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Aging for Amateurs: Problems we face when we're 'long in the tooth'

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Bill Simpson aging for amateurs.  

When I went to my dentist last week for my usual six-month exam and cleaning, I was distressed to learn that I had three cavities, which are the first in many years.

Dr. K reminded me that I was at the age of the second peak of dental decay, which happens in most of our lives. The first is in our teen years, the second in our 70s and 80s. Why is that and what are the other common dental problems we are likely to have as we become “long in the tooth?"

That phrase is part of the answer. As we grow older, our gums tend to recede, making our teeth appear to be longer. That also makes them more susceptible to decay in the section of the tooth than is newly exposed to food particles and bacteria trapped by plaque and held against the tooth surface.

Also contributing to risk for cavities is a dryer mouth. Our salivary glands tend to produce less saliva as we age and we tend to drink less fluid overall as our sense of thirst is not as acute as when we were younger. Add to that the many medications that some of us take that can cause a dry mouth.

Diuretics such as hydrochlorothiazide (HCTZ) and furosemide that we take for high blood pressure and swelling, medicines for depression, bladder-control problems and allergies can all dry us out. Less saliva decreases its washing effect, so instead of bacteria and food particles being swallowed and eliminated, they stay in the mouth and against the teeth.

A recent study showed that almost two-thirds of seniors have periodontitis, an infection of the tissues, including bone, that hold the teeth in place. If this isn’t treated, teeth may loosen and fall out or need to be extracted. Early periodontitis has few symptoms, another reason for regular dental check-ups. Later symptoms include bad breath that won’t go away, painful chewing and bleeding after brushing or flossing.

What can we do to minimize the risk of these problems? It’s a three part plan: regular brushing and flossing using the correct technique; avoiding dry mouth; and regular visits to the dentist for evaluation of our dental health and cleanings.

Brushing should be simple, we’ve been doing it for so long. But, as we say about so many things, the devil is in the details.

The American Dental Association and the National Institute on Aging have some specifics.

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1. Brush twice a day, using a soft-bristle brush and fluoride toothpaste

2. Brush all surfaces of the teeth using small circular motions and short back-and-forth strokes (it should take two minutes to clean all surfaces well).

3. To prevent periodontal disease, the toothbrush needs to go in at a 45-degree angle between tooth and gum so bristles go below the gum line and remove plaque.

If you have trouble holding or using a toothbrush, talk to your dentist or dental hygienist about an electric or battery-operated toothbrush or special grips to make a regular toothbrush easier to hold.

Clean between the teeth once a day, using pre-threaded flossers, tiny brushes made for cleaning between the teeth, a water or air flosser, regular dental floss or wooden plaque removers. Use whatever is easiest for you to handle because daily plaque removal is important. Again, your dentist or dental hygienist may have specific suggestions for specific areas of your mouth or problems you have.

For problems with mouth dryness, talk to your doctor about the medicines you take. If any are likely to cause dry mouth, ask if there are alternatives. Make a habit of sipping on water or sugarless drinks that don’t contain caffeine or suck on ice chips (don’t chew!) throughout the day. Use sugar-free chewing gum or sugar-free candy (tartness stimulates saliva best) when water isn’t available. If you use a mouthwash, choose one that is alcohol free.

And I’ll say it again as I’ve said it regarding other health problems: Avoid tobacco in all forms. It’s bad for your oral health, too.

Every aging amateur should have a full mouth exam at least once a year by a dentist that includes periodontal probing to measure the depth of the pockets or spaces between the teeth and the gums. People with no history of periodontal disease should have two cleanings per year.

Those with periodontitis may need as many as four cleanings a year. Work with your dentist to decide a cleaning interval that is best for you, but don’t put it off. Preventing problems is much better than treating them.

Bert Keller and Bill Simpson write the occasional column, “Aging for Amateurs.” Simpson, a retired physician, wrote this installment. Comments, questions and suggestions are welcome at

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