Americans are living longer than ever before. The number of seniors is projected to nearly double from 55 million today to 88 million in just a few decades.1 The average life expectancy in the US is nearing 80 years, which is more than ten years longer than 50 years ago.2
As we age, we all worry about our health, and for good reasons. According to the Centers for Disease Control, "approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions."3 A lot of attention is placed on diseases such as diabetes , cardiovascular disease , osteoporosis , cancer , and Alzheimer's disease or dementia. Oral disease is often overlooked, and it's much more important than you may think. This article will tell you why, so you can be motivated and equipped to improve your oral health and encourage your loved ones to do the same.
Many aging adults and seniors have less than optimal oral health. If you're part of that group, you're not alone. Over 30% of seniors consider their oral health "fair" or "poor,"4
and one in four said they had not seen a dentist in the last five years.5
Waiting to address oral conditions can lead to greater pain, expense, time, and delays in screening for diseases that impact your overall health.6 In addition, research demonstrates that poor oral health can help cause or complicate the management of a wide variety of health conditions. Common medical conditions and their medications and treatments can also accelerate oral disease.
Your oral health matters , and there's no better time than the present to take the actions necessary to promote and maintain it.
The implications of poor oral health
Examples of how oral health risk increases as you age include:
Tooth decay : As you age, your risk for tooth decay increases. Decay most often results from poor oral hygiene, receded gums, failing fillings or crowns , and some medications used to treat other conditions. Over 93% of seniors have decayed, missing, or filled teeth. On average, seniors have more than nine decayed or missing teeth and 43 decayed or missing tooth surfaces.7
Periodontal disease (periodontitis): Among American seniors, 70% have moderate to severe periodontal disease.8 This number increases based on race, income, education level, and access to care.9 Poor oral hygiene and infrequent professional tooth cleanings allow bacteria to collect around and under your gums (gingiva), causing redness, swelling , and bleeding. Eventually, the fibers that support your teeth become damaged or lost, teeth loosen or fall out, and the tooth-supporting bone becomes infected. Invasive procedures such as scaling and root planing , tooth removal (tooth extraction), and oral surgery are typically required to treat severe periodontal disease. In addition to the greater time and expense involved, you should know that some procedures are not recommended if you have certain medical conditions or are taking certain types of medication.
Missing teeth: One in four older Americans have lost several or all of their teeth. This is typically a result of severe periodontal disease or tooth decay.10 Tooth loss (edentulism) is also a known side-effect of radiation and chemotherapy treatment for cancer. Missing teeth can profoundly affect your diet, self-image, social interactions, and physical and mental health.
Oral cancer : Oral cancer is diagnosed in over 50,000 Americans a year. While treatment methods are improving, the 5-year survival rate is only about 60%, far worse than many other forms of cancer.11 Long-term smoking and heavy alcohol use, especially in combination, greatly increase your risk of developing oral cancer.12 Your physician rarely examines your mouth for signs of oral cancer. That's why your dentist is your frontline health care professional to screen for and diagnose this serious disease. As with most cancers, early detection is key, and failing to visit your dentist regularly can lead to less positive outcomes.
Dry mouth (xerostomia): Dry mouth is a condition where your salivary glands do not produce enough saliva to keep your mouth moist and healthy. Reduced saliva can lead to a rapid formation of tooth decay, especially at the gum line. Many medications and health conditions are known to cause dry mouth. Over 80% of seniors use at least one prescription drug, and 39% take five or more.13 General aging, cancer treatment, alcohol and tobacco , even your sleep habits can also contribute to dry mouth.
Interactions with other health conditions: Poor oral health is associated with many chronic physical conditions and behavior disorders. It's essential to understand the effects that your oral health can have on medical conditions and the effects those conditions can have on your oral health. In some cases, the illness may be made worse by poor oral health. Here are a few examples that may be relevant to you or someone you love:
- Kidney disease
- Cardiovascular disease
- Respiratory diseases
- Dementia and Alzheimer's disease
- Sleep apnea
- Immune system disorders
- Impacts on your nutrition
- Anxiety and depression
Care at home
Regular dental visits are not enough to keep your mouth healthy. Even if you do visit the dentist twice a year, the real question is, "What steps are you taking the other 363 days of the year?"
- Brushing twice daily with fluoride toothpaste and flossing every day is important to maintaining your oral health. Special toothpaste is available if you experience gum sensitivity, eroded tooth enamel , periodontal disease, or dry mouth. A prescription from your dentist may be necessary.
- Use mouthwashes or rinses every day. There are mouthwashes and rinses available that can elevate fluoride content, increase antimicrobial action, or stimulate saliva based on your particular needs.
- Tooth pain or missing teeth can affect what you eat, and poor nutrition can impact your ability to fight disease. People with these conditions often avoid foods that are fibrous, hard, or crunchy such as proteins, fruits, and vegetables. If you have trouble eating nutritious meals, talk to your physician or dentist. They may be able to dramatically improve your ability to eat or recommend supplements to help you get the nutrients you need.14
- Avoid tobacco and use alcohol in moderation.
- Removable dentures require the same cleaning as your natural teeth but with different products. Brush your dentures twice a day with a denture brush and a nonabrasive denture cleaner. Then, remove stains by soaking them in a mild cleaning solution appropriate for dentures. Floss or interdental brushes may help to remove stains between the denture teeth. Always rinse your removable dentures and bridges (fixed partial denture), and your mouth with clean water or a nonalcoholic antimicrobial mouth rinse before reinserting them.
Care at the dentist
Dentistry has changed a lot in recent years. Dentists are taking a more conservative approach to treating issues that focuses on disease prevention, preserving your natural teeth, and repairing existing fillings and crowns. Unlike in the past, extractions and artificial tooth replacement are typically considered only as a last resort.15
In addition to conducting exams, taking X-ray (radiograph) images, and providing professional tooth cleanings, your dentist can also play a vital role in the early detection of symptoms of both oral and systemic disease, increasing your chances of successful treatment.
- Be open and honest with your dentist or hygienist when they take your health history and current health status . Mention any medical conditions you have, medications you are taking, any family history of disease, and changes you have noticed in your mouth.
- If you are asked to complete and sign any additional paperwork, such as informed consent forms, be certain you understand what you are signing. Don't hesitate to ask questions if you are unsure.
- Be sure to understand all of the treatment recommendations and options that your dentist or hygienist is describing. If you are not clear, ask them to repeat it, ask questions, and write it down. If possible, have someone with you who can ask additional questions. If you are unsure, seek a second opinion before deciding on a course of treatment.
Pain management : While becoming less common, dentists still prescribe opioid-based medications for pain in some severe cases. Studies have shown that seniors taking opioids for dental pain are at increased risk of adverse effects or negative interactions with other medications they take. This is especially true if you take medications for anxiety or depression, which commonly use opioids as part of the treatment. Electronic medical records are not always available to dentists, so it's important to inform the dentist of any drugs you are taking (prescription or over-the-counter). You should always ask your dentist if the prescription they are recommending contains opioids and if there are alternatives that can reduce the possibility of interactions or dependence.16
If you oversee a loved one's medications, monitor their use just as you would for yourself. Use over-the-counter or prescribed medications only as intended and only for as long as needed. Look for possible adverse reactions. If you notice any abnormal signs, especially shortly after taking the drug, contact your poison control center immediately. Then, contact your physician and dentist as soon as possible.
Anesthesia: If you have cardiovascular disease, you should talk to your dentist and/or physician before getting dental treatment that requires anesthesia. Some types of anesthesia include epinephrine, which can increase blood pressure and heart rate, especially in older adults.17
Mobility issues: Disabilities, or the pain and stiffness of arthritis or osteoporosis, can cause difficulty with your oral care at home and at the dentist. Don't let these issues interfere with your regular oral hygiene routine or keep you from going to the dentist. More information is available on this topic within the articles specific to the condition. Individuals with cognitive decline, limited mobility, or who are more prone to falls also avoid dental visits more than others. Talk to your dentist, health care provider, or local community services about options that may be available.
Caring for an elderly or disabled adult: If you are caring for a parent, spouse, or friend who has difficulty maintaining a healthy mouth, there are steps you can take to help prevent many problems. Some things are most important:
- Help them keep their mouth clean with reminders to brush and floss daily. If difficulties arise, talk to a dentist or hygienist who can give helpful tips or suggest different approaches.
- If you are caring for someone confined to a bed, don't neglect their oral health. "Bad" bacteria from the mouth can enter the bloodstream or be inhaled into the lungs.18
- Make sure they get to a dentist regularly. There are dentists who specialize in the care of the elderly and disabled. The Special Care Dentistry Association (www.scda.org) is a good resource for these purposes.
- For individuals with missing teeth or who wear dentures, pay attention to their eating habits. Difficulty chewing, swallowing, or eating less frequently can be signs of dental pain or issues with dentures.
If your loved one is moving to a care facility:
Older adults who have moved into assisted living or long-term care facilities often have difficulty maintaining their oral health, especially if they are frail or disabled.19 Not all care facilities train their staff about the importance of oral health and the consequences of poor oral health on chronic health conditions. If you are considering assisted living facilities for a parent or loved one, some important questions to ask include:
- Does your facility have staff educated in the importance of oral health?
- Is assistance with oral health a part of your staff's daily routine, and what steps are taken when a guest needs additional assistance due to underlying conditions?
- How often are your guests seen by a dental professional as part of their stay?
- How does your staff coordinate the medical and dental health needs of your guests?