, and many municipal water systems across the United States add fluoride to the water to help fight cavities. This gives basic, unfiltered tap water a dental health edge over bottled water.
Diet is also an important component of dental and overall health. “Whether we’re talking about cavities, periodontal disease or oral cancers, pay attention to the diet. Cavities especially are a sugar-related disease, so avoiding or minimizing added sugar is important at any age, but as we get older, there’s a tendency with loss of teeth to have a softer diet,” which usually means lots of carbs and sugar. “Having a healthy diet is going to help with oral cancer,” too. “Like most other cancers, having a high amount of fruits and vegetable also helps with avoiding or minimizing the cancer risk,” she says.
If you smoke, chew tobacco or drink alcohol, know that these habits can also damage dental and oral health. Smoking and chewing tobacco causes bad breath, leaves unsightly stains on teeth and puts you at much greater risk for developing cancer in the mouth and throat. The American Cancer Society reports that “most people with oral cavity and oropharyngeal cancers (cancers of the throat) use tobacco, and the risk of developing these cancers is related to how much and how long they smoked or chewed.” The ACS also reports that about 70 percent of patients with oral cancer are heavy drinkers. Combining alcohol with tobacco use further increases your risk of oral and related cancers.
Lastly, Sehl says it’s important to know that no matter what dental issue you may be dealing with, “there is always hope. With dentistry today, we have procedures and tools that can restore the mouth to its optimal aesthetic and functional status. I don’t want people to lose hope or think, ‘It’s too late for me.’ It’s never too late.” Frost agrees. “You’re never too old to have a beautiful, youthful smile.”