Feeling long in the tooth? Your mouth is aging too…

As we age, our bodies change and our mouths are no exception. The changes in children’s mouths are most evident– babies start teething at around 6 months old, and continue to lose and gain new teeth all tCapturehe way through teenage years. As we reach adulthood, however, the changes usually happen much more slowly. However, your teeth, gums and jawbone continuously undergo regular wear and tear and physiological changes that may only become evident when a problem arises in your mouth.

With the ever-growing body of research evidence pointing to the tight interrelationship between the mouth and body, it is important to be aware of the changes that your mouth is undergoing to ensure appropriate hygiene and timely oral assessments in order to maintain a healthy mouth— and body— through all stages of your life.

Babies & very young children

Baby teeth (from 6 months to 6 years) are important! Yet, a whopping 40% of children are affected by early childhood caries before the age of five (AAPD, 2010). This is because many people don’t provide appropriate oral care to babies and young children, thinking that baby teeth will simply fall out. However, decayed baby teeth can cause pain, difficulties eating and communicating, and may even lead to abscessed teeth, which may lead to potentially life-threatening infection spreading to other parts of the body.

Children & adolescents

Dental caries are the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years. Tooth decay is FOUR times more common than asthma among adolescents aged 14 to 17 years (CDC 2014). Irregular teeth growth is another common problem for this age group, as is the eruption of wisdom teeth, which may cause crowding and damaging of adjacent teeth, the jawbone, or nerves. Partial eruption of wisdom teeth allows an opening for bacteria to enter around the tooth and cause an infection, which can result in pain, swelling, jaw stiffness, gum disease and general illness.

Adults

Across the globe, nearly 100% of adults have dental cavities (WHO 2012). While the causes for tooth decay are the same for all ages, the nature of the decay problem does change somewhat as people age. Adults are more likely to have decay around older fillings, and because many adults grew up without the benefits of fluoride, they may have many more fillings. Furthermore, the average adult between the ages of 20 and 64 has three or more decayed or missing teeth (NIDCR 2014). This may affect speaking, eating and may even cause bone loss around the missing tooth.

Gums also begin to recede in adulthood, exposing the roots and causing your teeth to become sensitive and painful when eating something sweet, salty or spicy or drinking or eating things that are hot or cold. Gum diseases are due to a buildup of bacteria that can lead to infections that can break down tissues and bone. With age, pockets form at the gum line and create storage and breeding grounds for bacteria. The two stages of gum disease – gingivitis and periodontitis – affect over 80% of adults in the United States and advanced gum disease affects 4%–12% of U.S. adults (CDC 2011). Gum disease is not only THE leading cause of tooth loss, but is also linked to heart attacks and strokes.

Pregnant Women

While tooth loss is not a necessary side effect of pregnancy, it can be the consequence of poor or delayed oral health care, unnecessarily common to pregnant women. Pregnant women experience hormonal changes commonly leading to gingivitis, which can be associated with more serious periodontal disease (periodontitis) leading to tooth loss. Periodontitis is associated with preterm birth and low birth weight, and high levels of cavity-causing bacteria in mothers can lead to increased dental caries in infants.

Older Adults

As we age, wrinkles and gray hairs are not our only problems; our teeth become more susceptible to cavities too. Decay of the tooth root is common among older adults, and this occurs as the gums recede, exposing the softer root surface, which decays more easily than tooth enamel. A common cause of cavities in older adults is dry mouth, which is both a normal aging process and a side-effect of many medications, including those for Parkinson’s, Alzheimer’s and hypertension. Dry mouth causes food and bacteria to stay on the teeth longer, which increases the risk of decay. Physiological changes, difficulties brushing teeth, and lack of insurance have jointly resulted in one-fourth of U.S. adults aged 65 or older having lost all of their teeth (CDC 2011).

As gums recede, many older adults develop gum or periodontal disease, which are caused by the bacteria in plaque irritating the gums. Advanced gum disease can even destroy the gums, bone and ligaments supporting the teeth leading to tooth loss, as well as spread to other parts of the body leading to potentially life threatening infections. 70% of adults 65 and older have periodontitis, which can be related to insufficient oral care or genetic factors (Eke et al, 2012).

There are about 39,500 cases of oral cavity or oropharyngeal cancer diagnosed each year. More than 7,500 people, mostly older Americans, die from oral and pharyngeal cancers each year (American Cancer Society, 2015). Oral cancers are more likely to happen in people over age 40. Early stages of oral cancer typically do not cause pain, but do have symptoms such as open sores, white or reddish patches, and changes in the lips, tongue and lining of the mouth, that a healthcare professional can recognize and treat.

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Unfortunately, the mouth has many odds stacked against it! Poor diet, smoking and alcohol, teeth clenching, regular wear and tear, and many other factors lead to its aging. However, maintaining proper nutrition, oral hygiene and visiting the dentist regularly are vital to keeping your mouth happy and healthy–and having people continue guessing your age!

For tips on caring for your mouth visit the National Institute on Aging: http://www.nia.nih.gov/health/publication/taking-care-your-teeth-and-mouth

References:

American Academy of Pediatric Dentistry (2010). Celebrate National Children’s Dental Health Month by Taking Care of Tiny Teeth. Retrieved from http://www.aapd.org/celebrate_national_children%E2%80%99s_dental_health_month_by_taking_care_of_tiny_teeth/

American Cancer Society. (2015). What are the key statistics about oral cavity and oropharyngeal cancers? Retrieved from http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/oral-cavity-and-oropharyngeal-cancer-key-statistics

Center for Disease Control (2014). Hygiene-Related Diseases. Retrieved from http://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html

Center for Disease Control (2011). Oral Health. Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancers At A Glance 2011. Retrieved from http://www.cdc.gov/chronicdisease/resources/publications/aag/doh.htm

Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O., & Genco, R. J. (2012). Prevalence of periodontitis in adults in the United States: 2009 and 2010. Journal of dental research, 91(10), 914-920.

National Institute of Dental and Cranofacial Research (2014). Dental Caries (Tooth Decay) in Adults (Age 20 to 64). Retrieved from http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesAdults20to64.htm

World Health Organization (2012). Oral Health. Fact Sheet No318. Retrieved from http://www.who.int/mediacentre/factsheets/fs318/en/

Photo Credit: https://www.flickr.com/photos/elijah/396033216/in/photolist-6BQANA-7Kba3q-jFcp8u-5Xge2X-AZLSU-beHTrv-9Eq3ZJ-a572F5-xff8U-7KbaAC-89G9xa-eiwhDG-6BwEhn-4CLhAB-61wvvS-5ZqCG4-61siZZ-61wvz5-61wvBL-6prpe8

Medicare Part Zero

ZERO.

That’s the Medicare dental benefits for its recipients. You heard right: ZERO!

There are over 49 million adults receiving Medicare (Medicare Trustees Report, 2012) and the population is only growing older!  Most do not have dental benefits and it is projected by 2030 the number of Medicare recipients will grow to 72 million (Administration on Aging, 2013).

Payment for dental services is generally out-of-pocket for seniors. Senior citizens aged 65 and over need dental care more than ever, yet 34% of seniors have income less than or equal to 200% of the poverty level (Levinson et al, 2013). 70% of seniors don’t have dental insurance (Dolan 2005) and 80% of the uninsured seniors can’t afford a major dental procedure (Henry J Kaiser Foundation). It is no surprise then that older adults with the poorest oral health are those who are economically disadvantaged and those who lack insurance. The risk for poor oral health is further augmented in those who are homebound, institutionalized or disabled.

Those who cannot afford dental health premiums, risk the preventative health protection that could avoid many negative outcomes. Tooth decay is almost completely avoidable, yet when people are unable to see a dental provider, they do not get the preventive services, such as early diagnosis. Many older adults take medications that have the complicating side effect of reducing salivary flow. This results in dry mouth, which contributes to dental decay. Intervention can halt or slow the progression of most oral diseases.

While many older adults are fortunate enough to have their teeth, many, due to aging teeth and gums along with deteriorating bone structure have major tooth issues. These teeth have more extensive (and older) restorations. The following are the dental health issues & exposure related to seniors:

  • 50% have untreated caries
  • 23% have severe gum disease
  • 30% lose their teeth
  • 30,000 oral cancers diagnosed annually.

Statistics from: Advance for Nurse Practitioners and Physicians Assistants

The avoidance of procedures to detect and prevent tooth problems due to lack of adequate dental health coverage leads to lower quality of life and poor additional non-dental health outcomes. For instance, left untreated cavities lead to pain and infection, loose or missing teeth causing trouble chewing and nutritional deficiencies. Studies continue to show a possible link between oral infections and systemic diseases such as diabetes, heart disease and respiratory infections. The incidence of oral and pharyngeal cancers is higher among older adults than for other age categories and late diagnosis leads to high mortality.

Primary care providers can play an important role in partnering with dental colleagues to improve the oral health of older adults by including oral health assessments, education and preventive interventions with their older adult patients so that many of the oral health problems, which are preventable are addressed. Advocating for dental care for the elderly population is an important health equity priority. An increased push for interprofessional education of dental, medical and nursing students will accomplish just that – equipping medical professionals, who traditionally do not include oral health assessment into their practice, with skills to competently educate, assess and manage senior patients and refer them for oral care should a dental issue arise.

Do you know a senior with oral health problems? Share your thoughts with us or with the White House Conference on Aging! http://www.whitehouseconferenceonaging.gov/submissions/register.aspx

References:

Advance for Nurse Practitioners and Physicians Assistants. Oral Care in Elderly Patients.http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/Oral-Care-in-Elderly-Patients.asp

Administration on Aging. (2013). Aging Statistics. http://www.aoa.gov/Aging_Statistics

Centers for Disease Control and Prevention.The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 201

Dolan, T. A., Atchison, K., & Huynh, T. N. (2005). Access to Dental Care Among Older Adults in the United States.Journal of Dental Education, 69(9), 961-974. Retrieved from http://www.jdentaled.org/content/69/9/96

Henry J. Kaiser Family Foundation. Oral Health in the US: Key Facts. http://www.kff.org/uninsured/upload/8324.pdf.

Levinson, Z., Damico, A., Cubanski, J., Neuman, T. (2013). A state-by-state snapshot of poverty among seniors: findings from analysis of the supplemental poverty measures. Henry J. Kaiser Family Foundation. http://kff.org/medicare/issue-brief/a-state-by-state-snapshot-of-poverty-among-seniors/

Medicare Trustees Report, 2012, Table V.B3 (p.209),https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads//tr2012.pdf