Brushing Up on Oral Health
You’ve probably heard the expression “long in the tooth,” but when it comes to older adults and gum disease, it’s a sad reality. About 70 percent of adults over the age of 65 develop periodontal disease — which in serious cases causes gums to pull away from the teeth — according to the Centers for Disease Control and Prevention (CDC).
But just as you can help minimize wrinkles with lifestyle steps like avoiding the sun, not smoking and eating a healthy diet, there are things you can do to protect your gums, notes Sasha Ross, a dentist at the Cleveland Clinic. Here’s why gum disease creeps up with age, and what you can do to help prevent it.
What’s going on as you age
As you hit your 50s or 60s, you may notice that your gums are receding. While this can sometimes be the result of overzealous brushing, most of the time it’s due to untreated gum disease, says Vera Tang, a dentist and clinical assistant professor of periodontology and implant dentistry at the NYU College of Dentistry. “Gum disease starts when bacteria that contain plaque builds up on your teeth and gums,” Tang explains. “When it’s not removed, it produces toxins that inflame the gums. Over time, that destroys your gum tissue, causing it to separate from your tooth and form spaces called pockets.”
These pockets also collect bacteria, which makes things worse. Over the longer term, gum disease can destroy both your gums and the bones supporting your teeth, which can lead to tooth loss.
While anyone can develop gum disease, there are certain conditions that raise your risk, says Mark Wolff, dean of the University of Pennsylvania School of Dental Medicine in Philadelphia. They include:
- Smoking. As it weakens your immune system, smoking makes it harder for your body to fend off a gum infection and makes it harder for gums to heal. Smokers face twice the risk of gum disease that nonsmokers do, according to the CDC.
- Diabetes. If your blood sugar is not well controlled, high glucose levels in your saliva encourage the growth of bad bacteria. This leads to more plaque on your teeth.
- Certain drugs. Some specific medications, including oral contraceptives, antidepressants and blood pressure drugs, can encourage the growth of plaque on your teeth, raising the risk of gum disease.
- Dry mouth. This condition, where the salivary glands in your mouth don’t produce enough saliva to keep your mouth moist, is more common with age. But since your body relies on saliva to help wash away plaque, dry mouth raises your risk of developing gum disease.
How to keep your gums healthy
Gingivitis is the early stage of gum disease, when plaque and tartar build up and inflame the gums, explains Ross. If not treated, the condition can progress to severe gum disease, otherwise known as periodontitis, which can cause tooth loss. Here’s how to prevent that from happening to you.
Brush and floss every day
Manual toothbrushes are okay, but electric and sonic devices are better. These powered toothbrushes reduced dental plaque 21 percent more and gingivitis 11 percent more than manual devices after three months of use, according to a 2014 analysis from the independent Cochrane Collaboration. They’re also usually easier to use if you have hand or wrist arthritis, adds Ross.
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Flossing can also be a challenge for older adults, she notes, but it’s important. Seniors who regularly floss have a significantly lower risk of developing gum disease, according to a 2020 study published in the Journal of Dental Research. If you find you no longer have the manual dexterity to floss successfully, consider using a tool like a floss holder or threader, a water flosser (a device that shoots out water to help clean between teeth and around dental implants and bridges) or an interdental brush (a tiny brush specially designed to clean between teeth).
The type of toothpaste you use is also very important. While any product that contains fluoride will help fight gum disease, look for one that contains stannous fluoride, which research shows is particularly effective, says Ross. Crest Gum Detoxify, Colgate Total SF and Parodontax Active Gum Repair are all good choices, she says.
See your dentist regularly
It’s very possible to have gum disease even if there are no warning signs, or just very subtle ones, like occasional bleeding after brushing, says Wolff. You should see your dentist at least once a year for a cleaning and thorough exam — though you may need to go more frequently, he notes. If you can’t afford to pay out of pocket — unfortunately, Medicare doesn’t cover most dental care — contact the Health Resources and Services Administration, which can refer you to a network of “safety net” clinics for people who qualify for reduced-cost care. Your local dental school may also run a clinic that provides low-cost care.
Recognize the early signs
If you notice persistent bad breath, or if your gums bleed — even a little bit — when you brush them or they're red or swollen, see your dentist, stresses Wolff. These can all be early signals that something’s amiss in your mouth.
Consider mouthwashes and medications
If you are beginning to develop gum disease, your dentist can prescribe a mouthwash that contains the antibiotic chlorhexidine, such as Peridex, PerioChip or PerioGard.
Get the right treatment
If regular cleanings and home care aren’t enough to keep your gum disease in check, your dentist may refer you to a periodontist, a dentist who specializes in gum disease, for a more targeted treatment, says Ross. This could include:
- Scaling and root planning. This is a deep-cleaning, nonsurgical procedure that is done under local anesthesia to remove plaque and tartar from the gums and smooth out any rough spots on your teeth. “Smoothing out these spots helps remove bacteria and provides a clean surface for the gums to reattach to the teeth,” explains Ross.
- Gum surgery. During this procedure, which is also done under local anesthesia, the gums are lifted back and tartar is removed, says Ross. Sometimes the surrounding bone is also smoothed out, to limit the areas where disease-causing bacteria can hide. The gums are then reattached so that they fit snugly around your teeth, which “limits the areas where bacteria can grow,” adds Ross.
- Gum grafting. This is when a thin piece of tissue is taken from another place in the patient’s mouth — like the roof of the mouth — and attached to where gum tissue has receded.
Hallie Levine is a contributing writer and an award-winning medical and health reporter. Her work has appeared in The New York Times, Consumer Reports, Real Simple, Health and Time, among other publications.