Aging & dental health: what you need to know

6 February 2022

As you mature in years, your body may change in ways you didn’t expect, presenting new health challenges and demands for care. Prevention may be key to avoiding issues that can become serious problems with age.

 

Dental health is no exception.  As you age, you may experience oral health issues that you’ve never had before due to natural aging, common health problems relating to aging, and medications that are commonly prescribed.

 

Fortunately, today there is a greater awareness of the importance of dental care throughout the aging process. More information and research are available about oral care and the prevention of dental health problems than ever before.

 

How aging affects oral health

 

Aging can affect oral health in many ways.

 

 

Common oral health problems in older adults

 

Gum problems

More than half of Australians over the age of 65 suffer from some degree of gum (periodontal) disease.

Gum disease is initiated by the bacteria in plaque, which can cause inflammation and irritation in the gums. This can then cause the gums to separate from the teeth and form pockets, which may house bacteria and food particles. This creates a dangerous cycle that can make inflammation worse.

Eventually, gum disease can weaken gums, attacking ligaments and even bones. When the supporting structure of the tooth is destroyed, the tooth becomes loose and will eventually fall out.  

Gum disease is relatively painless until it is severe. This means it’s easy for many seniors to have the condition without knowing, especially as their teeth and gums may be less sensitive.

 

Tooth decay

Wear and tear throughout the years weakens tooth enamel, leaving teeth unprotected and prone to decay, which leads to cavities and dental problems. The receding of gums — another effect of aging on the mouth — can also leave root surfaces exposed and more vulnerable to decay.

Root surface decay was shown in recent Australian studies to be common in adults in residential care.1 It is harder to detect than crown tooth decay.

 

Oral cancer

Cancers of the mouth (called oral and pharyngeal cancers) are diseases that mostly affect older adults. They are most frequently diagnosed in patients aged 55 to 64, with a median diagnosis age of 64.

 

TMJ disorders

TMJ (temporomandibular joint) disorders, which affect the bone structure connecting the jaw to the skull, are experienced by many older adults.4 The associated grinding of teeth can be damaging to tooth structure and enamel, leading to bone loss.

This is especially true for older adults whose enamel may already be vulnerable due to wear and tear and chronic health conditions.

 

Tooth loss

Tooth loss is a major concern for older adults, with approximately 25 percent of Australian adults over the age of 65 suffering from complete tooth loss.

Tooth loss occurs when severe dental issues are not prevented or treated. It has a severe impact on an individual’s quality of life as it affects their everyday activities like eating and talking. 

 

The connection between general health & oral health

 

Many seniors may consider their oral health a relatively low priority when compared to other health concerns, such as their cardiovascular systems, risk of stroke, or high or low blood pressure. However, research repeatedly shows that oral health is directly tied to overall health and many health conditions.

The bacteria in your gums (caused by plaque and particle build-up) can travel to other parts of your body through the bloodstream and respiratory tract, causing inflammation.2 This is a major source of sickness, infection, and weakened immune response in the body.

It can result in a damaging pattern. The mouth releases bacteria, causing inflammation which then makes it harder to fight off the bacteria in the mouth. More bacteria are then released, causing more inflammation.

 

This is at the heart of many of the connections between oral health and other health problems. The bacteria in the gums and mouth travel to other tissues and organs in the body, and this results in a problematic immune response.

 

Health issues in older adults that can cause oral health problems

 

Some health problems that are common in seniors can cause or exacerbate oral health issues.

 

Diabetes

The high blood sugar caused by diabetes weakens the white blood cells that aid the body in fighting off pathogens and bacteria, including the bacteria caused by plaque (the cause of tooth decay and gum problems).

Diabetes also causes blood vessels to thicken, slowing the natural movement of nutrients traveling in and waste products moving out of muscle tissue, including in the mouth. This also makes gum infection more common in people with diabetes.

 

Diabetes can cause other oral health problems, including these:

 

  • Dry mouth: Diabetes can decrease saliva flow, increasing the risk of ulcers, infections, and decay.
  • Thrush: Diabetes can cause many infections, and people take antibiotics as a result. These antibiotics may increase the risk of a fungal infection. The high-glucose saliva of those with uncontrolled diabetes can also create fungal issues or make them worse.
  • Delayed healing: Diabetes may slow blood flow to an affected site after a procedure or dental surgery, which can prolong healing time. This also can lead to more infections.

 

Osteoporosis

 

Osteoporosis weakens bones and can have a severe impact on oral health. As the jawbone becomes weakened by osteoporosis, teeth may loosen. This can result in severe decay, gum damage, and, ultimately, tooth loss.

 

Osteoporosis is a degenerative condition that causes systemic bone loss. Gum disease causes localised (in the mouth) bone loss as a result of bones being attacked by infection.

The relationship between osteoporosis and gum disease is still being studied. To date, studies have shown that both diseases share risk factors that are common among older adults, such as hormonal changes, age, and vitamin deficiencies. Radiographic measurements and clinical parameters of related studies have shown an association between the two conditions.3

 

Respiratory diseases & aspiration pneumonia

 

Gum (periodontal) bacteria travel rather easily to the lungs. In part of the immune response, the lungs may then “overreact” with damaging inflammation that can harm the connective tissue of the lungs.

The movement of gum bacteria into the respiratory tract can also produce aspiration pneumonia and make problems like chronic obstructive pulmonary disease harder to treat.

 

Medication & oral health

 

Aging often involves dealing with chronic and systemic conditions like hypertension, urological problems, issues with bones and joints, and more.

Many older adults are prescribed medications to treat these problems, sometimes multiple medications. Medications typically have side effects, and many of these side effects can impact oral health.

 

Dry mouth, or xerostomia, is one of the most common side effects of medications prescribed to older adults that can impact their oral health. Although dry mouth may not be a natural part of the mouth’s aging process, many older adults experience this oral health condition as a side effect of a medication and/or chronic health issue.

Dry mouth is not just uncomfortable. It can lead to more plaque, causing tooth decay and gum problems. Dry mouth can also cause bad breath, impacting social interactions and overall quality of life.

 

In rare cases, medications used to treat osteoporosis, including bisphosphonates and antiresorptive agents, have caused a serious condition called osteonecrosis, which can cause substantial damage to the jaw bone.

 

Older adults may be extremely sensitive to some medications. This issue is especially concerning as seniors may be prescribed multiple medications by different doctors as they face the multitude of chronic and systemic health issues associated with aging. Reactions to medications can impair memory and cognitive function, adding a layer of difficulty to proper oral care and hygiene.

 

Prevention: how to protect your teeth & gums as you age

 

Learning about the many oral health challenges faced by older adults can be worrying. But realising the huge impact that proper dental care and preventative measures can have on oral health outcomes is empowering.

The majority of the oral health problems described above can be controlled and limited, if not outright prevented, by taking care of your mouth and oral health. 

 

Daily oral hygiene

 

One of the most important factors in preventing oral health problems is caring for your teeth and gums. A good daily protocol includes the following:

 

  • Brush teeth at least twice a day, with a soft-bristled toothbrush and fluoride toothpaste. Adults with receding gums or tooth sensitivity may require special toothpaste.
  • Floss or use interdental cleaners daily.
  • Use a microbial mouthwash after meals, and brush to remove any particles or plaque. Alcohol-free mouthwashes may be preferable for those with dry mouth.
  • Replace your toothbrush every three to four months. If bristles appear worn, replace the toothbrush earlier.

 

Professional dental care

 

Seeing a dentist every six months for a professional cleaning and check-up can make all the difference in terms of ensuring oral health. This is especially true for older adults, who may become less sensitive to the pain or discomfort caused by an oral issue due to medication or loss of sensitivity. If they don’t feel pain as much, they may allow a problem to go untreated as it worsens.

 

A dentist will be able to identify any oral health issues, like decay or gum inflammation, early when these conditions are easier to treat. This will limit the damage the condition can cause and prevent further issues like tooth loss.

 

Some older adults may wish to see a dentist more frequently, every three to four months, if they are experiencing new systemic health issues or oral health problems.

 

Older adults with a full set of dentures on top and bottom may only need to see a dentist annually if they are not experiencing any problems.

 

Diet & nutrition

 

Sugary foods can cause tooth decay. Because of the holistic nature of health, eating a well-balanced diet can help older adults maintain general health that will also help in preventing oral health conditions. 

A balanced diet full of nutrients will best support overall health. If you are uncertain how to structure this, talk to your doctor or a nutritionist.

 

Dental insurance for older adults

 

The Australian government and Medicare do not generally pay for dental services. Some states and territories offer dental service programs, although there may be up to a year-long wait.

 

If you are covered by private health fund, most funds will cover only some of the cost of dental services. Speak to your health fund  about your coverage, as it varies greatly from plan to plan.

Because of growing awareness about the importance of oral care as it relates to overall health, particularly for the older adult population, there has been a movement calling for the government to provide easier access to senior dental care. The push for access to this coverage emphasises that oral health care is a basic human right rather than a privilege reserved for few.

 

Aging & dental health FAQs

 

Do teeth weaken with age?

Generally, older adults experience weakened teeth as they age. This is due to both the natural aging process (wear and tear on tooth enamel over the years) and oral health conditions (decay and gum inflammation) that may be related to chronic or systemic health conditions, or the medications used to treat them.

It’s common for older adults to need more extensive dental care as a result.

 

How do you keep your teeth healthy as you age?

Taking preventative measures to keep your mouth and teeth healthy can make a huge difference in their long-term health. Rather than seeing oral health problems as inevitable, take pride in your smile and do everything you can to maintain it. Good oral health care will not only boost your oral health but your general health and quality of life as well.

 

Daily oral hygiene (brushing twice a day, flossing at least daily, and using a suitable mouthwash after brushing and meals) can help you avoid decay and gum inflammation, which are the cause of many dental problems. Seeing a dentist at least twice a year can help to catch any problems early, so you can avoid severe issues like gum disease and tooth loss.

 

What issues do the elderly face in terms of oral health care?

Older adults are dealing with teeth and gums that have simply been used more. Seniors may experience natural aging problems that affect the mouth, like teeth shifting and shrinking teeth and gums.

 

Chronic and systemic health problems that are so often encountered by the aging population can have a serious negative impact on oral health. Inflammatory and degenerative diseases can weaken gums and bones, making the mouth much more vulnerable to tooth decay and gum disease. These issues can lead to tooth loss if left untreated.

 

Medications that are prescribed for these conditions can cause oral health concerns. Many of the medications cause dry mouth, which can increase tooth decay and affect overall quality of life. Other medications may cause memory or cognitive problems that can affect a person’s ability to perform daily oral care.

 

Complicating issues further for older adults is the fact that dental care is not covered by the government health plans for seniors. This limits access to professional preventative care and treatment.

 

General references

 

Aging and Teeth Shifting – Why It Happens and What You Can Do. (April 2020). New Lifestyles. Date Fetched: April 22, 2022.

 

Older Adult Oral Health. Centers for Disease Control and Prevention. Date Fetched: April 22, 2022.

 

Get the Facts on Healthy Aging. National Council on Aging. Date Fetched: April 22, 2022.

 

Grow Older With Good Oral Health. Alberta Health Services. Date Fetched: April 22, 2022.

 

Submission to the Royal Commission into Aged Care Quality and Safety. (June 2019). Australian Dental Association. Date Fetched: April 22, 2022.

 

Cancer Stat Facts: Oral Cavity and Pharynx Cancer. National Cancer Institute. Date Fetched: April 22, 2022.

 

TMJ Disorders. Mayo Clinic. Date Fetched: April 22, 2022.

 

Dry Mouth. Mayo Clinic. Date Fetched: April 22, 2022.

Managing Dry Mouth. (February 2015). Journal of the American Dental Association. Date Fetched: April 22, 2022.

 

'Unacceptable' Gaps in Dental Health for Older Australians. (April 2019). The Sydney Morning Herald. Date Fetched: April 22, 2022.

 

Oral Health: A Window to Your Overall Health. Mayo Clinic. Date Fetched: April 22, 2022.

 

Tackling Inflammation to Fight Age-Related Ailments. (December 2019). The New York Times. Date Fetched: April 22, 2022.

 

Oral Health Problems and Diabetes. Mayo Clinic. Date Fetched: April 22, 2022.

 

Osteoporosis and Oral Health. Mouth Healthy by the American Dental Association. Date Fetched: April 22, 2022.

 

Aging and Dental Health. American Dental Association. Date Fetched: April 22, 2022.

 

Why Oral Health Care is Important for Older People. Government of South Australia. Date Fetched: April 22, 2022.

Oral Health: An Essential Element of Healthy Aging. (2017). The Gerontological Society of America. Date Fetched: April 22, 2022.

 

Cost of Dental Care. Health Direct. Date Fetched: April 22, 2022.

 

Royal Commission Into Aged Care Quality and Safety Future Design of the Aged Care System. Australian Dental Commission. June 2020. Date Fetched: April 22, 2022.

Dental Reforms to Look After Older People Unable to Access Care Needed, Advocates Say. (April 2022). ABC News.

 

Medical references

 

1 Optimising Oral Health in Frail Older People. (October 2021). Australian Prescriber. Date Fetched: April 22, 2022.

2 Oral Health: Essential Element of Healthful Aging. (2018). Today’s Geriatric Medicine. Date Fetched: April 22, 2022.

3 Osteoporosis and Periodontitis. (2016). Current Osteoporosis Reports. Date Fetched: April 22, 2022.

4 Temporomandibular Joint Disorders in Older Adults. (2018). Journal of the American Geriatrics Society. Date Fetched: April 22, 2022.