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Dentistry and the Over Fifties

15th March 2017 0 comments

Dentistry and the Over Fifties

These days more and more young people reach adulthood and beyond with few, if any, fillings. In fact three of my children are in their 30s and barely have a filling between them. That’s not true though, of those of us who are over 50. We were brought up in the Fifties, Sixties and Seventies when sugar became freely available, sweets were often more than a once a week treat, when snacking started in a big way and when high sugar cordials and ‘pop’ became the drinks of choice.  On top of this, knowledge about dental decay was limited, fluoride wasn’t yet generally in toothpaste, brushes were often poor quality and dentistry, particularly NHS Dentistry, consisted of silver amalgam fillings and extractions; quantity, not quality.  It was still very common for adults to have all their teeth out and I imagine, as children, we all expected to end up with a mouth full of dentures.

Now of course, our expectations have changed but we carry the legacy of those years. We often have very heavily filled teeth and crowns, gaps where teeth have been removed, wear and erosion from a lifetime’s bad habits and gum disease leading to loose teeth and bad breath. Add to this growing numbers of medical issues which can affect the mouth such as type 2 diabetes and those which affect how we have our treatment e.g. high blood pressure or warfarin medication and you can begin to see why we are a special group when it comes to dentistry.

The teeth.

By the time you’re in your fifties and sixties you probably will have quite a few fillings. The older type of filling, amalgam, served a purpose but has now been superseded by much better filling materials. When we take an old amalgam out of a tooth we frequently find a crack or cracks in the floor or sides of the cavity. These cracks are often stained which means bugs are using them as a superhighway to the inner part of the tooth. Sometimes these cracks are the cause of hard to diagnose toothache and sometimes a corner or side of the tooth will break away because of them.  It may also be that you have cracks because your bite causes the teeth to be loaded too much. Modern fillings, which are generally tooth-coloured to blend in, are bonded to the teeth and are stronger than amalgams though not as strong as your teeth would be if they had never needed a filling.

You may also find your teeth are getting shorter. This may be because they are wearing too much, possibly from grinding (bruxism) or it may be because of erosion caused by acids in the diet or acid reflux. Frequently it’s a combination of both. You can have a worn mouth rebuilt but this is quite complex to do and demands your dentist has the necessary skills.  It’s much better to plan the work properly rather than carrying it out piecemeal.  Dentists call the subject of how teeth meet and move against each other ‘Occlusion’ and it’s important that your dentist properly understands this complex subject as it can affect how well your dentistry lasts.  If a tooth is very heavily filled then it may need a crown or a laboratory made filling as these are much stronger. Crowns can be tooth coloured and many are now all ceramic so they match your teeth. Veneers are a great cosmetic option where you have filled or broken front teeth crowding or gaps. Sometimes though, orthodontics may be a better option and patients in their 50s and 60s can still have orthodontics. In fact my oldest patient was in his seventies when he had his treatment done.

The Gums

The most common reason to lose teeth as we get older is gum disease, also known as periodontal disease or periodontitis. Our parents and grandparents talked about pyorrhoea, a condition where pus would ooze from the gums which were inflamed and bled. Often the person would have bad breath. This is a form of periodontitis.

Periodontitis is caused by bacteria in plaque that stick to and grow on the tooth’s surfaces, along with an over-aggressive immune response against these bacteria. Some people are very susceptible but most people will suffer gum disease to some extent. Over time the periodontal membrane, which fixes the tooth to the bone, breaks down, the bone disappears, and, if left untreated, the tooth becomes loose. You may get an acute infection (an abscess) and the tooth may need to be extracted. Occasionally teeth can be so loose they fall out.

In simple terms, prevention is the best way to deal with this condition. It’s all about effective cleaning to stop the plaque from building up. You should see a hygienist who can advise you on a one to one basis how best to clean your teeth. They also remove hard calculus deposits (plaque which has hardened) and polish the tooth surfaces to make it easier to keep the teeth clean. In the end though, it’s all about you and your cleaning efforts. You need to allow yourself the time, every day, to thoroughly clean your teeth and gums. Buy an Electric brush – the evidence is they do a better job. Use floss, tape or interdental brushes, e.g. TeePees daily too. You can also scrape the top of your tongue where lots of bacteria lodge. This helps to keep the total numbers down and can help with bad breath.

Medical Complications

As we age, many of us develop more long term medical conditions such as high blood pressure, heart problems, diabetes and osteoporosis. The list goes on but it could either be the condition itself or the medication you take for it that may have an impact on your dental treatment.  For instance, many blood pressure medicines cause a dry mouth as a side effect. A dry mouth affects tasting, eating and digesting food. It means your teeth feel sharper and rougher so that may irritate your tongue and, most importantly, it means you are much more vulnerable to decay. Not only that but the decay mainly affects the roots of the teeth, making it more difficult to treat.  Another example would be if you have heart disease or surgery. You may be taking warfarin or one of the newer blood thinning medicines. It’s likely you would bleed a lot more if you need an extraction so your dentist would need to take extra precautions if you need an extraction.

This is why it’s really important to keep your dentist and hygienist informed about your health and to always keep them updated about any medications you take, whether prescribed or not.

Loss of Taste

Over the age of 60 our sense of taste starts to deteriorate so food tastes less interesting. We seek out stronger tastes so may like saltier food.  Even as the other tastes fade, we can still taste sweet so we seek out sweeter tasting food and drinks. Of course this usually means more sugar which is the favourite food source for the bacteria which cause decay.

Health and Fitness

We’re constantly urged to get fit and stay fit and many of us take this message to heart.  Be careful, though of Sports Drinks, Energy Gels and Bars which are often high in sugar.  They may be needed by performance athletes but think whether a bottle of water would serve you just as well.  Constant exposure to sugar is a sure fire recipe for dental decay.

Care Homes and the Elderly

As we get older we may find ourselves responsible for our even older relatives who may be in a Care Home. If they have their own teeth they can be very vulnerable to decay.  Frequently staff are too busy to supervise proper teeth cleaning and the patient may be having their calorie intact boosted by a high sugar supplement.  It’s also very common that they are given gifts of drinks, sweets, chocolates and biscuits.

Added to this because of the medication these patients are on, many of them suffer from xerostomia (dry mouth) and this accelerates dental decay. Sadly, many who’ve kept their own teeth into old age can lose them to decay in as little as three or six months.

So the message should be: Make sure the teeth are being cleaned thoroughly, daily. Monitor sugar intake, particularly snacks and drinks. Family and carers should be encouraged to provide low-sugar treats. Too often, Patients’ bedrooms often resemble a sweet shop. Try and visit your dentist and hygienist regularly. Care Homes sometimes arrange for hygienists to visit them.

©Mark Hargreaves 2017

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