As people are living longer and keeping their teeth for longer, they are more likely to face significant dental challenges. Dr Paula Vassallo highlights some common problems and concerns, and gives advice on how to care for your teeth in the long run.

With age, the tissues in our mouth, like other body tissues, change. Soft tissues (gums and cheeks) lose their ability to stretch and muscles become soft and weak. The amount of saliva produced by glands in our mouth is frequently reduced. As a result, chewing of food may become more difficult, and the mouth may become more easily irritated and heals more slowly than when we were younger.

In addition, the teeth may become more brittle and are more easily broken or chipped. Fortunately, due to the reduced nerve tissue, little if any pain is experienced even with severe fractures. Teeth wear because of the grinding action of chewing. In severe cases, the hard enamel covering of our teeth is completely worn away.

As people get older and frailer, or if they experience a sudden weight loss, the gums also shrink and if they have dentures these may no longer fit properly. Poorly fitting dentures can cause mouth problems due to wear.

Good oral health is an essential part of general health. Oral health refers to the health of the mouth, teeth, gums, tongue and lips and associated structures. There are now known links between oral and general health among older people.

As people get older and frailer, or if they experience a sudden weight loss, the gums also shrink and if they have dentures, these may no longer fit properly

For example, people with rheumatoid arthritis have reduced salivary flow and it is estimated that 30 per cent will go on to develop Sjogren’s syndrome, an autoimmune disorder which is characterised by dry eyes, dry mouth and reduced vaginal secretions. A dry mouth can also be the side effect of the anti-rheumatic drugs.

There is also increasing evidence of a relationship between diabetes and gum disease. Many elderly people suffer from diabetes and the maintenance of strict oral hygiene is essential in the control of their diabetes. Diabetes by itself has been shown to affect the progression of gum disease; therefore all patients with diabetes should have regular dental check-ups.

As one ages, the gums shrink back, exposing the root of the teeth.As one ages, the gums shrink back, exposing the root of the teeth.

Common problems

Gum disease: Many adults experience some form of gum disease. Poor oral hygiene and improper fitting of dentures can increase the severity of gum disease. The signs of gum disease are gums that are red, swollen and tender or have pus between them and the teeth. Bleeding normally occurs with brushing.

This may be resolved with good oral hygiene. Older adults, like those with arthritis, sometimes have trouble brushing their teeth because they cannot easily hold the toothbrush. Their hands and fingers may be stiff, painful or weak. If this is the case, one can enlarge the handle of their toothbrush by wrapping a sponge, an elastic bandage or adhesive tape around it, push the toothbrush handle through a ball made of rubber or soft foam or use toothbrush adapters or an electric toothbrush.

Specially designed toothbrushes and toothpaste dispensers are also available and can be useful in such situations.

Root decay: When food and drinks containing sugar are consumed, the bacteria in the plaque break down the sugars and acid is produced. Frequent sugar intakes will dissolve the tooth surface causing the tooth to decay. As one ages, the gums shrink back exposing the roots of the teeth. These exposed roots are not covered by protective enamel and can decay quickly. This is known as root caries and is common among older adults.

Dry mouth: This occurs for a number of reasons, the most common being the side effects of the medications being taken. A dry mouth increases the risk of tooth decay. In addition both swallowing and speech become more difficult, and this may be compounded by altered taste. Wearing dentures also becomes more difficult.

If you suffer from dry mouth, sip water frequently and use non-foaming toothpaste or toothpaste for dry mouth. Saliva substitutes are also available.

Mouth infections: These are commonly found in older adults. Poor oral hygiene, unclean or poorly fitting dentures and conditions like diabetes increase the risk of such infections.

Altered taste: The sense of taste declines with age as taste buds degenerate. Medications, smoking, dry mouth and dentures all contribute to changes in taste.

Healthy teeth are necessary for a healthy body. With good habits at home like brushing, flossing, using interdental brushes, fluoride, regular dental care and avoiding tobacco products, older adults are able to keep their teeth for a lifetime. Everyone, even older adults with dentures need routine screening.

Good oral hygiene and dental care is valuable to the health and well-being of older adults as it affects one’s readiness to smile, the ability to eat comfortably and a person’s confidence when talking and socialising.

Ten tips to help adults keep their mouth healthy

Unclean or poorly fitting dentures can lead to infections.Unclean or poorly fitting dentures can lead to infections.

1. Brush teeth and gums with fluoride toothpaste twice a day. Fluoride protects against dental decay at all ages. Careful toothbrushing will reduce dental plaque and can help prevent gum disease. Toothbrush adaptors can be used when there is reduced hand mobility. If gums bleed do not stop brushing. This will stop after a few days; if it lasts longer consult your dentist.

2. Dentures should also be cleaned daily and should not be worn for 24 hours a day. Cleaning should be over a sink or wash-hand basin full of water or over a folded towel so they do not break if dropped. They can be cleaned with an ordinary toothbrush or a soft nailbrush. If denture cleaners are used, the instructions accompanying the product must be carefully followed. The mouth itself needs to be cleaned with a very soft brush or flannel when the denture is removed. Daily cleaning of dentures is vitally important to prevent mouth infections such as denture stomatitis (red sore gums) or angular chelitis (red sores at the angle of the lips).

3. Caregivers need to help with the daily oral hygiene routines of the elderly who are unable to perform these activities independently.

4. Eat a balanced diet that includes whole grains, vegetables, and fruits, and food which is low in sugar, saturated fat and sodium. Good nutrition is vital to maintaining healthy gums and avoiding tooth decay.

5. Avoid tobacco. Smokers have seven times the risk of developing periodontal (gum) disease compared to non-smokers.

Drinking high amounts of alcohol is a risk factor for oral and throat cancers.Drinking high amounts of alcohol is a risk factor for oral and throat cancers.

6. Limit alcohol. Drinking high amounts of alcohol is a risk factor for oral and throat cancers.

7. Sudden changes in taste and smell need not be considered a sign of ageing, but a sign to seek professional care.

8. Professional care helps maintain the overall health of the teeth and mouth.

9. See your dental care provider on a regular basis. Adults with dentures still need regular dental check-ups just as much as those with natural teeth as dentures do not last a lifetime. The mouth also needs to be checked for early signs of oral diseases or oral cancer.

10. Keep your dentist up to date on any new medicines you are taking. Visit your dentist before starting any medications for bone density problems.

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