The aging process often creates subtle or dramatic changes in the condition of teeth, mouth and gums. Here are some hard facts to ponder:

	At least half of non-institutionalized people over age 55 have periodontitis.
	Older people have three times more tooth decay than children.
	Almost one out of four people age 65 and older have lost all of their teeth.
	Receding gum tissue affects the majority of older people.
	Periodontal disease and tooth decay are the leading causes of tooth loss in older adults.

Keeping teeth clean and white may become more involved. The formation of plaque, a colorless layer of bacteria that builds up on teeth, accelerates as we grow older. Teeth also may darken in color due to changes in dentin, the bone-like tissue underneath tooth enamel.

Changes in teeth and supporting tissue. Tissues in your mouth, like other body tissues, change as you grow older. Soft tissues (gums and cheeks) lose their ability to stretch, and muscles become soft and weak. The amount of saliva produced by glands in your mouth is frequently reduced. As a result, chewing becomes more difficult, and your mouth becomes more easily irritated and heals more slowly than when you were younger. Other changes may occur.

Gums may begin to recede from teeth. This process exposes tooth roots to plaque and can cause tooth decay. In addition, older fillings may weaken and crack, allowing bacteria to accumulate around the edges of fillings, causing cavities. Unfortunately, many individuals over the age of 50 have decay on both teeth and roots which may require clinical care.

Decay. The rate of tooth decay may be increasing as you grow older. This is especially true when the amount of saliva is reduced. Tooth decay in older adults appears most frequently around the teeth at the level of the gums. The root portion of a tooth, when exposed, is especially subject to decay. Gumline or root decay is difficult to restore with fillings, because decay often reoccurs around this type of filling soon after it is placed.

Brittleness and wear of teeth. Nerve tissue and blood vessels are found in the pulps of teeth. When you were young, these nerves were very responsive to pain or to anything hot or cold. As you have aged, the pulp gradually became smaller with fewer blood vessels and less nerve tissue supplying the teeth. As a result, your teeth have less fluid content and have become brittle. Your brittle teeth may be easily broken or chipped. Fortunately, due to the reduced nerve tissue, little if any pain is experienced when even severe fractures occur.

Teeth wear because of the grinding action of chewing. Tooth enamel becomes thinner. In severe cases, the hard enamel covering is completely worn away leaving a softer part of the tooth (dentin) exposed. Dentin can be dissolved by acidic oral fluids. Teeth with only a fragile enamel shell may result. These teeth are easily chipped or broken.

"Dry Mouth" may develop. Caused by reduced saliva flow, dry mouth may lead to tooth damage. Reduced saliva flow may be a medical disorder or a side effect of medications such as antihistamines, decongestants, pain killers or diuretics. The reduced flow affects teeth because saliva acts a cleaning agent in the mouth to wash away acids produced by plaque. When the mouth is not adequately lubricated and moistened by saliva, plaque forms more quickly and produces cavities.

In addition, dry mouth can cause sore throat, problems with speaking, difficulty swallowing and hoarseness. Your dentist or periodontist can recommend various methods to restore moisture, including sugarless gum, oral rinses or artificial saliva products.

Be sure to tell your periodontist and other dental professionals about any medications that you are taking, including herbal remedies and over-the-counter medications.

Gum disease develops more readily. Bacteria found in sugars and starches create toxins which irritate the gums and cause gum tissue to separate from teeth. Left untreated, gum disease can cause unnecessary tooth loss. It also may dissolve the bone that holds your teeth in place. Poorly fitted dentures, poor oral hygiene, illnesses and some medications may increase the severity of gum disease and create chewing problems and pain in the jaw. Fortunately, visiting your dentist regularly can help reduce the spread of gum disease and its damaging effects.

Oral cancers. The incidence of oral cancer appears to increase with age. About 3 percent of all cancers detected are found in the jaws, lips, tongue and palate (roof of the mouth). The effect of oral cancers and their treatment can be devastating. Surgical treatment often results in loss of a portion or all of the jaws, tongue or palate. Facial disfigurement and serious impairment of chewing ability accompanies treatment of more extensive cancers.

Radiation (x-ray) therapy used to treat some oral cancers generally results in a reduced amount of saliva. The cleaning and lubricating effect of saliva is diminished, leaving tissues easily irritated and teeth subject to rapid decay.

Systemic diseases. Evidence of a disease occurring elsewhere in the body is sometimes noted in the mouth. Disorders such as those of the blood system (anemia) or diabetes are sometimes accompanied by inflammation and reduced healing capacity of the gums.

What you may not realize is that oral health is not just important for maintaining a nice-looking smile and being able to eat corn on the cob. Good oral health is essential to quality of life. Consider a few of the reasons:

	Every tooth in your mouth plays an important role in speaking, chewing and in maintaining proper alignment of other teeth.
	A major cause of failure in joint replacements is infection, which can travel to the site of the replacement from the mouth in people with periodontal disease.
	People with dentures or loose and missing teeth often have restricted diets since biting into fresh fruits and vegetables is often not only difficult, but also painful. This likely means they don't get proper nutrition.
	Most men and women age 65 and older report that a smile is very important to a person's appearance.
	And, maybe most importantly, recent research has advanced the idea that periodontal disease is linked to a number of major health concerns such as heart disease, stroke, respiratory disease and diabetes.

The Importance of Toothbrushing

Accumulation of food debris, plaque ( a white residue adhering to the teeth) or calculus (solidified plaque) increases the rate of tooth decay and gum disease. Good oral hygiene is perhaps the simplest and most efficient means to promote comfort and help reduce the dental problems associated with aging.

Toothbrushing for at least 3 minutes will help to remove plaque from the surfaces of your teeth. Plaque is the leading cause of tooth decay, so by removing it you are helping to decrease the risk of tooth decay!

Brush daily with a soft toothbrush that is not worn out or frayed. Your toothbrush needs to be replaced every 3 to 4 months.

Use toothpaste with fluoride in it. The use of topical fluoride, which is seen in toothpastes, gels and rinses, have been shown to significantly reduce dental cavities. It is important that young children are closely monitored when using fluoride-containing products so that they do not ingest an excessive amount. Only a pea-sized amount of toothpaste is necessary for a child to use.

Eat a balanced meal and limit food that is high in sugar.

Steps for getting the most out of your brushing:

Place the brush against your gum line (where the teeth and gums meet).

 Move the brush back and forth gently with short strokes.

Brush the inner surfaces of your front teeth with the   front part of your toothbrush.

 Brush the inner and outer surfaces of all teeth.

The Importance of Flossing

You floss to remove the plaque from between your teeth and above and below the gum line - places where your toothbrush can't reach.

By combining flossing and brushing at the same time every day, you can thoroughly remove plaque and prevent cavities and gum disease.

Steps for getting the most out of flossing:

Remove a length of floss about 18 inches long. Wrap most of the floss around the middle finger of one hand and just a few inches around the middle finger of the other hand.

Hold the floss taut between thumb and forefinger (leave about one inch between fingers) and guide it gently between the teeth. Do not snap it onto the gums.

Curve the floss into a C shape against the sides of each tooth. Use an up-and-down scraping motion to remove plaque between teeth and just between the gum line. Do not floss with a back and forth sawing motion.

As the floss becomes soiled, advance to a clean section of floss and continue.

Dental Aids

Many mechanical aids have been developed to improve oral hygiene. Some have practical application for the elderly.

Electrical tooth brushes have been shown to be effective in cleaning teeth. The larger handle can be held more easily and the mechanical movement of the brush compensates for those with limited movement.

Water irrigators can be useful in removing particles from between teeth. If you have pockets between your teeth and gums, use a water irrigator with care. Rather than being washed away, food particles can be forced into those pockets and can cause severe irritation.

Interdental cleaners are handles with small changeable brushes. They allow for cleaning between teeth. This is especially helpful when the gums have receded, creating large spaces between the teeth.

Oral lubricants can ease some of the problems created by a dry mouth. Glycerine, flavored with a few drops of lemon, can provide a lubricating effect. This will ease the irritation caused by dentures rubbing on the underlying tissue or dry cheeks rubbing on the denture teeth. Several prescription medications are available that can stimulate the production of saliva or act as a saliva substitute.

Denture Care

Denture care is necessary because wearing dentures does not mean that good oral hygiene can be neglected. If you wear dentures, they should be removed after eating and rinsed with warm water. The mouth should also be thoroughly rinsed.

Dentures accumulate calculus like the teeth they replaced. Dentures should be scrubbed with a stiff brush and cream to remove these deposits. Commercial denture cleaning solutions by themselves will not adequately clean dentures.

Do-it-yourself denture liners should be avoided. They become rough and irritating and harbor bacteria and food debris. Such liners are difficult to keep clean.

For more detailed information on any of the dental aids or cleaning procedures, consult your dentist. Dentists can help establish a routine to provide you with the most efficient means of cleaning your teeth and gums.

Dental Implants

More and more older people are selecting dental implants over dentures as a replacement option for lost teeth. Whether you have lost one or all of your teeth, dental implants allow you to have teeth that look and feel just like your own.

Older adults have similar success rate with implants compared with younger people. As long as you're in good health and your periodontist can restore healthy gums and adequate bone to support the implant, you're never too old to receive a dental implant.

A dental implant is an artificial tooth root placed into your jaw to hold a replacement tooth or bridge in place. While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support. 

In addition, dental implants are intimately connected with the gum tissues and underlying bone in the mouth. Therefore, they prevent the bone loss and gum recession that often accompanies bridgework and dentures and preserve the integrity of facial features. When teeth are missing, the bone which previously supported these teeth begins to deteriorate. This can result in dramatic changes in your appearance, such as increased wrinkles around the mouth and lips that cave in and lose their natural shape.

Since periodontists are the dental experts who specialize in precisely these areas, they are ideal members of your dental implant team. Not only do periodontists have experience working with other dental professionals, they also have the special knowledge, training and facilities that you need to have teeth that look and feel just like your own.

Talk with your preriodontist to find out if dental implants are an option for you.

Special Concerns for Older Women

Women who are menopausal or post-menopausal may experience changes in their mouths. Recent studies suggest that estrogen deficiency could place post-menopausal women at higher risk for severe periodontal disease and tooth loss. Hormonal changes in older women may result in discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour.

In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny, bleed easily and range from abnormally pale to deep red mark this condition.

Most women find that estrogen supplements help to relieve these symptoms.

Bone loss is associated with both periodontal disease and osteoporosis. Osteoporosis could lead to tooth loss because the density of the bone that supports the teeth may be decreased. More research is being done to determine if and how a relationship between osteoporosis and periodontal disease exists. Women considering Hormone Replacement Therapy (HRT) to help fight osteoporosis should note that this may help protect their teeth as well as other parts of the body.

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Sources:

 

California Dental Association

The American Academy of Periodontology

University of Missouri

Community & Public Health Administration,

Maryland Department of Health & Mental Hygiene