The U.S. is going through rapid demographic changes with dramatic increases in the number of older adults. The Census Bureau projects that by 2035, there will be 78 million Americans aged 65 years and older, outnumbering people under the age of 18. Chronic illness, disability or institutional living often affect routine oral healthcare among this demographic, which also faces unique oral health risks that could impact quality of life if left unattended.
“There are numerous disease processes that have a direct line with bad oral health,” says Dr. Chris Combs, whose practice, Bella Vista Dental, sits along Highway 71B in Bella Vista, a retirement community where the median age is 51.
As patients age, good oral health can become increasingly difficult to maintain, Comb says. First of all, many older Americans take both prescription and over-the-counter drugs that can cause chronic conditions like dry mouth.
“There are over 500 medications which can cause dry mouth,” he says. “With dry mouth you get an increase in cavities.”
Saliva acts as a cleanser and is partially responsible for keeping plaque off teeth. So when there’s less saliva, there’s more plaque, which causes cavities. Eventually, says Combs, some patients can end up loosing their teeth.
Fighting the consequences of dry mouth is best handled by having a regular cleaning regiment. While that should include coming in for regular checkups with a dentist, Combs says, the bulk of the work has to happen at home. He recommends brushing for at least two minutes every day preferably using an electric toothbrush.
“If you are losing some of your manual dexterity, you can get duct tape to put around the toothbrush handle to make it thicker, so you can do a better job,” Combs suggests.
Regular cleaning can also ward off periodontal or gum disease, which is another prevalent condition found among older adults. According to figures cited by the Centers for Disease Control and Prevention, about two in three people aged 65 or older have gum disease.
“As the plaque builds up,” says Combs. “There’s a little pocket between your tooth and the gum. That gets a little deeper and starts detaching from the tooth, so your gums recede, which exposes the root of the tooth.”
The roots are soft, which means they are susceptible to decay and decay can lead to tooth loss. Missing teeth and dentures, Combs says, can greatly impact nutrition and quality of life because adults in either situation often prefer soft, easily chewable foods instead of fresh fruits and vegetables, which have higher nutritional value and can also cleanse teeth.
A 2017 study published in the Journal of the American Geriatrics Society examined the influence of poor oral health on a cohort of older British men. It concluded oral health problems were associated with greater risks of being frail or developing frailty in older age, which can include functional decline, hospitalization, disability, long-term care and death.
Recent studies also suggest the connection between dental health and heart health may be stronger than previously thought. Experts believe the same bacteria that leads to tooth and gum decay may put the body into a state of low-grade inflammation that leads to heart disease.
“People who have more gum disease, tend have more heart problems,” says Combs.
Patients with replaced heart valves need to be especially careful, he warns, because the valves are very susceptible to that kind of bacteria.
Older adults should also be paying attention to any unusual changes in the mouth, which could be a sign of oral cancer. The median age for diagnosis is 62, according to the National Cancer Institute.
“Dentists check for red and white areas,” says Combs. “There are a lot of those in your mouth, but they look a little different, so if you notice something like that, let your dentist know.”
Patients should also consult a dentist before undergoing any oral cancer treatments.
“You need to get a dental exam,” Combs says. “Sometimes we need to get teeth out or fixed before radiation.”
Radiation in the jaw can keep the bone from healing later, which means extractions cannot be done following treatment, he explains. Combs recommends prescription fluoride toothpaste to decrease the odds of cavities.
He also suggests caregivers of older adults pay attention to any changes in eating behavior such as favoring one side of the mouth over the other or choosing soft foods, as both could indicate dental issues.
This story is produced by Arkansas Public Media, a statewide journalism collaboration among partner stations KUAR, KUAF, KASU and KTXK, and community partners AETN, and the Butler Center for Arkansas Studies. Arkansas Public Media's series on oral health in Arkansas is funded through a grant from the Delta Dental of Arkansas Foundation, and with the support of its partner stations. You can learn more about Arkansas Public Media's reporting at arkansaspublicmedia.org.