What is a Middle-Aged Mouth?

February 2009

By: Dr. Scott R. Harden

For the Year 2009, my articles will be in a WHAT or WHY theme and coordinate with questions from readers. If you have any dental questions that may prompt a good article, please send them to Kara Kiefer, editor@townelaker.com.

Many new patients I diagnose present with a “middle-aged mouth”. A “middle-aged mouth” does not include all middle-aged people, but is a term I use to refer to a condition of certain people’s teeth in their adult years. A “middle-aged mouth” refers to a person’s teeth that typically received various types of dental treatment at different times throughout their life often by different dentists. It also involves the overall wear and tear on teeth over the years that lead to broken teeth, broken fillings, and teeth that move into un-ideal positions. Therefore, a “middle-aged mouth” results from both dental care and from natural deterioration of teeth that noticeably manifests when a person reaches middle age. Stated another way, a “middle-aged mouth” implies an imbalance or lack of function and esthetics due to changes that have occurred over time. I have dedicated my career to focusing on the comprehensive evaluation of this issue that affects so many people. Below are several examples of what might lead to a “middle-aged mouth”.

A dentist may restore a broken tooth to solve an immediate problem, and not relate it to the overall functional or esthetic needs of the patient. This can especially happen during an emergency visit by a dentist that is not familiar with your mouth. Here is a typical example. John breaks an upper right molar and does not realize it or simply elects not to go to the dentist to fix it. Several years goes by until the tooth begins to hurt. Because of the fracture, the lower right molar that opposes the broken tooth moves up into the fractured area over the years and is now in a significantly improper position. Teeth will often move a considerable distance (growing out of the bone or dragging the bone with them) until they hit another tooth or the skin, a condition called “supra-eruption”. If a dentist now restores the broken upper right molar without addressing the lower tooth that shifted, John will now have a significant change in his dental function. For every action there is a reaction, and now John’s other teeth will receive abnormal stress and wear accordingly which creates additional dental problems. This is a step toward a “middle-aged mouth”.
A dentist may choose to place a dental implant to substitute for a missing tooth before considering the over functional needs of the patient. Here is an extreme example of steps toward a “middle-aged mouth”. Sarah has a single lower left back molar extracted. She chooses an implant and crown in order to avoid wearing a lower denture to replace this one missing tooth. In the mean time, Sarah also has moderate crowding on her upper and lower front teeth and a deep overbite. Unlike teeth, implants cannot be moved once they are set in place and remain in that position forever. Therefore, the implant position may not work out if Sarah later decides on receiving braces. This would create a complex concern that contributes to a “middle-aged mouth”.

Over the years a person’s teeth often shift into very un-ideal positions, become severely worn, and get darker. Patients with “middle-aged mouths” often have a collection of silver fillings, white fillings, white crowns, gold crowns, and maybe a denture. They may have whitened their teeth so that now old fillings in their front teeth appear dark and perhaps even look like a cavity. Abnormal habits of nocturnal (nighttime) grinding causes severely worn, chipped and shortened front and back teeth. Heavy brushing, grinding and poor function can all lead to gum recession. Extracted teeth (other than wisdom teeth or teeth coordinated with braces) that are not properly restored cause shifting of the remaining teeth into bad positions over the years and contribute to a “middle-aged mouth”.

Many adult patients have old restorations in their teeth (silver fillings, white fillings, crowns) that are over 20 years old and have bacteria actively penetrating underneath them. How long do restorations last? Most patients respond, I don’t know. The average life span of restorations is 10-15 years, which consequently means restorations get replaced 3 to 4 times during a person’s life. That is a revelation for many people. They initially get fillings before or during their teenage years. These will typically need replacing when the patient reaches their 30’s, 50’s and 70’s; middle age is in their somewhere.

What is the solution to correcting a “middle-aged mouth”? A person should receive a comprehensive new patient examination at the dentist and an overall treatment plan of your teeth. A proper treatment plan must eliminate decay and obvious problems, but must further eliminate the perpetuation of previous problems created by old restorations and significant natural changes caused by grinding, broken teeth, tooth movement and other factors.

Your evaluation should not be limited to a tooth level diagnosis but should encompass all of your teeth and how they appear and function together as a whole. This is crucial to the long-term success of your dental care, keeping your teeth healthy and avoiding the “middle-aged mouth”.