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 problem 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 ones 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 gumline 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 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 are 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 homecare, 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.
As one of Dr. Schweifler’s mentors often says, “Dentures are not a replacement for teeth. They’re a replacement for NO TEETH.” The point is that emphasis should be placed on preserving one’s dentition and avoiding the loss of teeth and the need for dentures. No teeth replacement option is as comfortable and functional as the natural dentition. If several teeth have been lost and/or a patient isn’t capable of pursing a fixed option, removable prostheses may be their best choice. Patients that have lost multiple teeth and don’t replace them with fixed (bridges, implants) or removable (denture) options only accelerate the disease process. When back teeth are lost and not replaced, the bite forces are now concentrated on fewer teeth, and often times, the teeth towards the front of the mouth that aren’t designed to take that level of stress. The results can be very destructive and include:
- shifting of teeth adjacent to missing teeth which adversely affects the bite, puts more stress on the jaw joints and muscles, and can accelerate periodontal disease;
- fracturing of teeth adjacent to missing teeth, putting those teeth at risk for loss;
- continued, irreversible bone loss in areas where teeth are missing, which can contribute to bone loss to those areas shared with remaining teeth.
Denture wearers often complain that their dentures don’t fit comfortably, they shift during eating or speaking, leading to frustration and embarrassment. Without teeth, the supportive jawbone gradually shrinks over time and compromises the fit of dentures, not to mention a person’s appearance. When the denture no longer fits snugly to the underlying jawbone, more bone destruction can occur and thus it’s typically recommended that denture wearers have new dentures made every few years to reduce the rate of bone loss over a lifetime.
Partial dentures rely on anchorage of metal clasps to remaining teeth and that makes these prostheses more retentive than full dentures. On the other hand, the excessive stress that these clasps and bite forces place on the remaining teeth puts those remaining teeth at a higher risk for loss.
Complete dentures don’t have any teeth to serve retention purposes. The upper denture gains some retentive features from the palate, and depending on the depth of the palate, the contact of the denture against the palate forms a suction-like seal. Some patients don’t have a very deep palate and thus their upper denture lacks this retention and they must rely on denture adhesive. With none of the retentive benefits of the upper arch anatomy, lower complete dentures are very challenging prostheses for most patients.
Dentures only have about one sixth the chewing power of teeth when fitting properly. Ill-fitting dentures offer patients even less chewing power and thus can lead to poor nutrition. Many denture wearers start limiting the kinds of food they eat because of the struggle to chew more tenacious foods or because they’re self conscious eating in front of others.
Implants have eradicated a lot of the challenges associated with dentures. They can be strategically positioned in areas underneath dentures and serve to lock those dentures into place. An implant-supported denture doesn’t shift around during chewing, alleviating the challenges of the past and allowing patients to chew a variety of foods more forcefully and confidently.
If a patient has lost their teeth and doesn’t want a removable denture, implants can also be utilized to allow for a fixed, permanent restoration. This image shows an option commonly referred to as “All on Four”, where 4 implants are strategically placed for an entire arch and the restoration is screwed into the implants and isn’t removed like a conventional denture.
Dr. Schweifler has grown strong professional relationships with specialists that are highly skilled and experienced in successfully placing dental implants. Once the surgeon places an implant or implants, these areas must be left alone to heal over several months. After implants have osseointegrated (bone adjacent to the implant fuses to it), Dr. Schweifler begins the restorative process. If you’ve lost a tooth or multiple teeth and are wondering if you could benefit from implants, please ask to consult with Dr. Schweifler to get educated and to explore your options.