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The Aging Mouth?

“23% of 65-74 year olds have severe periodontal disease. In healthy adults, there is no diminution in the production of saliva in the course of aging. In all probability at least one of the medications used (by older people) will have an oral side effect – usually dry mouth (Xerostomia).” – U.S. Surgeon General’s Report

1. Why is it important to have functional and attractive teeth in old age?

  • Old, as well as young people need to look good, and to feel good about themselves.
  • The way we look affects our confidence.
  • Old people who cannot chew properly often become malnourished, and this can affect their general health.

2. How can people keep their teeth into old age?

  • There is no need to be toothless in old age.
  • Older people are now keeping their natural teeth for longer than before.
  • Good oral hygiene and regular visits to your dentist should allow you to keep your teeth and gums in good condition.
  • Make sure that you continue to eat a balanced diet.
  • Chew your food well to ensure a healthy flow of saliva.
  • Cosmetic dentistry can provide older people with attractive and natural-looking tooth replacements.
  • Implants are available to support dentures and crowns.
  • Where there is not sufficient bone for an implant, bone can be built up.

3. What can I expect to happen to my teeth and gums as I get older?

  • Staining
  • Teeth darken in color as a result of staining.
  • The stains are usually brown, yellow and orange, or combinations of these colors.
  • Pigments in food cause a gradual darkening of teeth. Tea and coffee are the most common causes of discolouration.
  • Smoking causes severe staining. The nicotine sticks to the teeth, and is difficult to remove.
  • When nerves and blood vessels in the teeth die, the teeth become grey or black.
  • Some antibiotics taken over long periods can stain teeth grey.
  • Attrition
  • Normal eating eventually causes the chewing and biting surfaces of teeth to be worn down.
  • The teeth become flattened and shorter.
  • Attrition is the name given to this kind of toothwear.
  • Bruxism is a condition marked by the involuntary habit of grinding and clenching of teeth, often during sleep.
    It causes serious toothwear that can result in the loss of teeth, and jaw-joint pain.
  • Abrasion
  • Abrasion is the wearing away of the tooth surface at the gum line.
  • Brushing teeth too vigorously is the cause.
  • Abrasion and attrition cause the sensitive dentine layer of the tooth to be exposed.
  • Tooth sensitivity
  • This can be caused by teeth wearing down and the dentine becoming exposed.
  • Sensitivity to hot, cold and sweet foods and drinks causes pain.
  • This pain can be sharp, but will stop when the cause is removed, i.e. when the food or drink is no longer in the mouth
  • Gum disease
  • Most people have gum disease at some time or other.
  • Gum recession, or shrinkage results from gum disease.
  • Untreated gum disease causes the gum to lose its original attachment to the tooth.
  • The gum then re-attaches itself to the tooth at a lower level.
  • The tooth then looks longer.
  • As a result of gum shrinkage, spaces appear between the teeth where the gums used to be.
  • The gums will bleed easily, and the teeth will become loose.
  • Bone recession (shrinkage)
  • The bone around the teeth will be affected by gum disease.
  • The tooth loses its supporting bone, and becomes loose.
  • Gum and bone disease (periodontitis) are major causes of tooth loss.

4. Is dry mouth or xerostomia an inconvenience or a real problem?

  • Xerostomia is a medical condition.
  • The mouth is dry because the salivary glands are not producing enough saliva.

5. What are the causes of xerostomia?

  • Inadequate chewing is a common cause of dry mouth.
  • Chewing is needed to stimulate the flow of saliva. The frail and elderly can have difficulty chewing. If food is not chewed properly a dry mouth can develop.
  • Older people may avoid eating food that needs to be chewed well.
  • This may be because of ill-fitting dentures, or because of frailty or ill health.
  • Most older people are on medication, and some medications and other therapies can cause dry mouth. Some examples are:
  • Medication such as anti-histamines, anti-depressants and drugs to reduce blood pressure.
  • Radiotherapy.
  • Other possible causes of dry mouth are:
  • HIV and AIDS.
  • Mouth breathing.
  • Fatigue and anxiety.
  • Aging does not cause dry mouth. It is present in the elderly only when it is a symptom of a disease.

6. What are the effects of dry mouth?

  • Dry mouth causes a great deal of discomfort and can also cause the following problems:
  • The mouth becomes more susceptible to tooth decay and gum disease.
  • Oral infections and salivary gland infections may result.
  • Bad breath is associated with dry mouth.
  • A dry mouth can affect speech, swallowing and taste.
  • Difficulty with dentures can result from dry mouth.
  • Saliva is essential for the suction that dentures need to be firm and stable.
  • Dryness is often accompanied by a burning sensation in the mouth.
  • The corners of the mouth and the lips can become dry and cracked.

7. How can the problems caused by dry mouth be treated?

  • Production of saliva must be stimulated. All symptoms must be treated.
  • It is very important to stimulate the salivary glands by vigorous chewing.
  • Eat foods that require chewing such as fruit and vegetables.
  • Chewing sugarless gum also stimulates the flow of saliva.
  • Sialogogues are drugs that can be used to increase the flow of saliva.
  • Relief can also come with mouthwashes, lozenges, or toothpastes.
  • Sipping cold water or sucking ice can also bring relief.
  • Oral hygiene is important. Brush your natural and replacement teeth well.
  • Mouth infections and periodontitis that are caused by dry mouth can be treated with a fluoride or chlorohexadine mouthwash.
  • When dry mouth is due to a medical condition you will be referred to your doctor for diagnosis and treatment.
  • Ask your dentist how to maintain a comfortable mouth.

8. What can be done about halitosis?

  • Halitosis can have many causes. Here are a few guidelines:
  • Good oral hygiene is the best way to keep the mouth healthy and fresh.
  • Sugarless chewing gum is recommended. It stimulates the flow of saliva and freshens the breath.
  • Antibacterial mouthwashes help to protect the mouth against infection, and to freshen the breath.
  • Treatment of periodontitis and other oral infections and diseases is essential to your dental and general health.
  • Any decay of natural teeth must be treated. All decomposing materials smell, and that includes teeth.
  • Dentures and other tooth replacements must be kept very clean at all times.

9. Is there a danger of oral cancer in old age?

  • The chances of getting this disease do increase with age, especially for smokers.
  • Your regular dental check up will include a full mouth examination.
  • The earlier mouth cancer is diagnosed and treated, the better the chances of recovery.

10. Do dentures need special care?

  • General good health is dependent on the ability to eat comfortably.
    Here are some tips on dentures:
  • Dentures should be taken out of the mouth every night, and cleaned with a soft brush or a denture brush.
  • Full dentures will benefit from being left overnight in a soaking solution.
  • Soaking solutions can remove plaque, tartar and stains.
  • Smoking and poor oral hygiene will lead to staining and tartar deposits on the denture. This can irritate the gums and palate and cause a stomatitis. Regular cleaning and soaking can prevent this.
  • Dentures must not be left to dry out.
  • With time, the gums and bone shrink, and dentures may loosen.
  • Denture fixatives or adhesives can help to improve the firmness of dentures.
  • Fixatives help the wearer to adjust to new dentures.
  • Do not use denture fixatives to keep old, ill-fitting dentures in place. This can cause injury to the gums.
  • Dentures can be relined or rebased to improve the fit.
  • New dentures will have to be made when the changes in the gums and bone make the dentures too loose.

11. What can I do to ensure a healthy mouth and teeth as I get older?

  • Clean your teeth and tooth replacements thoroughly twice a day.
  • See your dentist twice a year to check the condition of your gums, natural teeth and tooth replacements such as crowns, bridges and dentures.
  • Make sure that you continue to eat a balanced diet.
  • Chew your food well to ensure a healthy flow of saliva.

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