Doctors are beginning to realize that the condition of a patient's gums, teeth and mouth is an important indicator of overall health, because the mouth can be the gateway for bacteria to cause problems in other parts of the body.
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Periodontal disease — bacterial infection that affects the gums and bone — has been linked to heart disease, arthritis and diabetes. "Bacteria from the mouth can get into the bloodstream, affecting parts of the body like the heart or joints, triggering inflammatory reactions," says Alexandre Vieira, associate professor of oral biology at the University of Pittsburgh.
Despite the dangers, many of us slacken on teeth care after retirement — especially if dental insurance isn't an option. According to a 2011 review study by Vieira and colleagues, over half of people over age 65 have root cavities in teeth where gum has receded. Along with the usual suspects — too many sweets, and not brushing and flossing enough — saliva contains fewer substances to fight bacteria as we age. And medications such as blood pressure drugs, antidepressants and diuretics can lessen saliva, inviting decay.
Still, tooth loss and gum disease are not necessarily a disease of aging. With a little vigilance, men and women over 50 can have healthy mouths, says June Sadowsky, an associate professor at the University of Texas School of Dentistry in Houston, who specializes in geriatric dentistry.
Below are common problems to watch for, and the best ways to prevent or treat them.
As we age, inflammation from bacteria can cause gum tissue to recede around the roots of the teeth, exposing the root. "That exposed tooth tissue is softer, so it can be attacked more easily by bacteria," says Marsha Pyle, dean of the School of Dentistry at the University of Missouri, Kansas City. Add a dry mouth and bacteria multiply. "Saliva has a pH, or acidity level, of 7, which is neutral," says Sadowsky. "Without saliva, the mouth is more acidic and bacteria thrive."
Remedies: Brush and floss at least twice a day, says Sadowsky: "Electric brushes are good for people who over-brush, wearing away the outside of their teeth. But don't move it back and forth as you would a regular toothbrush: Put it on the tooth and gum line, let it spin and move it to the next tooth."
Also key: Brush with a fluoride toothpaste and rinse with a fluoride mouthwash. Drink fluoridated bottled water as well. "Fluoride slows down the amount of mineral loss from teeth when you have the lower, more acidic pH that comes from bacteria," Vieira says.
Dry mouth — often caused by medications — can make it tough to swallow and even to speak. Without enough saliva to wash them away, bacteria can have a field day, decaying teeth and eventually eroding bone.
Remedies: "Talk to your doctor about reducing the dosage of your medications or substituting another drug that won't be as drying," Sadowsky says. Over-the-counter "saliva substitute" sprays — made of water and glycerin — aren't tasty, but they can help your mouth feel more moist. Choose a dry mouth toothpaste brand, formulated without sodium lauryl sulfate, such as Biotene or Tom's of Maine. Chew sugarless gum with Xylitol as well. "It's a natural sugar that helps fight bacteria," Sadowsky says. And stay hydrated with eight 8-ounce glasses of water a day.
"If you don't remove bacteria where the gum joins the tooth, it builds up, and the gums become inflamed and bleed when you brush," says Sadowsky. "Once bacteria are in the gums, they begin to affect bone." The bone erodes, teeth loosen and soon they're lost.
Remedies: Brush twice daily, floss and rinse once a day, and get a professional cleaning twice a year. If you have the disease, your dentist will clean out the pockets of bacteria surgically and add a prescription antibacterial rinse — chlorhexidine (Peridex or PerioGard) — to your daily regimen.
If you wear dentures, vigilance is still key, says Pyle. "Food can get under dentures and irritate and inflame tissues."
Remedies: Take dentures out at night, soak them in water and let the mouth rest. Remove and rinse dentures after you eat, brushing with a regular toothbrush or a special denture tooth brush. If your dentures wobble, consider dental implants. They are expensive — around $1,500 per implant — but provide extra stability. Implants are especially good for those who only have a few missing teeth.
Close to 37,000 Americans will get oral or pharyngeal cancer in 2012, and more than half will be age 62 or older. The greatest risk factors are tobacco and alcohol. "Every time you smoke, you increase the temperature of your mouth so that you may damage skin cells," says Vieira. "And you are exposing the tissue to chemical toxins. Alcohol also damages the cells."
Remedies: Stop using tobacco. Dentists can prescribe medications such as varenicline (Chantix) and products such as nicotine lozenges that decrease the urge for nicotine.
"If you drink alcohol, drink only in moderation," says Pyle. The American Dietary Guidelines recommend no more than one drink daily for women and two for men.
Also key: Watch for oral cancer symptoms as well, says Vieira. These can include a lump or thickening in the cheek, a sore throat, difficulties chewing or swallowing, or a red or white mouth ulcer that never heals. If you have any of these, see your doctor.
Also of interest: Are teeth whiteners worth the money?
Dorothy Foltz-Gray is a freelance writer who lives in North Carolina.
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