Tooth decay is likely in later life even with ongoing dental care. However, with good oral hygiene and proper dental care, seniors can retain all or most of their teeth. But the trick is that taking care of the gums is just as important as taking care of the teeth.
Proper Dental Care
Most tooth loss is caused not by cavities, but by gum disease. Gum disease results when bacteria enter the crevices between teeth and gums, where they create plaque. The presence of plaque causes an immune reaction that causes the gums to become inflamed. The inflammatory process eventually eats away at the structures that hold teeth in place. Inflammation caused by gum disease has also been linked to heart disease, certain cancers, and respiratory diseases.
Gum disease can be prevented by thoroughly brushing and flossing your teeth regularly. This means brushing at least twice per day with fluoride toothpaste, or after each meal. Flossing should be done at least once per day. Studies have shown that manual and powered toothbrushes are equally effective in eliminating plaque.
If you do use a manual toothbrush, use a soft-bristled toothbrush. Be sure to brush the back, front, and bottom of all teeth. Also brush your tongue and the roof of your mouth. Replace your toothbrush every 2-3 months.
If you have a physical disability that makes grasping a toothbrush difficult, you may find a powered toothbrush easier to handle. Here are some other fixes as well:
- Attaching the brush to your hand with an elastic band.
- Lengthening the handle by attaching a Popsicle stick or tongue depressor.
- Attaching a sponge or small rubber ball to the handle to make it easier to grasp.
If you do not want to create your own special handle, there are companies that make manual toothbrushes for people with grasping problems.
In addition to brushing, flossing at least once per day is necessary to remove plaque that forms between the teeth and below the gum line. When flossing, be sure to gently ease the floss between the teeth, and rub the floss gently along the side of each tooth and below the gum line. Do not forget to floss behind the back of the rear teeth! If you have extremely tight teeth, or extensive fillings—on which floss can catch and tear—try using waxed dental floss or dental tape.
If you have trouble handling the floss, you can tie the dental floss in loops to make it easier to handle or try using a commercial floss holder.
Mouthwashes help reduce bacteria levels that cause gum disease by removing plaque and food particles that were missed by brushing and flossing.
Getting Regular Exams and Cleanings
Although brushing and flossing help greatly, they do not remove all of the plaque, especially the hardened plaque that is the main component of tartar. For this reason, you need to see the dentist at least 1-2 times per year for a cleaning to completely remove the plaque and to check for tooth decay and gum disease.
The risk of serious mouth diseases, such as oral cancer, increases with age. Therefore, it is important to have your dentist closely examine any swelling, sores, or discoloration you notice anywhere in your mouth, jaw, cheeks, throat, tongue, or lips.
Though not as effective as when used in childhood, brushing with fluoride toothpaste (and using fluoride mouthwash) as an adult may help maintain healthy teeth and prevent tooth decay.
The topic of fluoridated drinking water in adults is controversial, since some researchers believe it may negatively affect bone health. However, evidence is weak and it has not affected recommendations by any professional organizations. The benefits of fluoridated drinking water for public health far outweigh any risks associated with it.
Many seniors experience decreased saliva flow as a result of certain medical conditions or as a side effect of various medications. In addition to causing problems such as difficulty swallowing and eating, persistent hoarseness or sore throat and a dry, sensitive nasal passage, dry mouth can also lead to tooth decay. To reduce the dryness, try sucking on sugar-free candy or chewing sugar-free gum—both of which help increase saliva flow. If that does not work, ask your dentist about the use of artificial saliva and oral rinses to help the problem.
Although starting proper tooth care later is better than never, it may not fully prevent the loss of teeth due to earlier poor dental and periodontal hygiene. In those cases where you do lose one or more teeth, it is important to replace them in order to prevent misalignment and problems with your remaining teeth. Depending on which and how many teeth are lost, tooth replacement can come in one of the following forms:
Bridges are artificial teeth that attach to remaining healthy teeth adjacent to where a tooth or teeth have been lost or extracted. Bridges can either be attached permanently (via a crown placed over adjacent remaining teeth) or are removable (attaching via a small metal clasp or other attachment device).
Dentures are artificial teeth that attach to gums via an adhesive. They are used when most or all of your teeth are lost or must be removed. While certainly not preferable to healthy, natural teeth, today's dentures are much more effective, comfortable, and cosmetically appealing than in the past.
If you do wear dentures, be sure to practice proper denture care. This includes brushing and soaking your dentures daily, brushing and rinsing the gums thoroughly before inserting your dentures, and using a strong denture adhesive. And you should still have regular dental examinations, even if you have a full set of dentures.
For people with minimal tooth loss who are in good health and have adequate remaining bone below the area where a tooth or teeth are lost, artificial tooth implants may be a viable option. Implants, which attach directly to the jawbone, are generally much more secure than bridges or dentures, and are maintained like natural teeth.
As we get older, teeth tend to become discolored and stained. To improve the appearance of your teeth, you may consider having your teeth professionally bleached or using a commercial tooth whitening product. For severely discolored or stained teeth, ask your dentist about veneer (tooth-colored material that is bonded to the teeth) or bonding, which paints a tooth-colored material onto your teeth.
Time for Your Teeth
Although you may be preoccupied with taking care of other parts of your body, do not neglect good dental care. After all, paying attention to your teeth is a small price to pay for a healthy smile.
Academy of General Dentistry
Mouth Healthy—American Dental Association
Canadian Dental Association
The Canadian Dental Hygienists Association
Healthy habits. Mouth Healthy—American Dental Association website. Available at: http://www.mouthhealthy.org/en/adults-over-60/healthy-habits. Accessed June 14, 2017.
Deery C, Heanue M, Deacon S, et al. The effectiveness of manual versus powered toothbrushes for dental health: A systematic review. J Dent. 2004;32(3):197-211.
Flossing. Mouth Healthy—American Dental Association website. Available at: http://www.mouthhealthy.org/en/az-topics/f/flossing. Accessed June 14, 2017.
Fluoride for the prevention of dental caries. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T360983/Fluoride-for-prevention-of-dental-caries. Updated November 21, 2016. Accessed June 14, 2017.
Gum disease information. American Academy of Periodontology website. Available at: http://www.perio.org/consumer/gum-disease.htm. Accessed June 14, 2017.
Hillier S, Inskip H, Coggon D, Cooper C. Water fluoridation and osteoporotic fracture. Community Dent Health. 1996;13 Suppl 2:63-68.
Näsman P, Ekstrand J, Granath F, Ekbom A, Fored CM. Estimated drinking water fluoride exposure and risk of hip fracture: A cohort study.. J Dent Res. 2013;92(11):1029-1034.
Palmer C, Gilbert JA, Academy of Nutrition and Dietetics. Position of the Academy of Nutrition and Dietetics: The impact of fluoride on health. J Acad Nutr Diet. 2012;112(9):1443-1453.
Senior oral health. American Dental Hygienists' Association website. Available at: http://www.adha.org/resources-docs/7255_Senior_Oral_Health.pdf. Accessed June 14, 2017.
7/15/2014 DynaMed's Systematic Literature Surveillancehttps://www.dynamed.com: Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;6:CD002281.
Last reviewed June 2017 by Michael Woods, MD, FAAP Last Updated: 7/10/2015