At the beginning of the twentieth century, about three million Americans (approximately 3% of the population) were 65 years of age or older. Fewer than 200,000 were 85 or older. Today (2010) there are over 40.2 million people over the age of 65 in the U.S., of whom over five and a half million are over the age of 85. There are now more people in this country over the age of 65 than there are children under the age of 8, and the proportion of those over the age of 85 is growing at a faster rate than that of any other age group.
Dental Health for Seniors: Seniors are seeking dental care at an unprecedented rate and in numbers that outweigh their proportion of the population. Many misconceptions and false stereotypes, both positive and negative, about older people may be held by health providers of any age, and these may inadvertently and incorrectly influence assessment, diagnosis, and management approaches. I will discuss three common dental problems for seniors.
The Three Common Dental Issues for Seniors
1. Root Caries
What is root caries?
Tooth decay (caries) is not just a problem for children but can happen at any age. In fact, one type of caries becomes more common the older we get. It is called by several names: root caries, root decay, or root cavities, to name three. Unlike the type of decay you are probably familiar with that occurs in the top (crown) of the tooth, root caries occurs where the gums have receded (shrunk) away to expose the root of the tooth.
What causes root caries?
Like all tooth decay, root caries is caused by bacteria. When your mouth is not kept clean, bacteria can cling to your teeth to form a sticky, colorless film called plaque. This plaque can lead to tooth decay. In addition, for root caries to occur, the root of the tooth must be exposed. Unlike the crown of the tooth that is covered by enamel, the root is made of softer dentin which decays much easier. Changes in the amount of saliva in your mouth can also put you at increased risk for developing caries. Saliva contains many chemicals that keep your teeth and mouth healthy. Many medications, chemotherapy, radiation treatments, and some diseases can cause your glands not to make enough saliva and therefore make cavities and other mouth problems more likely to occur.
How do I know if I have root caries?
Many people that have root caries do not know it. Because it occurs at or even below the gum line, the warning signs that often accompany tooth decay, such as sensitivity to cold or sweets, may be absent. In addition, as we age our teeth become less sensitive and may not warn us that the tooth is damaged. Often root caries is first found by a dentist or dental hygienist during a professional cleaning or exam when they can feel the softened root with a dental instrument. Radiographs (x-rays) can be helpful in finding root caries between the teeth.
What can be done to repair the damage to the tooth?
Root caries is very deceptive. Even when the cavity can be seen with the eye, it often appears small and not very alarming. However, because the damage is to the foundation of the tooth, a little damage can weaken the entire tooth and put it at risk for breaking off to the gum line. To illustrate, perhaps you have seen a large tree that appeared to be healthy but fell down because it was rotten at the root. Similarly, what appears to be a small amount of damage to the tooth may require a crown instead of a filling. Damage may have gone all the way to the pulp (inside) of the tooth and may require endodontic therapy (root canal) to prevent pain and infection. At times, so much damage has been done the tooth must be removed. That is why it is so important to have frequent exams so that root caries can be found early.
What can be done to prevent root caries?
Since root caries is caused from bacteria, the most important thing you can do is to keep your teeth clean every day. If your gums have receded, cleaning can be more difficult. We are trained to develop a method customized for your specific condition that will allow you to be able to clean more thoroughly. Be sure to tell your dentist if you have physical limitations that make it more difficult to clean your teeth. In addition to keeping your mouth clean, fluoride has been shown to be very important in the prevention of root caries. There are now many ways to be sure you receive the proper amount of fluoride depending on your unique needs, and your dentist can customize a fluoride treatment plan just for you. Your diet is also a very important factor because certain foods and snacks can greatly increase the number of bacteria that forms the decay-causing plaque. Finally, frequent professional cleanings and exams can help prevent root caries or find it early when it can be more easily repaired. Measures focused on prevention of root caries (such as an ADA-accepted sodium fluoride dentifrice, supplemental fluoride rinses and/or gels, xylitol-containing gums and lozenges, and dietary counseling) must be part of the plan of care for most dentate seniors.
2. Ill-fitting dentures – What are the problems?
Destruction of the jawbone
Jawbone gradually shrinks over time, but dentures don’t shrink. When the denture no longer fits exactly to the jawbone more bone destruction occurs at a faster rate. Some people are proud that they have worn the same set of teeth for 20-30 years but often we discover much greater bone damage than what normally should have occurred.
You look older
As jawbone shrinks a sunken facial appearance often makes people look older. There is an increase in deep age lines and wrinkles. A new denture may be able to lengthen the face, eliminating some of these unwanted features and without plastic surgery.
Undetected oral cancer
Guess what? Patients without teeth still need dental checkups. How often does your MD look in your mouth? Hundreds of diseases occur in the mouth. Oral cancer has the most serious consequence. It may appear as a red or white sore or bump which may or may not be painful. Other signs may be swollen lymph nodes of the neck, and difficulty swallowing and speaking. Most times oral cancer may not even be noticed by the person affected by it until it is too late. This is especially true for denture wearers. Please see your dentist for an oral cancer screening!
If the teeth move and flop around the cheek and tongue you struggle to form words and control the denture. The ability to speak involves the tongue, teeth, lips, cheeks and the roof of the mouth. A denture that’s properly fitted allows all 5 of these components to work together properly.
Risks of denture adhesive – Zinc
Millions of people use denture cream (also known as denture adhesive). Some, but not all, denture creams contain zinc. Recent case reports in the scientific literature indicate a possible association between excessive use of zinc-containing denture creams and neurological and hematological problems.
In each situation, the patients had ill-fitting dentures and reported using excessive amounts of denture cream with zinc for years. These individuals reported using two or more tubes of denture cream per week for years. The researchers theorize that the patients swallowed excess denture cream exposing them to excessive amounts of zinc over a period of years. It is well documented that swallowing excessive amounts of zinc can raise blood levels of zinc which can lead to lower blood levels of copper. The lower blood level of copper can then lead to brain and blood disorders.
In 2010, GlaxoSmithKline, a major manufacturer of denture cream, voluntarily decided, as a precautionary measure, to stop using zinc in the following denture cream brands: Super Poligrip Original, Super Poligrip Ultra Fresh and Super Poligrip Extra Care.
Dentures only have about one sixth the chewing power and ability of teeth when fitting properly. Ill-fitting dentures can be a culprit in poor nutrition among seniors. When a person loses his natural teeth, his jaw bones begin to shrink away, leading to the jaw continually “remodeling” itself. Dentures that once fit well start slipping. So, a senior may start limiting the kinds of food he eats because it’s too hard to eat, or because he’s embarrassed that others may see him having trouble chewing. And it happens during a really important stage of a person’s life. Especially for frail seniors who really need their nutrition.
If a senior does lose her natural teeth, instead of traditional dentures, she could have implant-supported dentures. These implants are attached to the jaw bone, and a special denture snaps onto the implants. These implant-supported dentures fit more snugly than traditional dentures, so eating different foods shouldn’t be a problem.
3. Oral Systemic Connection
Did you know that the health of your mouth can affect the health of your body? Recent scientific research suggests a very strong correlation between chronic oral infections from periodontal (gum) disease and systemic health. Research at major universities and medical centers strongly supports an oral systemic connection. According to published statistics, more that 60 million Americans show signs of periodontal disease, a chronic bacterial infection that affects the gums and bone supporting the teeth. Almost 30% show signs of the more severe disease, chronic periodontitis. We now have reason to believe that the health of your teeth and gums may have a significant effect on the overall health of your body. To “at risk” patients, this added burden could have a complicating effect on their pre-existing medical conditions.
According to numerous studies, there are three ways oral disease may affect your overall health. First, bacteria from your gums enter the saliva. From the saliva it may adhere to water droplets within the air you inhale each time you breathe. These bacteria laden water droplets may be aspirated into the lungs, potentially causing pulmonary infection and pneumonia. This can be very troublesome for the elderly or those who may suffer from generalized weakened immunity, associated with chronic obstructive pulmonary disease (COPD). Inflammatory mediators found in inflamed gums called “cytokines” can also enter your saliva. As they too are aspirated into the lungs, they have pro-inflammatory effects on the lower airway, which can contribute to further pulmonary complications.
Secondly, bacteria associated with periodontal disease can enter the body’s circulatory system through the gums (periodontium) around teeth and travel to all parts of the body. As the oral bacteria travels, it may cause secondary infections or it may contribute to the disease process in other tissues and organ systems. Finally, inflammation associated with periodontal disease may stimulate a second systemic inflammatory response within the body and contribute to or complicate other disease entities that may have an inflammatory origin such as, cardiovascular disease, diabetes, orthopedic implant failure and kidney disease. Whatever the route oral bacterial may influence, it is in every patient’s best interest to maintain their mouth in an optimum state of health.
The trend of good dental health for seniors and keeping their teeth longer is expected to increase, and the number of seniors is expected to keep growing as the “Baby Boomers” begin to cross the threshold out of middle age. Dentistry for older adults will increasingly become focused on prevention, restoration, and maintenance, rather than on replacement.