The old adage, “Don’t look a gift horse in the mouth” applies in some ways to the topic of oral care for the elderly. The original meaning of the saying comes from the technique of determining the age of a horse by looking at its teeth. The patterns of tooth eruption and wear can be used to accurately find a horse’s age, and in the case of a horse received as a gift, it’s either perhaps better not to know its true age, or rude to question the value of a gift.
The teeth in the mouths of elderly humans can also tell tales of aging, often stories we’d rather not hear.
Unfortunately, almost all the things that can cause trouble in the mouth of a mature adult can cause trouble in the mouth of an elderly adult, only more easily. In addition, aging adds its own challenges to these irritants and troubles, making it particularly challenging to keep the mouths of the elderly free from problems. On the other hand, most of these ailments of age in oral health can be prevented or managed, and the elderly are keeping their natural teeth longer. Growing old does not automatically mean having bad teeth.
Abrasion (wear and tear)
The effects of wear and tear on the teeth are cumulative over a long life: people are living long past the age our teeth were expected to serve. Cracks in the teeth admit bacteria, and the chances of needing a root canal or similar procedure increase greatly after age 65. As well, exposure to acidic foods and drinks can also have the cumulative effect of dissolving enamel. Abrasion is hard to avoid, but keeping away from acidic food and drink in the long run is a good idea.
As with so many other dental and oral problems, gum disease (gingivitis) is more common among the elderly. Signs such as bleeding gums, receding gums, loose teeth, and bad breath are indicators. The best approach is of course prevention through careful and regular oral hygiene: brush and floss at least twice a day, and quit smoking. A dentist will recommend treatment for more advanced gingivitis.
The rates of tooth decay in seniors rival those of young children, but for a different combination of reasons. For young children the primary causes are poor oral hygiene, softer tooth enamel, and sugary foods. By contrast, for the elderly tooth decay is caused mostly by poor oral hygiene, damaged enamel, dry mouth, and gum recession. Gum recession in the elderly exposes soft root tissue, and presents surfaces more prone to holding food and collecting tartar and plaque. The elderly are also more likely to have grown up without fluoride in water and toothpaste, to have lacked the benefits of modern dentistry, and to possibly be living with failing fillings as an additional weak spot in the mouth.
All teeth are set in a complex structure of bone, ligaments, gums, and other elements that collectively are called the “periodontium”. The stability of the teeth in the mouth is a consequence of the health of the periodontium which, like our bodies generally, ages. Good oral care in the forms of regular careful cleaning, regular dental visits, and good diet are all contributors in maintaining a healthy periodontium as we age, and can reduce the negative impacts of time on our mouths. A weak or diseased periodontium can lead to pain and possibly tooth loss.
The elderly have increased risk for cancers of the mouth, especially in the tongue, lips, and gums. Much oral cancer is related to smoking and the risk increases with age and the length of time smoked. Men more susceptible than women.
Oral cancers can be masked or mistaken for less dangerous things such as yeast infections and herpes; dentists are the first line of defence in spotting potential problems.
Teeth become increasingly yellow with age, as the dentin naturally yellows, and as the enamel covering the dentin thins. Smoking and substances such as coffee, tea, red wine, and so forth can also stain the teeth. Some measures to restore whiteness exist, but their effectiveness is less dramatic for the elderly.
Dry mouth (xerostomia) is strongly associated with a variety of medications, and the elderly are generally more frequent users of medications. The effects of an inordinately dry mouth on oral health are increased tooth decay and other detrimental effects, such as bad breath, increased risk of infections, and difficulty eating. Regularly drinking water, chewing sugarless gum, and over the counter mouth moisteners can all help.
With aging comes less resilient and elastic tissues, and the mouths of the elderly are more prone to cuts and abrasions that heal more slowly, creating sites for possible infections. Also, the dryness of the mouths of many elderly people can lead to yeast infections and other similar problems. Cleanliness is vital, often employing antibacterial mouthwashes.
Related Aging and Complicating Factors
Loss of effective oral hygiene often accompanies the development of dementia: maintaining regular schedules can become increasingly challenging for those with cognitive decline. Family members and support workers will need to step into the breach as dementia progresses.
Loss of oral sensitivity
As aging progresses, the sensitivity of the mouth and teeth decrease. While this can be seen as a blessing, the fact is that this loss of sensitivity can mask pain symptoms of tooth decay, gingivitis, and other oral health problems.
Loss of dexterity
Loss of manual dexterity caused by arthritis or other age-related causes can also present a challenge to maintaining good oral health, as brushing, flossing, and denture care become more difficult. Tools such as electric toothbrushes and water flossing equipment can help.
Dentures, partial plates
At the same time as the elderly are more likely to have dental prosthetics, they are also often less likely to manage these things successfully. Cleaning and applying dental adhesives can pose challenges, and the gums of the aging mouth can often change their form, necessitating frequent re-fitting of removable prosthetics. Implants can help, but they can also be beyond the financial reach of the elderly.
Recognizing the Connection Between Oral Health and Overall Health
Increasingly, the connections between good oral health and good overall health are being revealed. A sick mouth can sicken the whole body, and a sick body can harm the mouth. Unfortunately, the financial resources of the elderly are often limited, dental coverage is lacking, and getting to appointments can be logistically difficult. With these factors, attention to dental care can lapse for the elderly.
What to do?
Steps to prevent dental problems for the elderly include attention to regular and frequent brushing and flossing, regular visits to the dentist, and an electric toothbrush for those with dexterity challenges. With attention and care, the worst effects of aging on oral health can be prevented or minimized.