Joshua Davidson

As we age, we find that our trips to the doctor’s office become more frequent.  However, our visits to the dentist begin to wane.  Dental care is no longer a priority as more chronic disabilities increase.  In fact, the American Dental Association reported in 2007 that many individuals over the age of 70  are no longer going to the dentist for regular care. 

Unfortunately dental care is, not only overlooked by older adults, but also by healthcare providers, social service providers, and family caregivers.  It is interesting, for instance, that many senior centers will offer well-being classes as well as medical clinics; but neglect to offer any program related to dental care.  In fact, it is not uncommon for senior centers to bring in professionals who practice medicine, chiropractic care, podiatry, and audiology.  But typically dental care is not addressed.
 
For many elderly, pleasing teeth is not a priority.  This is in part due to the fact that when they were growing up, preventive dentistry wasn’t practiced.  There was no dental insurance, and frankly, many just did not have the money to spend on their teeth.  Subsequently, this set a precedent for poor dental hygiene.

There are other obstacles the elderly face regarding oral health.  Dental care is thought of as cost prohibitive and dental insurance is just not affordable.  Medicare does not pay for dental treatment unless it is oral surgery.  Unfortunately, in our country many elderly have to live frugally, often earmarking their money for essentials such as medications, rent, insurance, and other expenses that they feel are more relevant to their day to day existence.

However, it still remains that dental care among the elderly is of the most paramount importance.

Over time teeth do deteriorate. When teeth age,  the color darkens because there is less cell turnover.  The edges wear and surfaces become flatter, rough and less reflective. If teeth are not as reflective, they do not look shiny and thus less aesthetically pleasing.  This is called “attrition”. Because of this, the elderly may get discouraged and feel that no matter what they do, their teeth won’t look good.

In addition, often there is no precipitating pain or discomfort that might necessitate a trip to the dentist; thus further compounding the situation.  When we age, the nerves at the root of the tooth can become less sensitive or even dull, a common occurrence.  This would be the equivalent to losing sensation in the toes .  If you stub your toe and don’t feel it, infection can set it in without notice.  Therefore, it can be too late once the dental disabilities have advanced. 

Subsequently, the elderly are more at risk for cavities, gum disease, and oral cancer.   In addition, when the elderly already have heart disease, diabetes, and other vascular diseases, they are at a higher risk for gum disease.  If gum disease goes untreated, the elderly may be at risk for heart disease, diabetes or a stroke.  Poor nutrition can also be an outcome of gum disease.   In the United States, the American Dental Association reports that more than half of adults age 75 or older have periodontal disease as a result of untreated cavities at the gum line of the tooth.

In fact, The American Dental Association has found that the aging process actually increases the risk for cavities even if dental hygiene is practiced regularly.  This is principally due in part to the elderly frequently using medications that cause dry mouth.  On average, the elderly take 3-4 different medications daily, and those who are older than 75, have 11 – 13 drugs prescribed for them.  Dry mouth (xerostomia) is a direct result of medications and can become a huge problem when it goes untreated.  For instance, a dry mouth can further exacerbate vulnerable teeth, making the elder susceptible to tooth decay and periodontal disease. The saliva in the mouth contains minerals which help keep teeth strong.Actually,  it is the saliva that begins the process of digestion.  Saliva can also reduce the concentration of sugar in delicious foods like cake and ice cream. Without saliva, the rate of decay can skyrocket.

Additionally, age-related oral changes include losing teeth which can result in not replacing them.  As a consequence older individuals might have difficulty with chewing,  speaking,  recurring headaches, and chronic joint problems in the jaw.  The jaw joint is one like any other and arthritis of this joint is not uncommon. There are over the counter medications that can help reduce the discomfort of an arthritic jawsuch as ibuprofen. However, the quality of life might still become affected even with medication.  Therefore,  increasing the chances of depression, anxiety, and isolating behaviors.

Furthermore, often there is no precipitating pain or discomfort that might necessitate a trip to the dentist. This is because the nerves at the root of the tooth can become less sensitive or even dull. a common occurrence.  This would be the equivalent to losing sensation in the toes .  If you stub your toe and don’t feel it, infection can set it without notice.  It can be too late once the dental disabilities have advanced. 

Also, a common assumption among the elderly is that because they have dentures there is no need to see a dentist.  However, denture wearers need as much care as anyone else who have their own teeth. Dentures attract plaque, and therefore, can place the denture wearer at risk for gum disease.  Dentures must be taken out of the mouth every night to let the gums breathe.  After taking the dentures out,  gums should be gently brushed in order to get rid of bacteria that has accumulated throughout the day.

To sum it up, oral disease can be just as problematic as physical and mental disease. 

But there is good news if dental hygiene is practiced regularly.  Restorative procedures are less invasive since as we age our nerves actually reduce in size, therefore, becoming less sensitive to pain.

As caregivers,make sure that the elderly receive a cleaning twice a year. Every time the elder goes for a cleaning, ask the hygienist to apply topical fluoride.  This is done routinely for children and should be provided to the elderly as well.

The caregiver should also ask the dentist if an oral cancer screening can be performed. The average age for oral cancer is 63 and left untreated results in death. In fact, 37,000 Americans will be diagnosed with oral or throat cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour.

As we have discussed, dry mouth is a huge problem among the elderly.  To avoid a dry mouth, caregivers can make sure that water is sipped throughout the day.  A good idea would be to use a straw which would make sipping much easier.  Buy products that have xylitol in them such as gum or mouth sprays.  Xylitol is a sweetener but cannot cause decay.  For instance, chewing gum for 10 minutes every 4 hours helps stimulate saliva flow.There are also mouthwashes and mouth sprays that help retain moisture in the mouth that have xylitol in them.  Keep in mind that you are looking for pH balanced oral products.  Also, sugarless candies are helpful. Many of these products mentioned can be found by doing a Google search or asking a pharmacist. 

Finally, the caregiver should make sure that the elder’s teeth are routinely brushed two to three times a day as well as flossed daily.  It is advisable to have a well-lit mirror readily available so that the elder can brush the teeth effectively.

In conclusion, many elderly do still have their own teeth despite what is often portrayed in the movies, TV, and in the media.  But unfortunately, as we age, teeth can become discolored and many elders feel uncomfortable with smiling. However, teeth can be bleached at any age even among the elderly. 

But the elderly have to be vigilant about their oral health so that teeth do remain for a lifetime. The elderly need more than any other population need to be good consumers of oral health.   Everyone needs bi-annual check-ups, but in many instances, more visits may become necessary as we get older.  Good oral hygiene improves quality of living which permits successful aging to occur.  Remember  to  brush your teeth, floss your gums, chew gum for your dry mouth!  But most of all do remember that you never are too old to go to the dentist.

To read other blogs written by Rita Dichele, click here.

Joshua Davidson is a recent graduate of the Arizona School of Dentistry and Oral Health in Mesa, Arizona. He simultaneously received his Master’s Degree in Public Health from A.T. Still University in Kirksville, Missouri.  He will begin his career as a dentist at a public health clinic while focusing on the issues of geriatric dental care.

Rita Dichele holds Masters’ degrees in Counseling and Healthcare Administration.  Currently, she is an advanced doctoral learner at Capella University where she is writing her dissertation on successful aging.  She is also an adjunct instructor at A.T. Still University in Kirksville, Missouri,  teaching geriatric courses. Rita resides in Shrewsbury, Massachusetts and serves as a board member on the Council on Aging. She is a town appointee for the Shrewsbury Cultural Council, facilitates two groups at the Shrewsbury Senior Center, and is a certified SHINE Medicare/Medicaid counselor.  Rita is also a past presenter at the 2009 American Society on Aging Conference.