LOSING YOUR TEETH can dramatically affect more than your smile. It ups your risk for a whole host of late-life health hazards, from heart disease to cancer to dementia.

The majority of older adults have periodontal disease—the number one cause of tooth loss. 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 American Dental Association, 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.”

THANKS TO fluoridated water and toothpaste, an increased focus on oral health care and a reduction in smoking, it’s not uncommon today to see adults living out their entire lives with a full set of their own teeth. 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. Gum disease has also been linked to the development of diabetes, heart and lung disease, rheumatoid arthritis and certain cancers. (The reverse is true too; having chronic disease often makes your mouth more vulnerable to dental problems and tooth loss.)

Poor oral health often leads to discomfort and pain; problems speaking, chewing and swallowing; and yes, tooth loss. That can alter what foods we can eat, lead to nutritional deficiencies and generally impact your emotional health, self-esteem and quality of life.

TOOTH LOSS doesn’t have to be your future. “With good oral hygiene and preventative techniques, you can hold on to your teeth,” says Adila S. Baig, director of the Special Care & Geriatrics Clinic at the University of Maryland School of Dentistry.

To do that, it helps to recognize the major causes of tooth loss as enemies—thieves that are coming for your teeth and your overall health. Here are the threats and how to protect yourself from them.

WHILE JUST about every older adult has had a cavity in their lifetime, about 1 in 5 adults over 65 currently have untreated tooth decay. “The myth is that cavities are only a childhood problem, but they’re definitely an adult problem and are certainly an older adult problem,” says Stephen Shuman, director of the Oral Health Services for Older Adults program at the University of Minnesota School of Dentistry in Minneapolis.

In fact, older teeth can be even more susceptible to decay, because there are more opportunities for cavity-causing bacteria to grow. Receding gums expose the roots of the teeth, which are more vulnerable than the crowns. Old fillings can break down, exposing cracks where bacteria can invade. Meanwhile, vision problems and dexterity challenges from conditions like arthritis can make it difficult to clean between your teeth and brush well, giving germs another leg up.

• Customize your dental visits. If you’re even seeing the dentist at all you’re ahead of the game: About 4 in 10 older adults didn’t have a single dentist visit in 2022. How often do you need to go? That’s between you and your dentist. While twice a year is a common schedule, it’s not a standard. “There is nothing magical about a six-month checkup,” Shuman says. People with excellent oral health may only need to go annually; those with challenges may need to go every three months.

• Automate your toothbrush. “I recommend that everyone over the age of 40 use an electric toothbrush,” Dunbar says. Why? An electric toothbrush spins on its own to do all the work for you. Plus, it may have a timer to help you reach the recommended two-minute brushing mark, and many have a feature that signals when you’re brushing too hard, which can contribute to gum recession. (To use this brush, put it on top of your teeth and let the brush spin, then move on to the next spot. Don’t use a manual brushing motion.) And scrape or brush your tongue while you’re at it, Dunbar adds: “So many odors in the mouth come from the tongue—the tongue is a constant sponge that holds bacteria.” Use your toothbrush twice a day.

• Go high-tech with your flossing. While it’s crucial to do it daily, navigating a string in between teeth can be challenging. Dunbar recommends using a water flosser to clean between your teeth. Since it shoots out water into your mouth, it’s another tool that does the work for you.

• Stop smoking. If you smoke, you’re more than three times more likely to lose all of your teeth than a nonsmoker. Four in 10 older adults who currently smoke have lost all of their teeth. But it’s not too late to quit: Just like there are benefits to your heart and lungs if you reduce or stop smoking at any age, the same applies to your mouth.

ABOUT 2 IN 3 adults over 65 are currently dealing with gum disease. Its most common symptom: Your gums bleed when you brush.

“If you rubbed your eyeball and it bled, you’d go straight to the ER. So why do we ignore it if our gums bleed?” Dunbar asks. Gum disease can destroy gums and the bones that keep teeth in place, leading to tooth loss. Other symptoms of the disease: loose teeth, pain during chewing, persistent bad breath and receding gums.

“Even if you have not lost any teeth, gum disease impairs your ability to chew hard food,” adds Uchenna Akosa, assistant professor and director at Rutgers Health University Dental Associates. “That will affect your nutrition and can put you at risk of malnutrition in the future,” she explains.

• Up your dental game. Brushing and flossing daily are musts for maintaining gum health. Again, mechanized tools can be a big help.

• Up your schedule. If your gums bleed regularly, talk to your dentist about the frequency of your appointments: Early intervention can prevent acceleration of the disease and future tissue damage and tooth loss.

ABOUT 6 IN 10 older adults complain of dry mouth. Reduced saliva production promotes bad breath, tooth decay and tooth loss. “Saliva helps neutralize acids and remineralize tooth structure. Dry mouth puts you at a higher risk for cavities,” Shuman says.

• Review your meds. The more medications you take, the fewer natural teeth you’re likely to have, research shows. 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

• Hydrate. Sip water throughout the day and rinse after eating. Consider an over-the-counter dry mouth rinse such as Biotene, Act or TheraBreath.

• Ask your dentist about high-fluoride toothpastes. Baig often puts older patients on a prescription toothpaste that contains a higher level of fluoride, which remineralizes tooth enamel to protect teeth from decay.

• 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.

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.

An implant is a false tooth that is implanted through the gum and into the jawbone. Sometimes, artificial bone may need to be placed in the site to encourage new bone growth to fortify a tooth. It’s even possible to replace all your teeth with implants.

A bridge is a set of one or multiple artificial teeth; removable bridges are taken out at night, while fixed bridges are attached to adjacent teeth and remain in your mouth.

“Well-placed implants and well-restored teeth look and function as natural as your own. And they last a long time with proper maintenance,” says Wolff. “In the vast majority of cases, we can figure out how to regrow bone, expand tissues, and place implants. But this is not inexpensive.” (See below, “How to Afford Better Teeth.”)

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.