Adults

Dentistry for older adults


Overview

No matter what age, prevention is the key to maintaining good oral health. Knowing what particular dental problems you are at risk for developing and how you can reduce those risks will help you decide the most appropriate means to prevent dental problems.

Susceptibility to various dental problems change as people age. Each person’s risk factors are unique. A thorough understanding of what they are is necessary to adequately reduce those risks.

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Tooth decay

During the first three decades of life the primary cause of tooth loss is decay. From the middle 30s to the late 50s, periodontal (gum) disease is identified as the main reason teeth are removed. And after age 60, tooth decay is again the major cause of tooth loss.

But the type and extent of tooth decay experienced by seniors is very different from that which affects children.

Decay in late life often occurs around the edges of fillings and crowns or on root surfaces of teeth that are exposed because of gum recession. This kind of tooth decay advances rapidly and is generally difficult and expensive to treat. It frequently requires a larger filling or new crown to be placed.

If the problem is isolated to the root of a tooth all that may be necessary is a filling, but this is more the exception than the rule. In some instances because the decay is so extensive the tooth may need a root canal or must be removed.

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Dentures

For those seniors who use dentures or removable partials there is additional concern. Throughout life, the bone and tissues supporting replacement teeth continue to undergo remodeling. This constant and unpredictable change in the shape and size of these tissues affects the fit, bite, and position of artificial teeth in relationship to other mouth tissues.

This involves not only the gum tissue that artificial teeth rest upon, but also the natural teeth, which assist in supporting removable partials. Because the remodeling process is so slow, many patients are not aware of the changes until a problem arises: pain, chewing difficulties or an alteration in appearance.

Regular professional examinations can identify potential problems and correct them before a patient experiences a problem. Routine visits to the dentist also can provide patients with the most up-to-date information on tooth replacement devices, new aides in maintaining good oral hygiene, and a chance to reinforce the knowledge a patient has on what they should and should not be able to do with artificial teeth.

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Implants

The sophistication of new technology and techniques are giving way to more options and many patients are opting for dental implants, a permanent replacement.

Older adults are keeping their teeth longer. But baby boomers (those born between 1945 and 1964) are contributing to the rise in dental implants placed each year. Periodontal (gum) disease and tooth decay are common occurrences among this population and often lead to tooth loss.

Top reasons cited for tooth loss leading to implant placement were periodontal disease, tooth decay and accidents, violence or injuries.

Dental implants have a number of advantages. They can facilitate proper chewing, give the feel of natural teeth and promote self-confidence with improved speech and appearance. If a tooth is missing or needs to be replaced because it has fractured or decayed, it can be replaced without affecting adjacent teeth, making it easier to brush and floss.

But, not everyone is an ideal candidate for dental implants. Patients must be healthy enough to tolerate an oral surgical procedure and dentists must consider each patient individually. The ideal candidate is in good general and oral health and has healthy gums that are free of periodontal disease. Adequate bone in the jaw is also needed to support the implant. Heavy and long-standing cigarette smoking has been shown to adversely affect long-term prognosis.

Dental implants can also be the more expensive solution for adults with missing teeth.

However, the field of dental implants continues to advance. Computer software has been developed to help treatment planning and ensure precise placement. Patients in need of these services can benefit from dental implants as opposed to traditional methods. It used to be patients had to wait a long time between the extraction of the tooth, placing of the implant and final restoration. Now, thanks to advances in dental implants, this waiting period has been greatly reduced.

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Dry mouth

Imagine the feeling of a thirst that is so strong it seems it will never be quenched, a constant burning sensation on the tongue, or lips that are constantly dry and cracked. Thirsty yet? Unfortunately, thousands of people, particularly the elderly, are affected by this condition called xerostomia or “dry mouth.”

Dry mouth is not something to be taken lightly by any means. It can cause a lot of discomfort and have some extremely negative impacts on a person’s quality of life.

When a person has dry mouth, there is an increased risk of cavities and periodontal disease because there is less saliva to cleanse the teeth and gums. In addition, this condition is known to affect a person’s speech, taste sensation and ability to swallow.

When a patient’s salivary glands significantly decrease the production of saliva, or cease production altogether, there is a high risk of cavities or other oral diseases. Saliva is the mouth’s self-cleansing mechanism. It helps remove food debris and plaque from tooth surfaces.

A permanent feeling of dry mouth or decreased saliva flow can be caused by systemic-diseases such as: rheumatoid conditions, dysfunctional immune system, and hormonal and neurological disorders. Biological aging is a contributing factor to this condition, but does not cause dry mouth.

Dry mouth in others can be caused by radiation therapy directed at the head and neck region of the body, which can result in permanent damage to the salivary glands. In addition, there are over 400 drugs that can cause dry mouth as a side effect. The more common drugs are decongestants, diuretics, antihypertensives, antidepressants, and antihistamines.

Many patients that experience dry mouth complain of a sore or burning sensation on the tongue; dry, cracked lips, and at the corners of the mouth; and are often thirsty.

If patients exhibit these symptoms, they should immediately see an oral health professional. With a little extra care, dry mouth can be adequately controlled.

The WDA recommends those affected by dry mouth take the following precautions to keep the mouth wet and reduce the likelihood of cavities or periodontal disease:

  • Brush and floss teeth at least four times per day (after each meal and before bedtime)
  • Brush and rinse dentures after each meal
  • Keep water handy to wet the mouth at all times
  • Chew sugarless gum
  • Avoid tobacco, alcohol, sodas and foods high in sugar content
  • Use moisturizer on the lips to alleviate discomfort

Currently, a drug called Salagen is the only drug approved by the Food and Drug Administration to stimulate saliva secretion from salivary glands. However, it is not a drug for everyone with dry mouth, and it can only be obtained with a prescription from a doctor.

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WDA