The aging mouth – and how to keep it younger

Teeth, gums, and the rest of the oral cavity need extra care and attention if you want them to stay healthy in your later years.

Aging isn’t always pretty, and your mouth is no exception.  A century ago the need for dentures in later life was almost a foregone conclusion. Today, three-quarters of people over 65 retain at least some of their natural teeth, but older people still suffer higher rates of gum disease, dental decay, oral cancer, mouth infections, and tooth loss. While these problems are nothing to smile about, you can still do a lot to keep your mouth looking and feeling younger than its years.

Wear and tear

Teeth are amazingly strong. Your molars can bear down with over 200 pounds of pressure. But they’re not indestructible. A lifetime of crunching, gnawing, and grinding wears away the outer layer of enamel and flattens the biting edges. Tooth surfaces are also affected by exposure to acidic foods such as citrus fruits and carbonated beverages, which dissolve the protective enamel. Weakened enamel can set the stage for more serious dental problems. A crack or break in the tooth’s outer surface leaves the delicate pulp tissue vulnerable to irritation and inflammation. And, since the nerves at the tooth’s core lose sensitivity with age, the problem may be well advanced before you notice any pain.  The chance of having tooth damage severe enough to require a root canal or similarly invasive procedure triples once you’re over age 65.

Just because you’ve got a few gray hairs doesn’t mean you’re out of the woods when it comes to cavities, either. The rate of tooth decay in people over 65 now outpaces that of schoolchildren. A prime target of dental caries in older adults is around the neck of the tooth, adjacent to the gum line. Gum tissue naturally recedes with age, so the soft root tissue becomes exposed. In addition, adults who grew up before the advent of fluoride products and dental sealants often have fillings from childhood and adolescence that eventually break down. Decay around the edges of those fillings is also a problem.

While there’s not much you can do to stem the natural attrition of the tooth surface, the pillars of cavity prevention — brushing, flossing, and regular cleanings at the dentist’s office — remain the same at any age. People who have trouble brushing and flossing by hand because of arthritis or other disabilities should probably switch to an electric toothbrush. Fluoride, found in toothpaste, mouth rinses, and tap water in some communities, helps the body rebuild the mineral crystals that make up the tooth enamel and may also inhibit bacteria-laden plaque from adhering to the teeth. Fluoride rinses and gels, and varnishes  may be able to halt the progression of root decay and in some cases reverse the damage.

Make the moist of it

Age brings more health problems, and that often means multiple medications, many of which can have a detrimental effect on your oral health. For example, calcium-channel blockers for heart disease and anti-seizure drugs can cause the proliferation of puffy gum tissue, particularly around the lower front teeth. Good oral hygiene can combat this problem. In extreme situations, overgrown gums can completely cover the teeth, so they need to be trimmed back surgically.

Hundreds of medications list dry mouth (xerostomia) as a side effect. Lack of saliva is more than just uncomfortable. It makes eating and swallowing difficult, causes bad breath, and leads to irritation and infection of oral tissues. It also raises your risk for gum disease and tooth decay; new cavities can begin to form within as little as three months after dry mouth begins.

You can moisten a dry mouth by chewing sugarless gums or sucking on sugarless candies. Simply drinking more water can help; try holding it in your mouth for a few seconds before you swallow. Alcohol and caffeinated beverages dry out the mouth, so imbibe them in moderation. Tobacco is also drying, so there’s one more reason among the multitude for avoiding it. Although not perfect, over-the-counter artificial saliva products may counteract xerostomia. If dry mouth is a problem, you need to be especially conscientious about brushing and flossing because of the increased vulnerability to cavities.

The mouth-body connection

The well-being of your aging mouth is tied to the health of the rest of your body. There’s mounting evidence of an association between gum inflammation and conditions such as diabetes, heart disease, stroke, and respiratory problems, all of which are more prevalent in later life. Scientists postulate that bacteria from gum infections travel through the bloodstream to trigger inflammation in organs and tissues at distant sites.

For diabetes, a disease that afflicts nearly a quarter of Americans over age 60, the cause and effect may go in both directions. Over the years, uncontrolled blood sugar damages the blood vessels that supply the gums, so they become susceptible to infection, which accelerates periodontal disease. High blood sugar also translates into increased sugar in oral fluids for bacteria to feed on. Conversely, inflammation from oral infection may increase the body’s resistance to insulin, leading to greater difficulty in keeping blood sugar under control.