More dental problems as you get older? Aging may not be the real reason
Older people are living longer and keeping more of their teeth.
That's good news — but it also means that seniors need to be more vigilant than ever about oral health.
Over the past 20 years, the portion of adults 65 and older with no teeth fell from about 32% to an all-time low of 17%, according to the most recent report from the National Institute of Dental and Craniofacial Research. Among those 75 and older, it fell from 38% to 22%.
'More people are keeping more of their teeth for longer,' said Dr. Don Curtis, a professor at UCSF School of Dentistry. 'So there's more teeth to take care of and more teeth that are vulnerable to chronic disease.'
Older adults are at higher risk than younger populations for developing many dental problems, including periodontal disease (gum disease), root cavities and oral cancer. About 66% of U.S. adults 75 and older have periodontitis (serious gum disease) compared to 42% in the overall adult population, according to one 2016 estimate.
Aging may not be the reason
These dental issues aren't necessarily due to aging itself, but rather other things that often happen with your overall health, mobility, dexterity and cognition as you age that can in turn affect your oral health, dentists say.
For example, many older adults take multiple prescription medications to manage chronic diseases like diabetes, heart disease and osteoporosis. One of the most common side effects of using multiple medications is dry mouth, or having less saliva (hyposalivation), which can make you more susceptible to cavities — one major contributor to losing teeth.
Even some common medications for allergies can disrupt saliva flow, as can SSRIs, a class of antidepressants whose side effects can include grinding and clenching. Grinding over time can wear down tooth enamel and make a person more vulnerable to tooth loss.
'Hundreds of medications can cause disturbed salivary flow,' said Dr. Elisa Chavez, a professor at the University of Pacific School of Dentistry in San Francisco. 'Often, people aren't thinking about it or it doesn't strike them as critical. But these are things that can increase risk of developing cavities.'
More than 30% of patients over age 60 suffer from dry mouth, according to one 2014 study in the Journal of Dentistry.
Gum recession also tends to become more common with age. Recession exposes more of the roots of the teeth where plaque accumulates, which can cause decay and heighten the risk of gum disease.
'The average 70-year-old is more vulnerable to decay because of gum recession than a 7-year-old,' Curtis said. 'Everyone thinks once they're an adult they're not going to get cavities anymore but that's not the case.'
Studies have also found that people with diabetes, a chronic condition that's more common in older adults, are at higher risk for gum disease and loose teeth.
Some older adults also have problems with mobility because of arthritis or tremors, which can make it harder to brush and floss regularly or get to the dentist as often as they used to.
Cognitive impairment can also complicate matters, making it harder to remember daily oral hygiene or to point out a new problem, like bleeding gums. One 2013 study found that among homebound elderly adults, 96% said they had not seen a dentist since becoming homebound.
'For patients who have significant cognitive issues, having regular dental visits are important because they may not be able to identify things like a well older adult would,' Chavez said. 'Those opportunities for intervention early on are really important in that population.'
But, perhaps hearteningly, 'Poor oral health is not an inevitability of aging,' Chavez said.
'You can maintain good oral health,' she said. 'The thing is to identify risk factors — the presence of chronic diseases that result in loss of ability to care for yourself or get regular care, and medications that can have an impact.'
Interdental brushes, and other solutions
Let your dentist know if you've been diagnosed with a new condition or started any new medications since you last saw them, Chavez said. This includes flagging any changes in your ability to maintain daily oral hygiene.
'Dentists and hygienists can give you points and ideas about oral hygiene aids,' she said.
For older adults with limited dexterity, for instance, at-home tools like interdental brushes, oral rinses, irrigation devices and power toothbrushes can be helpful, according to a 2021 study led by UCSF's Curtis that examined how to treat older adults with periodontal disease.
Curtis recommends using an electric toothbrush with a timer.
'Without a timer, many people often think they spent adequate time but they haven't so they're leaving plaque, which is what leads to potential decay and inflammation associated with periodontal disease,' he said.
After eating, brush first, then floss, then brush a little more, Curtis said. This is because flossing helps break up plaque colonies between the teeth.
If you grind your teeth, consider a night guard, which can help lessen damage and tooth loss.
Older adults with gum recession can also ask their dentist about a high-fluoride varnish.
In 2022, a Department of Veterans Affairs study of about 68,000 older adults found that the topic varnish applied over the roots helped decrease decay by 29% over a three-year period.
'Dentures are not a foregone conclusion,' Chavez said. 'We can maintain oral health into older ages and that's exactly what we want to do.'
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