Are older adults at a higher risk for dental problems?
Adults aged 65 and over currently account for over 12 percent of the U.S. population but account for a much higher proportion of my time spent delivering dental treatment. Why are older adults at such a high risk for dental problems?
In a nutshell, more years equals more disease, more teeth succumbing to the chronic effects of periodontal disease and more dental decay. Medical advances, especially with new pharmaceuticals, continue to increase the average lifespan. However, as life is prolonged, it comes at the cost of more chronic illnesses, impaired abilities and complicated medication regimens.
The effects of dry mouth
It has been my experience that there’s nothing more destructive to the dentition than a dry mouth caused by medications. Saliva has a natural buffering ability against acid-producing bacteria and when the salivary rate drops, the acids produced by these bacteria can wreak havoc on the dentition.
I have seen many older patients go from dental stability to rampant disease over the course of a few short months, usually as a result of new medications. A common, especially high-risk combination for any older adult is a dry mouth, along with a diminished ability to adequately provide his or her own homecare.
This is a common scenario with stroke patients that struggle with the dexterity needed to brush and floss and patients with cognitive impairment like dementia.
The most vulnerable area of the tooth to the cavities caused by dry mouth are the roots. As periodontal disease is chronic and tends to progress as people age, older adults will generally have more gum recession and more root exposure.
The root surfaces are softer than the enamel present on the crown of the tooth and as bacterial plaque tends to accumulate primarily at the gum line, decay can penetrate the root surface much more easily.
Repairing root damage
Repairing the damage caused by root cavities can test any dentist’s technical abilities. The key to a better prognosis is early detection. If the damage is in its early stages, I will often treat these root cavities with conservative gum line fillings.
My goal in these situations is to treat the decay so it doesn’t progress and then focus on preventive measures. Unbeknownst to many of my patients, teeth that have been treated with crowns are still vulnerable to root decay and may require crown replacement.
Root decay that extends deep enough may warrant root canal treatment or even tooth extraction. In extreme cases, multiple teeth require extraction and a patient that was dentally stable only months earlier is pursuing dentures.
The most frustrating aspect of treating those that have succumbed to root cavities is that such disease is often easily avoidable with routine dental visits and daily preventive measures.
When patients complain that their mouths are uncomfortably dry or we diagnose such a problem, we immediately place them on a supportive regimen to both protect against root cavities and to alleviate discomfort. Such patients are given prescription toothpastes with higher fluoride concentrations to counteract the acid-producing bacteria.
We also encourage the periodic sipping of water throughout the day and keeping a glass of water bedside for rehydrating the mouth during the night, when salivary flow is at its lowest. These two simple, conservative strategies can have profound preventive benefits and keep older adults out of the dental chair. There are also several wonderful, over-the-counter products to lubricate the mouth and aid with the discomfort of a dry mouth.
If you are an older adult that has gotten out of the routine of seeing the dentist or has been neglecting a dental problem, I would encourage you to make an appointment. As older adults are keeping their teeth longer, we are asking more and more from those teeth.
Not investing time in your oral health will inevitably cost more time, money and anguish in the long run. Routine dental visits and some conservative, preventive strategies can make the difference between uneventful dental maintenance and a perpetual state of decline.