Dental care is important at every age and stage of life. A healthy smile will support many aspects of your overall health and quality of life. An experienced dentist in Los Altos, Dr. Schweifler treats patients of all ages and works with seniors to address the common dental concerns that can develop as we age.
Americans are living longer and as of 2011, the first Baby Boomers began reaching senior status. In 2014, those over the age of 65 represented 14.5% of the U.S. population, but it’s projected that seniors will represent 21.7% of the U.S. population by 2040. Dental decay and periodontal disease are among the most destructive of chronic degenerative diseases and as lifespans increase, seniors will be putting higher demands on their dentitions. Older adults will account for an increasingly larger proportion of a typical general dental practice and it’s important that older adults seek care from those providers that understand their unique risks and who can offer preventive strategies to reduce these risks, while effectively diagnosing and treating their conditions.
RISKS COMMON TO OLDER ADULTS
As Americans are living longer, they are taking more and more prescription drugs that commonly have as a side effect, dry mouth or xerostomia. Normal salivary flow has the ability to counteract the acids created by bacterial plaque, reducing the risks that these acids lead to dental decay. With reduced salivary flow, the oral environment becomes progressively more acidic, putting seniors at a higher risk for aggressive decay, especially on the roots of teeth. Seniors are at a greater risk of periodontal progression (i.e. bone loss and gum recession) that exposes more tooth roots unprotected by the hard enamel found on the crowns of teeth. Patients who have lived most of their lives with no dental problems can become very “high risk” for tooth decay almost overnight due to the combination of the following:
- medication-induced dry mouth
- more exposed tooth roots
- more nooks and crannies for plaque and food to collect
- reduced dexterity that often occurs with this population due to such challenges as arthritis or dementia
Preventing the destruction associated with root decay takes a multifaceted approach. It starts with understanding the role you have in maintaining a plaque-free environment. This is achieved when you partner with our dental hygienists. Because plaque and food debris tend to hide out and it’s difficult for you to see where it’s collecting, our hygienists can show you where it is and in the process help you raise your level of homecare. By showing effective brushing and flossing techniques and incorporating other plaque-removing gadgets into the mix, your hygienist can help you so that you can manage much of this risk on your own. Having more frequent visits with the hygienist is also effective at reducing the risk of root decay progression. Patients at risk for root decay also benefit from prescription fluorides that can strengthen tooth structure and resist the acidic environment consistent with a dry mouth. Of course, a diet high in sugar and refined carbohydrates can also increase one’s risk for the decay process. We also encourage that our patients at high-risk for such decay have more frequent exams. The easiest decay to treat is that which is discovered at its infancy. Once root decay spreads below the gum line and under crown margins, the treatments become much less predictable and often lead to tooth loss.
While periodontal disease isn’t unique to seniors, like any chronic disease, more years amount to higher risks. Periodontal disease occurs when the body creates an inflammatory reaction to the presence of bacterial plaque. If the initial inflammatory reaction of gum inflammation (GINGIVITIS) isn’t reversed, it can lead to the degradation of the bone surrounding the teeth and ultimately put these teeth at risk for loss. Some individuals are at a higher risk for periodontal disease than others and elicit a stronger inflammatory reaction to even light levels of bacterial plaque. This bone destruction doesn’t typically cause symptoms until its later stages and thus it’s often true that patients have no real awareness of their disease severity until the point at which treatments are more invasive and less successful. Like any other chronic disease, the highest success rates with treatment occur at the earliest diagnosable stages.
With more lost teeth, the chewing system endures more and more stress: the balance of biting forces is displaced across fewer teeth which accelerates the demise of those teeth.
Many of the preventive protocols associated with root decay are consistent with periodontal disease. The goals for reducing periodontal risk center on plaque control. With an effective hygienist coaching you to a higher level of home care, you will have less plaque, less inflammation and less risk for continued bone loss. If the gum pockets are deepening and becoming less manageable, you may be a candidate for a Scaling and Root Planing procedure where the hygienist non-surgically removes the plaque deposits below the gumline that are causing the irritation, planes the tooth roots back to a smooth condition and ultimately shrink those inflammatory pockets to a healthier, more manageable state.
With bone loss comes a higher risk of tooth mobility. As patients with mobile teeth chew, the forces of mastication on the compromised system just leads to more tooth flexure and ultimately more bone loss. Such patients are candidates for splint therapy (i.e., nightguards) that can displace the bite forces across an appliance while sleeping and at least, reduce the rate that bone is lost. In more advanced stages of periodontal disease, where several teeth have been lost to the disease process, dentures may be the inevitable next step.