AARP Smart Guide to Oral Health

18. Use toothpaste with fluoride

Certain foods and beverages — particularly acidic ones such as sodas, sports drinks and even fruit juices — can demineralize tooth enamel and erode it over time. “The frequent sipping of acidic/sugary drinks is one of the most common ways of getting cavities,” Kapadia says. Using fluoride toothpaste is “essential, even for adults, because fluoride is the key for remineralization of tooth enamel,” Torres says. Always choose an ADA-approved fluoride toothpaste so you know it’s safe and effective. 

19. Ask about prescription toothpastes

Adila S. Baig, director of the Special Care & Geriatrics Clinic at the University of Maryland School of Dentistry, often puts older patients on a prescription toothpaste that contains a higher level of fluoride, which remineralizes tooth enamel to protect teeth from decay. 

20. Keep your toothpaste in the tube

Some social media influencers are putting toothpaste into clear or near-clear pump dispensers to give their bathrooms a cleaner-looking aesthetic. But dental professionals warn against this trend. Toothpaste is in a tube because it loses effectiveness when exposed to ultraviolet light. Light exposure can also break down the preservatives in toothpaste and possibly lead to bacterial and fungal growth.

21. Rinse with the right mouthwash

Good news: You can skip alcohol-based mouthwashes, which can be overpowering and may even dry out your mouth. “I would avoid alcoholic mouthwashes,” Kapadia says. “Studies have shown that they kill the good bacteria as well as bad bacteria.” Krikunenko recommends ADA-approved alcohol-free mouth rinses with fluoride and ingredients to reduce plaque and promote gum health. Look for mouthwashes that include CPC, or cetylpyridium chloride, which reduces bacteria in the mouth. A few to consider: Crest Pro-Health Multi-Protection CPC Antigingivitis/Antiplaque Mouthwash ($5.99), Colgate Enamel Health Mouthwash ($5.99) and ​​Listerine Total Care Alcohol-Free Anticavity Mouthwash ($7.99). 

22. Rinse at the right time

Don’t use any mouthwash — even ones with fluoride — right after you brush. You’ll wash away all the concentrated fluoride that brushing leaves on your teeth. Instead, rinse at another time, like after lunch or dinner.

23. Prevent cavities with probiotics

Bacteria in the mouth are normal — everybody has them — but our bodies are constantly trying to balance the good bacteria with the bad bacteria. And when the bad bacteria are in higher amounts, they’re producing more harmful acid that breaks down the teeth and causes cavities, says general dentist Heidi Aaronson, owner of New Generation Dental Center in Wellesley, Massachusetts.

“There are now probiotics aimed at reducing those bad bacteria specific to the mouth. One that comes up more than any other is called BioGaia (you can buy it online at biogaia.com). It comes in little droplets you put on your tongue daily, or there are little lozenges. The drops, but not the lozenges, are also available at CVS. No prescription required. It’s basically good bacteria that reduces the bad bacteria, and there are more than 200 studies that have shown it’s more effective in many cases than just fluoride alone. I just started using it a couple of months ago. It’s not cheap, but it’s one of the more promising things happening right now in preventive care.”

BE PROACTIVE

24. Deal with pain immediately

If you have minor tooth pain, don’t wait until it becomes unbearable. Get it checked immediately. “A delay in addressing tooth pain can ultimately make the experience of getting it repaired less than wonderful,” Donley says.

25. Stop smoking

Smoking and using tobacco products are leading factors in the development of gum disease, which can cause permanent tooth loss if left unchecked. Tobacco use also increases your risk of developing certain oral cancers. More than 60 percent of oral cancers are directly linked to smoking, according to the Oral Health Foundation, and smokers are up to 10 times more likely to develop oral cancer than never-smokers. Additionally, smoking and tobacco products can significantly stain your teeth. So can vaping and using electronic cigarettes.

26. Reduce staining

In addition to tobacco, other teeth-staining culprits include red wine, coffee, tea, cola drinks and dark-colored foods like berries. “Teeth are a little bit porous,” Dorfman says. “So over time, there’s a cumulative effect [of staining], so teeth tend to get darker and darker with age.” If preventing stains is your focus, consume these foods and beverages in moderation, or make it a habit to rinse your mouth out with water after enjoying them to reduce their staining potential. You can also eat more cauliflower, spinach, lettuce and broccoli, which have iron and minerals that help create a protective film on your teeth.

27. Slow down enamel loss

The outer layer of our teeth is covered in enamel, a tough protective substance that defends against erosion. “You can think of enamel like a hard, tough barrier,” Wang says. “But once it’s worn down, it exposes the internal dentin of the tooth, which is more susceptible to sensitivity and pain.” If you’ve experienced tooth staining or sensitivity, you’ve had a loss due to erosion. To help maintain that barrier, avoid or limit sugary, starchy and acidic foods, and those high in vitamin C. To slow enamel loss, Kapadia suggests eating more dairy products, which are high in calcium and phosphates. He also notes that staying hydrated helps maintain saliva flow, which naturally protects teeth.

28. Don’t ignore tooth sensitivity

If your teeth are sensitive to cold or hot foods or beverages, or you notice pain while brushing, talk with your dentist about possible solutions. “Sensitive teeth are typically the result of worn-down tooth enamel or exposed tooth roots, but sensitivity can also be caused by other factors, such as a cavity, a cracked or chipped tooth, a worn-down filling or gum disease,” says Anabella Oquendo Parilli, assistant dean for international programs and clinical assistant professor of cariology and comprehensive care at the NYU College of Dentistry. 

Kapadia notes that teeth-whitening treatments can sometimes cause temporary sensitivity. Depending on the source of your tooth pain, your dentist may suggest an over-the-counter toothpaste that decreases sensitivity or prescribe an in-office fluoride application to strengthen enamel. In extreme cases, sensitive areas may require an application of bonding resin.

29. Prevent teeth grinding from further damaging teeth

Bruxism, or teeth grinding, is relatively common. However, many people don’t realize the extent of their grinding until they look at old photos of themselves. “If you feel like, ‘Wow, my teeth are a lot shorter now than they used to be,’ it could be a sign that you’re grinding your teeth,” Frank says. 

Additionally, bruxism can lead to chips and fractures in the enamel, especially along the edges or cusps, Kapadia says, adding that it can also cause visible grooves or notches along the gum line. To prevent further damage to your teeth, you could try an over-the-counter mouth guard. However, for best results, Krikunenko recommends working with a dentist who can fit you with a custom-made mouth guard. Be forewarned: It’s going to run you anywhere from $200 to $1,000. 

“Oftentimes, if patients are grinding their teeth, they’ll go to the drugstore and get a boil-and-bite guard, only to come back with more problems and pain after wearing it,” Krikunenko says. “With a custom bite guard, we monitor it. We make sure that the patient is biting evenly and that their jaw is supported in the right position when they’re wearing it.” 

30. Chew sugarless gum

If you enjoy chewing gum, make it sugarless. It may actually help prevent tooth decay, research suggests. Chewing gum for 20 minutes following a meal can increase saliva production and help wash away food particles and bacteria that could lead to cavities. Always look for a gum that’s ADA approved, so you can be sure it’s actually sugar-free. Additionally, Kapadia says there’s evidence that chewing gum artificially sweetened with xylitol can reduce acid production in the mouth. This can prevent plaque formation, slow bacterial growth and provide other benefits. But consume carefully: High levels of xylitol can lead to side effects such as irritable bowel syndrome and diarrhea.

31. Reevaluate your diet

Certain foods and beverages cause tooth erosion. Those same items — and others — can also result in cavities, which are tiny holes on the hard surface of your teeth that require repair. Untreated cavities can lead to pain, chewing problems and tooth abscesses. Sour candy, bread, carbonated drinks, alcohol, potato chips, dried fruit and even ice chips can cause cavities. So rinse your mouth and brush your teeth 30 minutes after eating or drinking anything listed above.

DENTAL REPAIR

32. Address cavities

If you have a cavity, your dentist will likely recommend a filling. Without treatment, cavities can grow, eventually affecting deeper layers of your teeth. “To treat a cavity, your dentist will remove the decayed portion of the tooth and then fill that area where the decayed material was removed,” Oquendo Parilli says. Modern fillings are made from gold, porcelain, silver amalgam, tooth-colored plastic or resin. Oquendo Parilli suggests talking with your dentist to determine the right filling for the location and extent of your tooth damage — as well as for your budget.

33. Know when to save a tooth versus pull it

If you have a tooth that’s significantly decayed, discuss all your options with your dentist and consider a second or third option if you feel your dentist is pressuring you in any way. “Any time you can hold on to the tooth, that’s best,” Frank says. “Even if it appears a large chunk of the tooth is broken down, there is still a lot of root left underneath the gums and into the bone.” If your tooth has enough material left to effectively grip a filling, dental crown or other restoration procedure, it may be salvageable. If not, alternative treatment might include tooth extraction, a bone graft and then a dental implant, Kapadia says. 

34. What to know about tooth loss

Losing a single tooth might not mean anything, says Mark Wolff, dean of the School of Dental Medicine at the University of Pennsylvania. “We need to look at a patient’s bite and gum health and assess if we anticipate other teeth drifting and moving,” he says. If the missing tooth leads to gaps or tilting in your remaining teeth, or if you’re missing more than one tooth, dental restoration with implants or removable or fixed bridges might be necessary.

But tooth loss is still an enormous risk. The average older adult has about 20 remaining teeth. One in 6 adults over age 65 have lost all of their teeth, according to data from the Centers for Disease Control and Prevention (CDC). 

Having nine or fewer teeth is associated with a higher risk of any cause of death, including heart disease and cancer, compared with those who retained at least 20, according to research in Frontiers in Public Health. A meta-analysis of more than 34,000 people found that those who are missing all their teeth had 1.4 times higher risk of developing dementia; research has found that dental care may be a potential strategy in dementia prevention.

35. When to consider implants

If your tooth must be pulled — or if you want to address earlier tooth loss — a dental implant can restore your smile and let you chew normally. Dental implants involve a screwlike base typically made of titanium or zirconia that is surgically implanted in the jaw. A prosthetic tooth that matches the color of your surrounding teeth is attached to the base. Implants can replace a single tooth, multiple teeth or even all your teeth. Dental implants can be pricey, with estimates ranging from roughly $3,000 to nearly $6,000 for a single tooth replacement.

36. When to consider veneers

If you’re looking to upgrade the look of chipped, cracked, misshapen or discolored teeth, look into dental veneers — thin, tooth-colored shells that attach to the front of your teeth to cosmetically improve their appearance. Dental veneers “get bonded right on the front of the tooth. And they can change the color, the shape, the size and sometimes even the length of the tooth,” Oquendo Parilli says. A single-tooth porcelain veneer, which can cost between $925 and $2,500, should last 10 to 15 years. Less expensive composite resin veneers, which run around $250 to $1,500 per tooth, last roughly 5 to 7 years. However, Kapadia says make sure the work is done by a licensed dentist and not an illegal veneer tech.

37. Consider dentures

If you must replace all your teeth, dentures may be the most affordable option. Many providers now offer 3-D dentures, which are created by 3-D printers using a digital scan of your mouth — either in the dentist’s office or in a lab. 

While traditional dentures can require up to five office visits to produce a mold of your mouth and perform fittings, 3-D dentures can be made in as few as two appointments. Still, it’s smart to explore pricing, durability and product life expectancy for both traditional, milled dentures and 3-D-printed dentures. (Traditional dentures typically range between $1,000 and $3,000 per set, while 3-D dentures can be significantly more expensive.) There are also implant-supported dentures, which attach directly to your jawbone. These can be even pricier.

That said, if you lose your teeth and dentures are necessary, it’s important that you wear them. For those with tooth loss, wearing dentures regularly is associated with a lower risk of mortality and cognitive decline. Dentures may also boost social confidence, helping you keep connections that uphold thinking capabilities.

38. Deeper into dentures

According to Kapadia, there are benefits and drawbacks to both traditional and modern dentures. “Traditional dentures are typically made from acrylic resin, which can feel bulky and may not provide the most natural appearance,” he says. “Modern dentures can be made from a variety of materials, including lightweight acrylics and flexible polymers that provide a more natural appearance and comfortable fit.” Traditional dentures use suction to stay in place, typically aided by denture adhesives, which may not always be reliable. 

Modern dentures, on the other hand, “can offer a more precise fit, reducing movement and discomfort,” Kapadia says. “This improves chewing efficiency and speech clarity.” Modern dentures also typically need less maintenance than traditional dentures. As for costs, Kapadia says modern dentures generally are more expensive up front, especially if implants are involved. “However, they can offer long-term savings by reducing the need for frequent adjustments and replacements,” he says.

39. Ask for a treatment plan

If your dentist recommends a lot of work, ask for a treatment plan. It should list everything that will be fixed, provide a timeline and detail costs, both before and after insurance. If you don’t understand specific terms, look them up or ask. Make sure you understand everything, from what is urgent to what can be put off for a while. 

40. Get a second or third opinion

If the estimated bill for dental work is shockingly high or you see a new dentist who suddenly recommends a bevy of work, get at least one more opinion. These are red flags, and they’re so common that many dentists offer first-time customers a “second opinion” deal where you can be seen and get a free estimate. When you find a dentist who can offer another opinion, be sure to have your previous dentist forward any records or X-rays. 

41. Combine coverage

In some cases, you can use dual dental plans to lower your costs. This typically happens when you have two jobs that provide dental care, or a spouse who has a separate dental plan you can pair with your own. If you’re on Medicare, some Medicare Advantage plans can pair with another dental insurance plan. You’ll still pay monthly premiums, but the lowered cost of dental work may make it worthwhile. In either case, run the numbers and talk to your dentist about the best course of action.

A HEALTHY MOUTH

42. Clean your tongue

Brush or scrape your tongue — either with your regular toothbrush or a dedicated tongue cleaner — each time you brush your teeth, Delgado says. Start with the back of the tongue and brush or scrape toward the front. “If you don’t brush your tongue, the surface can accumulate food particles, bacteria and plaque,” he says. This can inflame the papillae, the protrusions that give the tongue its rough surface, and temporarily stain the tongue. However, most patchy tongue discolorations are harmless and clear up on their own with good oral hygiene. Kapadia says copper tongue scrapers are popular due to their antimicrobial properties, while stainless steel ones are durable and easy to clean. “So many odors in the mouth come from the tongue—the tongue is a constant sponge that holds bacteria,” Dunbar adds.

43. Check for irregularities

If you have patchy white discolorations, bumps, sores or other tongue irregularities that do not clear up within two weeks, get your dentist to check them out. “Most minor sores, like a canker sore, will go away within 10 to 14 days, so I always tell patients, ‘If it’s not gone within two weeks, I need to see you,’ ” Krikunenko says. Creamy white patches could be a sign of oral thrush, a fungal infection that frequently affects older adults with diabetes or those who wear dentures. Kapadia says treatments for oral thrush range from do-it-yourself rinses using salt water, hydrogen peroxide or baking soda to prescription antifungal medications. Tongue bumps, ulcers or sores that aren’t healing on their own should be professionally screened for oral cancer.

44. Look for lumps

While you should ask your dentist to screen for early signs of mouth cancer at least once a year, the Mouth Cancer Foundation also recommends doing an at-home two-minute self-check for signs of oral cancer at least once a month. “Oral cancer is on the rise,” Judge says. “If you’re noticing any kind of swelling or any kind of lump that’s lasting more than 10 or 12 days or so, you want to make sure that you get into the doctor or dentist to have it evaluated.”

45. Look for signs of gum disease

Periodontal disease — called gingivitis in its early stages — is a severe infection of the gums that can damage gum tissue and eventually lead to tooth loss. The condition is extremely common. In fact, “50 percent of U.S. adults have some form of periodontal disease, and adults 65 and older have a 70 percent chance of having periodontal disease,” Wang says. Gum tissue can’t regenerate after it’s damaged, so it’s crucial to catch and reverse gum disease early or avoid it altogether. Proper brushing and flossing, reducing sugar in your diet and routine dentist visits are essential to combat periodontal disease.

We’re on the cusp of a periodontal crisis, says Edgard El Chaar, clinical professor at the University of Pennsylvania. People who don’t brush twice a day for two minutes at a time, as recommended by the ADA, are at increased risk of having a heart attack, heart failure or stroke, according to a study in the International Journal of Cardiology. “Gum disease is a progressive disease,” El Chaar says. “It’s a silent killer.”

46. Understand options for damaged gums

If gum tissue is damaged, medical interventions can help stop the progression of gum disease. For example, your dentist may recommend tooth scaling and root planing to remove plaque below the gum line and reduce the risk of gum and tooth loss. “Scaling involves removing plaque and tartar from the tooth surfaces, particularly below the gum line,” Kapadia says. “Root planing smooths the root surfaces, making it more difficult for plaque and tartar to reattach, and helping the gums heal and reattach to the teeth.” More severe cases of gum regression might require gum graft surgery. In this procedure, a periodontist — a dentist specializing in gum disease — removes healthy gum tissue from elsewhere in your mouth and grafts it onto the area needing repair.

47. Address bad breath

The occasional bout of bad breath is embarrassing and affects almost everyone from time to time. Chewing some herbs — especially mint and parsley, which kill bacteria in the mouth — can naturally freshen your breath. But if you have chronic bad breath, also known as halitosis, don’t ignore it. Generally, bad breath comes from food and plaque that sits on the teeth and around the gums and is not cleaned away, Krikunenko notes. “Ultimately it comes down to how often you brush and floss your teeth and come in for regular cleanings,” she says. If you’ve tried these, your halitosis could be a sign of dry mouth, periodontal disease, poor oral hygiene or another health condition. While over-the-counter mouth rinses may reduce symptoms, the only way to find the root cause of halitosis is to see a professional.

48. Reconsider sharing

Did you know that cavity-causing bacteria can be contagious? When you share food, drinks or lip balms — or you kiss — bacteria pass from one mouth to the other. And if your pal has poor oral health, you could pay the price later. Additionally, Krikunenko says, “Babies are not born with cavity-causing bacteria; it is transferred from adults when they engage with the baby. So if you want to protect your little one from this, please avoid kissing your baby on the lips and sharing food.”

49. Review your meds for dry mouth side affects 

If you frequently experience dry mouth, your prescription medications could be the culprit. “According to various studies and reports, a significant proportion of commonly prescribed medications in the U.S. list dry mouth (xerostomia) as a potential side effect,” Kapadia says. To reduce symptoms, first talk with your pharmacist or physician about the availability of equivalent, alternative medications that don’t cause dry mouth. Here’s a list of common meds that can contribute to dry mouth:

• Anti-anxiety medications, such as alprazolam (Xanax)
• Anticholinergics such as oxybutynin, used to treat overactive bladder 
• Antidepressants such as citalopram (Celexa)
• Antihistamines to treat allergies, like loratadine (Claritin)
• Antihypertensive medications like captopril, an ACE inhibitor
• Diuretics (“water pills”), such as hydrochlorothiazide
• Muscle relaxants, like orphenadrine
• Pain medications, like NSAIDs (ibuprofen) and opioids

50. Consider over-the-counter relief for dry mouth

Over-the-counter oral rinses for dry mouth may also help, such as Biotene, Act or TheraBreath. Or simply try drinking more water or chewing sugar-free gum, Delgado suggests. For more severe cases, Kapadia says prescription drugs such as Pilocarpine or Cevimeline can increase saliva production. And don’t make it worse with sugar. If you tend to suck on hard candies or cough drops to relieve dry mouth, choose candies or gum that contain xylitol, a natural sugar alcohol that won’t promote cavities, and may even prevent them.

51. Recognize signs of TMJ disorders

Temporomandibular joint (TMJ) disorders can cause pain in the muscles and bones of your jaw, pain while chewing, facial pain (especially around the ear) and even migraines. If you think you have a TMJ disorder, get an evaluation from your dentist. “We diagnose the reason for the pain — using X-rays and other tests — and then once we know what the root cause is, we can create either a specified bite splint or an appliance that the patient wears, usually at night, similar to a night guard,” as a treatment, Krikunenko says. In some cases, physicians or dentists may also prescribe muscle relaxers, anti-inflammatory medications or even Botox to help alleviate pain associated with TMJ disorders. Some, like corticosteroids and Botox, can be injected directly into the affected areas, Kapadia says..

LOOKING GOOD

52. Opt for effective whitening techniques

If you’re self-conscious about yellowing or discolored teeth, there’s an array of whitening options on the market. Start with simple over-the-counter whitening strips, pens or tray-based kits, or look into more comprehensive — and more expensive — in-office whitening options from your dentist. Whitening toothpaste delivers limited results and can erode enamel long-term.

“The results are probably going to be faster and more obvious when you whiten in a professional setting, because the concentrations of medications that we’re able to use as dentists are going to be higher,” says Oquendo Parilli. While purely in-office whitening processes are available, Oquendo Parilli believes that a dentist-supervised whitening plan with custom-fitted trays that patients use at home achieves the best results. Erin Fraundorf, founder of BOCA Orthodontic + Whitening Studio in Ladue, Missouri, also recommends in-office treatments with professional-grade take-home kits and OTC products that work great for maintenance. Be realistic — getting a perfect paper-white smile, however, may require fillings, crowns or veneers.

53. Go purple

Have you seen purple toothpastes, which promise to whiten teeth, go viral on social media? The purple hue is a color balancer that masks any yellow on the teeth and makes them appear whiter, Wang says. “As long as the purple toothpaste has fluoride in it so it can help prevent cavities, it’s perfectly safe to use,” she says. “These toothpastes are a temporary solution, so they work best for people who are looking for just a slightly brighter smile, rather than drastic changes,” she notes. Kapadia says marketing claims around purple toothpaste are often exaggerated, adding that traditional whitening toothpastes with proven ingredients like hydrogen peroxide may be more effective.

54. Choose the right lip balm

Your lips form and frame your smile, so give them some TLC, too, as part of your healthy smile routine. To avoid dry, cracked lips, “stick with natural lip balms, such as those with shea butter or beeswax,” advises Anthony Youn, a plastic surgeon in Troy, Michigan, and host of The Holistic Plastic Surgery Show podcast. (Even better: Use one that contains sunscreen.) Also, avoid lip balms with menthol; it can dry or irritate your lips, Youn says.

HOW TO AFFORD BETTER TEETH

55. Shop for dental insurance

Dental care is expensive, and for many of us, it’s a luxury. Only about 3 in 10 adults over 65 have dental insurance, according to the most recent data from the CDC. In most cases, Medicare does not cover routine dental cleanings or even common procedures like fillings, tooth extractions or dentures. 

For that reason, purchasing extra coverage is a must. “People with dental coverage are more likely to go to the dentist and receive important services,” says Mike Adelberg, executive director of the National Association of Dental Plans. 

Generally, you have two choices: independent coverage or, if you’re 65-plus, Medicare Advantage with a dental plan. (For example, the AARP Dental Insurance Plan provides individual and family coverage through Delta Dental.) Prices vary based on plan and other factors. You can also access your state’s free health insurance counseling service by doing an internet search for [your state] + “senior health insurance counseling.” 

56. Choose carefully

If you have a large dental expense coming up—implants or bridges, for example—you should review your current coverage. You may need to purchase a temporary, pricier plan that has a high annual maximum and—this is important—no waiting period for procedures. “We frequently see older people coming in with a Medicare Advantage plan thinking they have a lot of coverage, but it turns out they may just have preventive coverage,” Shuman says.

57. Look for low-cost options

Dental and dental hygiene schools and community health centers may be able to provide treatment at reduced cost. Your state’s agency on aging may also be able to refer you to dental programs in your area. If you have a regular dental provider, ask if they offer a sliding fee program. Dental offices may also participate in credit programs that help you finance care.

58. Create a dental savings account

El Chaar recommends setting up a dental fund, if feasible. “We plan for retirement or long-term care, but no one plans for how much they’ll spend annually in dentistry,” he says. At a minimum, you want to have enough put away to accommodate your yearly cleaning(s) and X-rays for prevention. Additional savings would then go to an unexpected cavity, crown or implant. It’s never too late to start a fund, El Chaar says.