Let's do a bit of time traveling. Cast your mind back to
the days when your grandparents were the age you are now.
Chances are at least one of them wore dentures, or needed
to. And way back then, you probably
thought that's what
happened when people got older, and at some point it would
eventually happen to you.
Fortunately, that's one possibility that doesn't have to
come true. The fact is teeth can last a lifetime, as long
as they're properly maintained. Along with consistent
brushing and flossing, the process involves a healthy diet,
access to fluoride-related preventative agents (like
fluoridated water, toothpaste, rinses or gels) and regular
visits to your dentist.
The more compromised your mouth is through missing teeth,
gum disease or tooth decay, the more important it is that
you see your dentist. Dental science has changed
dramatically since granddad's day. Back then, it was
frequently a matter of "fill or pull." Happily,
dentists have seen their practices shift from filling
decaying teeth to a focus on prevention -- keeping the mouth
healthy and the teeth intact.
"In days of yore, dentists were focused on teeth to
the exclusion of (almost) everything else," says Dr.
Victor Sterling, author of Fill in the Gaps: A Practical
Guide to Healthy Teeth (Addison-Wesley). "Before
fluoridation came into effect, there was such a tremendous
amount of decay they really didn't have time for anything
else. They were kept busy from morning to night just filling
teeth.
Now, with fluoridation and the dramatic reduction in
the number of decayed teeth, dentists are focusing on gum
disease, and as a result, fewer people are losing teeth due
to gum disease and fewer are having full dentures."
Dentists of course, can't take full credit for the
improvement. It's up to each patient to "attack the
plaque" by faithfully undertaking two simple low-tech
procedures: brushing and flossing.
Plaque
Plaque, the nasty scum that coats teeth and collects in
the crevice between tooth and gum, is a mixture of bacteria,
food particles and protein molecules in saliva. The
bacteria, especially Streptococcus mutans, feast on dietary
carbohydrates -- sugars and starches -- and excrete acid
that etches cavities in teeth.
Left unattended for 24 hours,
plaque begins to harden, eventually forming a stone-like
covering called calculus, commonly referred to as tartar.
(It's this hard coating dental hygienists scrape from your
teeth.)
Tartar, with its microscopic fissures and crannies,
contributes to the attack on teeth and gums by providing a
hideout for yet more bacteria and plaque, adding even more
of the destructive acid to the environment surrounding teeth
and also irritating gums.
Attacking plaque
- Brush at least twice a day, suggests Sterling: Right
after breakfast to clear your mouth of plaque formed
overnight as well as the morning's toast; then before
going to bed.
- Use a soft- or medium-bristled brush directed at a
45-degree angle and concentrate on one or two teeth at a
time. Place the bristles inside the cuff of the gum
where it joins the tooth -- without forcing -- and then
gently brush back and forth, rolling up and out to
dislodge the plaque from the cuff.
- Use a low-abrasive fluoride toothpaste that won't wear
teeth down. (Look for the seal of approval from the
Canadian or American dental associations.)
- Scrub too vigorously with a hard toothbrush and you'll
eventually wear a groove in the tooth enamel, leaving
teeth sensitive and vulnerable to decay.
- A toothbrush can reach three of the tooth's five
surfaces but it can't scrub plaque from between teeth.
That's why you need to floss.
- Choose the floss (waxed, unwaxed, flavoured or not)
with which you feel most comfortable. Slip it between
two teeth down to just under the gumline, then slide it
up one tooth and then repeat on the other tooth. Plaque
is soft, so you don't have to do this energetically.
- If it's too hard to get your fingers in there, use a
floss holder, available in drug stores or even your
local supermarket.
- Encourage healthy gums with a gum massage using the
rubber tip found on some toothbrushes or under a water
irrigator.
The fluoride factor
People who've managed to reach
adulthood without dental caries (tooth decay) owe a debt to
a turn-of-the-century Colorado dentist who noticed many of
his patients whose teeth were mottled had few cavities. The
mottling indicated a high fluoride intake (fluorosis),
consistent with the relatively high amount of fluoride
occurring naturally in the area's water.
By the 1930s,
scientists had determined a level of one part per million
would not cause mottling, but would protect teeth from
demineralization. Many communities, backed by the American
Dental Association and the American Medical Association,
then began starting to introduce fluoride to local drinking
water sources.
When the small amount of fluoride normally present in
tooth enamel is bolstered through water fluoridation,
fluoride toothpastes, mouth rinses or fluoride treatments,
the enamel -- already the hardest substance in the body --
becomes even tougher and more resistant to decay. This
preventative action is especially beneficial when children
receive the treatment in their first eight years of life.
Before widespread fluoridation, studies indicated three
distinct danger periods for tooth decay: around age seven,
when the crowns of baby teeth were threatened; age 14, when
the permanent teeth were under attack and later, between 30
and 40 when cavities began to appear with an ongoing
frequency.
Fluoride's efficacy doesn't diminish as the mouth ages;
in fact, it may be more critical to adult teeth than was
once believed. It's thought that fluoride use and the
presence of calcium and phosphorus in saliva can reverse
some degree of demineralization of coronal tooth enamel.
Fluoride also helps prevent root caries -- cavities that
bedevil older folk when the gum tissue that normally covers
the roots recedes or when incorrect brushing wears a groove
in the tooth enamel at the gumline, leaving roots
vulnerable. Because they're not protected by enamel but are
covered with a softer layer called cementum, exposed roots
are more susceptible to decay than are the enamel-covered
crowns.
The dreaded root canal
These cavities present a challenge to the dentist:
firstly, they have to be detected and then accessed for
treatment. If decay progresses too far into the cementum,
reaching the nerve canal of the root, excruciating pain
ensues.
Although the term strikes fear in the hearts of many, a
root canal offers blessed relief from the pain of an
infected tooth. After freezing the tooth and creating a
small opening in the top (or tongue side, if the aching
tooth is in the front), the dentist carefully removes all of
the soft tissue from each of the tooth's roots.
The
now-hollow tooth (and each root) is packed with a special
material and the opening is filled. Unfortunately, the tooth
can be vulnerable to fracture and should be strengthened by
a crown or other restorative procedure.
Adults, especially those who grew up in a pre-fluoride
era, often have several old fillings whose interface with
tooth enamel can fail, allowing bacteria to establish a
foothold of decay. These, along with root cavities and
periodontal disease (gum disease) present serious dental
challenges to older people. Part of the problem lies in the
aging process.
"As people get older, there's some normal change in
the tissues in the mouth," says Linda Jamieson,
coordinator of the dental hygiene program at Georgian
College in Orillia, Ont. "More importantly, there tends
to be a big change in their medical conditions, in the
number of drugs they're on, lifestyle changes -- even
economic changes." Losing dental benefits on retirement
discourages some from continuing the regular dental checkups
they'd maintained during their working lives, she points
out.
Sadly, dental health really can deteriorate as people
become infirm or have difficulty with mental alertness.
Daily oral hygiene then rests with others -- home care
workers or long-term care providers who may not be
adequately trained to clean teeth properly or who are too
overburdened with work to do a careful job. And a good job
is vital if cavities and gum disease are to be kept at bay.
Beyond the obvious cosmetic appeal of natural teeth and
the resulting effect on self-image and self-esteem, good
oral health is an important factor in preserving good
general health. For this reason, older people, whose health
may be less stable -- or their caregivers -- need to be
especially conscious of good oral care.
It's a growing dilemma. Schmitt, who is also a specialist
in geriatric dentistry, notes that during her involvement
with the Metro Toronto Homes for the Aged, "a very
interesting phenomenon was taking place in the population
coming into the homes.
There was a significant change --
more and more were keeping their natural teeth." But
having someone else clean your teeth can be humiliating and
handling the situation sensitively is a challenge for
caregivers. "It's not an easy thing to do because there
is a privacy and self-esteem issue," says Schmitt.
She stresses the importance of dental care for people
with Alzheimer's Disease as well, noting that "the best
time to treat is right now, because it's only going to get
worse."
Special consideration for seniors
Xerostomia, or dry mouth, is an uncomfortable condition
that plagues older people, Linda Jamieson points out.
Although it can be the result of a disease process that
affects salivary glands, it's often a side effect of
medications used to control hypertension, depression,
Parkinson's Disease or other disorders. The problem is often
compounded when patients are taking multiple medications or
undergoing radiation or chemotherapy for cancer of the head
or neck.
Dry mouth increases the risk of cavities and gum disease,
says Jamieson, noting "there are antibodies --
immunoglobulins in the saliva that target some of the
bacteria.
"There's also less natural cleansing, so we get
bacteria and food debris accumulating around the teeth that
otherwise might have been washed away."
If the situation is extreme and the patient ultimately
has to have dentures, the dry mouth will result in the
dentures causing rubbing and discomfort. Oral lubricants or
synthetic saliva can help, but not cure the situation.
People who've managed to reach adulthood without dental
caries (tooth decay) owe a debt to a turn-of-the-century
Colorado dentist who noticed many of his patients whose
teeth were mottled had few cavities. The mottling indicated
a high fluoride intake (fluorosis), consistent with the
relatively high amount of fluoride occurring naturally in
the area's water.
By the 1930s, scientists had determined a
level of one part per million would not cause mottling, but
would protect teeth from demineralization. Many communities,
backed by the American Dental Association and the American
Medical Association, then began starting to introduce
fluoride to local drinking water sources.
When the small amount of fluoride normally present in
tooth enamel is bolstered through water fluoridation,
fluoride toothpastes, mouth rinses or fluoride treatments,
the enamel -- already the hardest substance in the body --
becomes even tougher and more resistant to decay. This
preventative action is especially beneficial when children
receive the treatment in their first eight years of life.
Before widespread fluoridation, studies indicated three
distinct danger periods for tooth decay: around age seven,
when the crowns of baby teeth were threatened; age 14, when
the permanent teeth were under attack and later, between 30
and 40 when cavities began to appear with an ongoing
frequency.
She used to think it was just the oral bacteria,"
says Jamieson, "now the top three risk factors for
periodontal disease are diabetes, tobacco use and the
bacteria. And we're starting to feel that in the segment of
the population that has a very fast progressing gum disease,
those other factors are more significant than the
bacteria."
Gingivitis
Early periodontal disease, known as gingivitis, is
indicated by puffy, red gums that bleed easily. This is the
point at which action should be taken to stop the process in
its tracks before it reaches an even more destructive stage.
All too often though, people assume they've brushed or
flossed too hard and they try to be more gentle or stop
flossing, with the result that the disease does go on to the
next stage.
Periodontal disease launches a sneak attack. It's not
painful, but unless discovered during a dental exam, the
damage it causes may be irreparable.
Gum tissue forms a cuff around the neck of each tooth (a
cuff that should be cleaned by proper brushing and
flossing). As periodontal disease progresses, this tissue is
gradually destroyed, deepening the cuff around affected
teeth. (Your dentist, using a probe, measures the amount of
gum recession during your checkup.)
As this pocket deepens,
it becomes impossible to clean by normal oral hygiene
techniques and becomes a haven for bacteria. A resulting
inflammatory response destroys the microscopic strands of
protein that hold the tooth anchored to the bone -- and
damages bone as well. Without early intervention, the tooth
will be left without support and will have to be extracted.
But periodontal disease does more than threaten teeth. A
number of studies point to a strong relationship between
periodontal disease and cardiovascular disease (CVD),
myocardial infarction (MI) and even stroke. It's thought
that oral bacteria released into the bloodstream from the
inflamed pockets in the gums encourage platelets (particles
in the blood that are part of the blood clotting mechanism)
to clump, forming thrombi or clots. Gum infections also
trigger an inflammatory response that also promotes clotting
and vascular complications that lead to CVD and MI. People
with CVD also appear to be at risk when oral bacteria
migrate to, and damage, heart valves.
Keep your dentist informed
It's important to keep your dentist informed of your
medical history, including the drugs you're taking. Are you
taking an aspirin every day? Blood thinners? Does your
dentist know of your history of heart, circulatory or other
serious disease?
Drugs, including those used to treat hypertension, can
interact, perhaps dangerously, with some local anesthetics.
Even if you've lost the battle to keep your teeth and
consequently wear full dentures, you still need to see a
dentist regularly. As gums and bone change, those dentures
will fit less snugly and may require a relining for a
comfortable fit. (Improperly fitting dentures can cause
constant friction on tissues in the mouth that can lead to
pre-cancerous growths.)
This visit gives your dentist an
opportunity to examine the state of your mouth, noting
unusual bone loss (possibly a consequence of osteoporosis),
the presence of tumors or even indicators of diabetes.
Other changes and their effects
The mouth is a dynamic environment. When a tooth is lost,
its neighbors will shift, causing changes in a person's
bite, perhaps enough to create malfunction in the hinge of
the jaw, the temporomandibular joint. Opposing teeth, left
without resistance, tend to grow longer than normal. Loss of
a tooth though, leads to bone loss. It also can affect
self-image and provoke loss of self-esteem.
Teeth, of course, are chiefly used for biting and chewing
the food needed to maintain a vigorous body. But when those
teeth are sensitive to hot, cold or acidic foods, people
dodge discomfort by avoiding the offending chow, and a
once-balanced diet goes askew.
If chewing is less efficient
-- the result of broken or missing teeth -- food is
swallowed in chunks. When it's not sufficiently ground up,
there's less surface area available to acids and enzymes in
the digestive tract, and fewer nutrients are absorbed.
Forces exerted during chewing or grinding change when
teeth are removed and facial muscles or jaw joints (temporomandibular
joints or TMJ) can become strained and painful. TMJ syndrome
frequently results in migraine headaches or restricts the
mouth from opening fully.
Verbal communication is another important function of the
mouth and teeth. With everything in the oral cavity intact
and functioning normally, speech is easily interpreted.
Unfortunately, missing teeth can interfere with normal
speech formation, resulting in embarrassment and
misunderstanding. (It's a problem frequently faced by people
who are in the process of adjusting to new dentures.)
