By Dr Igor R. Blum, Reader in Primary Dental Care & Advanced General Dental Practice and Honorary Consultant in Restorative Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King’s College London
Did you know that your oral health offers important clues about your overall health, or that problems in your mouth can affect the rest of your body? Fact is that oral health is inextricably linked to our overall health, quality of life and wellbeing. Therefore, looking after our teeth is also about looking after our overall health.
Not only is the mouth essential for eating, drinking, tasting, breathing, verbal and nonverbal communication, but saliva helps to wash bacteria and food particles off your teeth and neutralise the harmful acids that come in contact with your teeth. The antibacterial properties of saliva are part of our body’s defence system against infection. Thus, healthy teeth, gums and saliva are important for effective chewing and swallowing, and therefore for good nutrition and wellbeing.
Unlike decades ago when losing your teeth and getting dentures was the expectation, many older adults in the UK have experienced improved oral health because of exposure to water fluoridation, greater emphasis on preventive dentistry and societal emphasis on the importance of maintaining the natural teeth. The result is reduced tooth loss and decreased prevalence of the complete loss of the natural teeth.
Epidemiology
There are 10.8 million people aged 65 or over in the UK. Owing to advances in medical care, the proportion of people aged over 65 years is predicted to rise from 17.2% currently to 22.4% in 2032. In contrast, the proportion of adults with no teeth in England and Wales has reduced from 37% in 1968 to only 6% in 2009. The proportion of adults with more than 21 teeth increased from 73% in 1978 to 86% in 2009. Further huge improvements are projected as younger generations age, assuming future tooth loss continues at current low rates. As a result, we might expect that over 90% of those aged 35-44 in 2009 have a realistic prospect of retaining a functional natural dentition of 21 or more teeth by the age of 80. Thus, ageing adults are no longer living with the expectation that they will lose all of their natural teeth and enter old age with dentures.
What’s the link between ageing and oral health?
As we continue to live longer and retain more of our natural teeth throughout the duration of our lifetime, our gums recede, exposing the roots of our teeth to decay. In addition, we face the challenge of adequately maintaining our teeth, gums and any dental work at a time when our overall health might be deteriorating owing to medical conditions such as arthritis in the hands and fingers, which makes good oral health care difficult or impossible to perform. Thus, oral health often gets more challenging as we age.
Like many areas of the body, your mouth is teeming with bacteria – most of them harmless. Normally the body’s natural defences and good oral health care, such as daily brushing and flossing, can keep the bacteria under control. However, without proper oral hygiene, the buildup of bacteria can reach levels that increase our vulnerability to tooth decay and gum disease (periodontitis) potentially resulting in tooth loss.
Gum disease is caused by a build-up of bacteria called ‘plaque’. Plaque forms constantly on your teeth. It is important to remove this dental plaque to avoid bad breath and gum inflammation, including bleeding from the gums. If the dental plaque is not removed, the gum
disease will, in time, affect the bone under the gums. As this bone supports the tooth roots, your teeth may gradually become loose.
The same dental plaque that causes gum disease can also cause decay, particularly if you often have sugary foods and drinks. There is a particular risk of decay at the gum edge when the gum has receded, as the ‘neck’ of the tooth is not protected by enamel (the hard coating that covers most of the tooth).
As we grow older, we often find that decadesold fillings, crowns and bridgework can crack or crumble, last but not least because of the increasing challenge of maintaining our teeth and dental work as efficiently as we used to prior to facing physical and/or cognitive challenges. As a result, it is not uncommon to find that teeth and dental work are falling apart in the older population, even though they have worked a lifetime to maintain them.
Sometimes elderly people are reluctant or unable to tell their dentist about their dental problems. They might even overlook dental problems because of other more demanding health problems. In such cases it is essential for family members to watch out for symptoms. Untreated dental problems can lead to a number of diseases, especially in elderly people.
What’s the link between oral health in the ageing population and overall health?
The challenges identified in improving oral health are significantly pronounced for older adults. A host of medically complex health issues, including diabetes, depression, dementia, osteoporosis and reduced mobility pose pressing concerns for maintaining oral health in an increasingly elderly population. For instance, diabetes reduces the body’s resistance to infection – putting the gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. On the other hand, osteoporosis – which causes bones to become weak and brittle – has been linked with the loss of bone supporting our teeth (periodontal bone loss) and tooth loss. Certain medications used to treat osteoporosis carry a risk of damage to the bones of the jaw, particularly following the extraction of a tooth.
In addition, certain medications such as decongestants, antihypertensives, antihistamines, painkillers, diuretics and antidepressants can reduce saliva flow, resulting in dryness of the mouth, thereby increasing vulnerability to tooth decay and gum disease (periodontitis). Furthermore, the reduction or loss of saliva and its protective function combined with suboptimal denture care puts denture wearers at increased risk of developing opportunistic infection in the mouth, such as oral fungal infection, also known as denture stomatitis.
There is some evidence that untreated gum disease (periodontitis) is associated with an increased risk of developing heart disease. Poor dental health increases the risk of oral bacteria entering the blood stream, where they attach themselves to the blood vessels and potentially increase your risk of cardiovascular disease. The oral bacteria can also affect the heart valves. In addition, there is a strong connection between diabetes and cardiovascular disease, and evidence that people with diabetes benefit from gum (periodontal) treatment. Other cardiovascular conditions such as atherosclerosis (clogged arteries) and stroke have also been linked to inflammation caused by oral bacteria, according to the American Heart Association.
How can I maintain good oral health?
Good oral hygiene and regular dental examinations are the best way to protect yourself against the development of dental disease. To maintain good oral health, you should:
- Thoroughly remove plaque from your teeth (and dentures if you have them).
- Brush your teeth in the mornings and at night using a small-headed, soft- to mediumtextured toothbrush and fluoride toothpaste containing 1350 to 1500ppm (partsper million) of fluoride. Your dentist may prescribe a higher-fluoride toothpaste if they think you need it.
- Electric or ‘power’ toothbrushes are useful for people with limited hand/finger dexterity. The handles are thicker and easier to hold, and the oscillating toothbrush head does most of the work. There are many products available, and your dental team can help you decide which are best for you. If you have arthritis you may find it difficult to grip a toothbrush handle, but you can get handle adapters.
- Clean in between your teeth at least once a day using long handled interdental brushes or dental floss or tape.
- Cut down on how often you have food and drinks containing sugar – especially sweets that last longer in the mouth, such as sugary mints.
- Schedule regular dental check-ups with your dentist and have regular professional cleanings of your teeth and gums as often as they recommend.
What’s the best way to care for removable dentures?
Removable partial or full dentures require proper care to keep them clean, free from stains and looking their best. For good denture care:
- Remove and rinse dentures after eating. Run water over your dentures to remove food debris and other loose particles. You may want to place a towel on the counter or in the sink, or put some water in the sink so the dentures don’t break if you drop them.
- Remove and gently clean your dentures daily. Soak and brush them with a soft-bristled brush and nonabrasive denture cleanser to remove food, plaque and other deposits. If you use denture fixative, clean the grooves that fit against your gums to remove any remaining adhesive. Don’t use denture cleansers inside your mouth.
- Soak dentures overnight. Most types of dentures need to stay moist to keep their shape. Place the dentures in cold water or a mild denture-soaking solution overnight. Avoid hot or boiling water that could warp your dentures. Check with your dentist about properly storing your dentures overnight. Follow the manufacturer’s instructions on cleaning and soaking solutions.
- Rinse dentures thoroughly before putting them back in your mouth, especially if using a denture-soaking solution.
- Schedule regular dental check-ups. Your dentist will recommend how often to visit to have your dentures examined. Your dentist can help ensure a proper fit to prevent slippage and discomfort, and also check the inside of your mouth to make sure it’s healthy.
- See your dentist promptly if your dentures become loose. Loose dentures can cause irritation, soreness and mouth ulcers.
What if I have mouth ulcers?
Mouth ulcers can be caused by a variety of causes, including broken teeth, poorly fitting dentures or sharp pieces of food i.e., crisps. Once the cause is removed, ulcers should heal within 3 weeks. If you notice an ulcer which does not heal within 3 weeks, see your dental team straight away. Many serious conditions, such as mouth cancer, can be better treated if diagnosed early at a routine check-up.
What if somebody is housebound?
Some dentists carry out home visits. Ask your dental team for further information.
