Dentistry for Seniors, Part I

December 2005

By: Dr. Scott R. Harden

In the mid 1980’s, while I attended dental school at Emory University, geriatric dentistry was first introduced as a separate area of study. Geriatric dentistry, based upon population growth tables, was predicted to provide a much larger future demand in dentistry that would have unique challenges for the dentist. Special needs of older persons seeking dental care included: systemic and oral health, physiology and psychology of aging, socioeconomic problems, effective communication, dental management, special problems in home health care, and managing frail elders in institutional and long-term care settings.

GERIATRIC DENTISTRY (dentistry for seniors), has, in fact, dramatically impacted the field of dentistry in the last several decades. Now that we have entered into the “new millennium”, over 20% of the population is over the age of 65. This predicted increase of the senior population, coupled with better education and concern by this age group for their overall medical and dental health, means that seniors are retaining more of their teeth. Studies show that approximately 50% of people 55 years or older have at least 23 of their 32 natural teeth remaining.

The American Dental Association (ADA) and Oral-B Lifetime of Healthy Oral Care survey* also found the following statistics:

  • 70% of seniors that were surveyed reported that they had a regular dental checkup at least once per year.
  • Seniors believed that healthcare is dramatically improving with every generation.
  • 95% of seniors believe that healthy teeth and gums are very important to their overall health.

Certain conditions can occur in seniors that are not normally found in younger individuals and further can affect the health of their teeth, as well as their overall physical well being.

The following conditions are general concerns for patients over 50 years old that should be routinely evaluated by a dentist:

  • Dry Mouth (Xerostomia)
  • Tooth Wear and Excessive Staining
  • Dental Decay (Root Surface)
  • Gum Disease (Periodontal Disease)
  • Loss or Alteration in taste
  • Denture Care

In Part I of this article, I will review the first three topics noted above, and will conclude next month in Part II with the remaining three topics.

Dry Mouth (Xerostomia)

A condition common to the elderly whereby saliva flow is decreased. The causes can include certain medical conditions, certain medications such as antihistamines, pain relievers and decongestants, among others. Other causes can be ill fitting dental appliances such as full or partial dentures. If a person allows this continued dry mouth condition to persist, there is an increase in the level of dental decay due to the increased level of bacterial colonies and plaque accumulations. The reason for this is that saliva has a natural bathing effect on teeth that helps decrease the level of bacteria from forming. There is also a greater risk for periodontal disease due to the decreased level of saliva. Patients are urged to see their dentist and/or physician to evaluate this condition. Certain products are available that can help correct this condition such as artificial saliva replacement drops, oral rinses such as Biotene mouth rinse and Oral Balance a moisturizing oral rinse. Sugarless lemon drops have also been found to be an excellent saliva stimulant that can help increase saliva flow. Many new and exciting treatment alternatives have been developed in dentistry over the years that can help seniors restore their teeth to a much more functional, healthy and youthful appearance.

Tooth Wear and Excessive Staining

With the increased wear of teeth over the years, many seniors may notice an unaesthetic appearance. Teeth can become unsightly and can make one appear older than they really are. Teeth can also stain, especially since these areas of enamel wear are excellent places for debris and plaque to accumulate and stain over the years. Also, as the protective enamel wear occurs, the yellowish dentin is more apparent causing teeth to appear darker. Hypersensitivity of teeth is also common causing unnecessary discomfort in patients.

Dental Decay (Root Surface)

As one ages, the incidence for decay can increase, especially root surface decay. The exposure of the tooth’s root surface occurs in seniors primarily from gum tissue receding as one ages. Root surfaces do not have a protective enamel layer and are primarily composed of softer cementum, which easily decays. Plaque and bacterial accumulation can collect on these surfaces increasing the risk for this type of decay. Since the root surface lacks enamel, decay can more easily penetrate the tooth’s pulp (nerve),  which can cause endodontic (root canal) problems and in worst scenarios, tooth loss. Older fillings may also wear and fracture as one ages causing weakening or loss of teeth.

About 200 million people in North America, Europe and Japan have lost one or more of their teeth. For years, dentures have been the only option for permanent tooth loss. However, more and more people are choosing dental implants as an alternative treatment for tooth loss.