The “Golden” Years
When I was first practicing dentistry I had the pleasure of treating a sweet 80 something “young” lady with a very sharp wit. One day as I came in to check on her after a cleaning, I asked her how she was enjoying her “golden years”. She didn’t bat an eye and replied, “Sonny, they may look golden but it’s actually rust”. Fourteen years later I find her response to be more and more accurate. I see this on a personal level but also witness patients struggle every day with the challenges to maintain a healthy mouth as the body changes.
One of the biggest issues as we get older is decay (cavities).Today we see more decay in older adults than we do in kids. Some causes for this are changes in our bodies and also in the environment of our mouth. Decay starts with acid. Acids are graded on the pH scale. The lower the pH number the stronger the acid. Water is neutral and has a pH of 7.0. Battery acid has a pH of 1.0. Any acid that has a pH of 5.4 or lower will start leaching minerals from teeth (starts decay or “cavities”). This loss of minerals leads to softening of the enamel so that it wears faster, and decay in the enamel and dentin (the root surfaces, which is softer than enamel). Just for conversation sake, a regular Pepsi has a pH of 2.49 as well as having a lot of sugar which will also be turned into acid by bacteria (bugs) in the mouth. Juices have the same problem with a low pH and a lot of sugar. Bottom line, foods that are acidic and/or have sugar lead to decay.
As we get older there are many changes in the body and the mouth in particular. Here are a few.
Decrease in saliva flow due to general aging as well as an increase in medications, the majority of which have the side effect of decreasing saliva. It is important to know that the saliva is critical in protecting the teeth. Saliva keeps the teeth slippery to prevent food from sticking. Saliva neutralizes (pH of saliva is 7.4) the acids that cause decay (cavities). Saliva actually repairs the teeth by providing minerals that can go back into the enamel (the outside shell of the tooth) and provides antibodies to decrease bacteria that produce acids.
Recession of the gums leading to exposed root surfaces. This not only exposes more of the softer tooth surface (dentin) to decay but also allows more nooks and crannies for food to collect. This food is then broken down by bacteria (bugs) in the mouth to produce acid. As long as the food is present the acid is being produced, plus, for twenty minutes after it is gone.
Decrease in dexterity to be able to keep teeth clean. Whether it is rheumatoid arthritis or just stiffness in the fingers, hands and wrists, it all makes it more difficult to clean the mouth.
Older restorations start breaking down through wear and tear. The longer we are around the more likely we are to have larger restorations which are also more difficult to maintain and are more likely to break down.
Decrease in taste sensation. For most individuals, the last taste buds working are the sweet ones. This many times leads to the proverbial “sweet tooth”. We eat more sweets because we can taste it. Every time we take a nibble of something sweet, the bacteria in our mouth continues to produce acids for twenty minutes after the sweetness is gone. So the frequency of the sweets has a greater influence on the amount of acid produced (leads to cavities) than the amount of sugar eaten.
Most of my elderly patients have a list of at least 3 or more prescription medications that they take on a daily basis. The most common ailments for which medications are prescribed are high blood pressure (hypertension), heart disease, high cholesterol, diabetes, arthritis just to name a few. Increased use of these medications alter our body chemistry and, in particular, contributes to decreased saliva flow (Dry Mouth). Often times the first thing one does to combat a dry mouth is to drink something. Unfortunately, for those that don’t drink water and opt for a diet soda or other sweetened beverages the results can be really bad. The real irony with diet or regular sodas is that they cause dehydration due to the sodium content within the beverage. So someone with a dry mouth drinks more and more and still doesn’t get relief of their dry mouth or hydration needs. The side effect is rampant tooth decay.
Even though the cards are stacked against us as we get older, we can still fight back. Here are some suggestions that can help decrease decay.
Sip water. This will help clean the debris from around your teeth, dilute the acid (water has a pH of 7.0) in the mouth and increase the saliva flow and production.
Decrease snacking frequency. If you are going to snack, make the most of it and get it done quickly (30 minutes or less).
Clean your mouth at least twice a day. This includes brushing, flossing AND any special tools that help clean out those nooks and crannies (proxibrushes, sulca brushes, tooth picks or electric tooth brushes).
Use high concentration fluoride toothpastes (prescription strength from your dentist). If you use this right before bed without rinsing afterward, the fluoride sits around the teeth longer and is more effective at reducing decay.
Recent studies also now suggest the use of custom fit trays with bleaching gel (carbamide peroxide) in them for five minutes a day. These studies indicate an overall decrease of bacteria in the mouth as well as an increase in pH (neutralizing the acid).
Bottom line is that you can do a lot to help yourself. “Don’t wait till it hurts” because as we get older it usually won’t hurt until it is a major problem. Get into your dentist at least a couple of times a year and let them find any issue when it is still small. The best course is to prevent the “rust” but if that doesn’t work just get it taken care of early. Like everything else as we age we need more maintenance. It is like my grandmother used to say, “ it is hell getting old”. Welcome to the “Golden Years”!