Geriatric (Elderly) Patients-Changes In Teeth And Supporting Tissue

Tissues in your mouth, like other body tissues, change as you grow older. Soft tissues (gums and cheeks) lose their ability to stretch, and muscles become soft and weak. The amount of saliva produced by glands in your mouth is frequently reduced. As a result, chewing for the mature adult population becomes more difficult, and your mouth becomes more easily irritated and heals more slowly than when you were younger. Other changes may occur.

Decay
The rate of tooth decay may be increasing as you grow older. This is especially true when the amount of saliva is reduced. Tooth decay in older adults appears most frequently around the teeth at the level of the gums. The root portion of a tooth, when exposed, is especially subject to decay. Gumline or root decay is difficult to restore with fillings, because decay often reoccurs around this type of filling soon after it is placed. As a result there is an increase of decay incidents in mature adults and the senior population.

Periodontal disease
Evidence of periodontal disease is red or swollen gums that bleed with the slightest irritation. Pockets often develop between teeth and gums and can pack or trap food debris. This disease is generally found in varying degrees in older adults. If not treated, the disease becomes more and more destructive. In the elderly, periodontal disease is a primary cause for loss of teeth. Depending on the severity of your gum disease, your dentist will discuss with you your options to treat your particular condition.
Brittleness and wear of teeth
Nerve tissue and blood vessels are found in the pulps of teeth. When you were young, these nerves were very responsive to pain or to anything hot or cold. As you have aged, the pulp gradually became smaller with fewer blood vessels and less nerve tissue supplying the teeth. As a result, your teeth have less fluid content and have become brittle. Your brittle teeth may be easily broken or chipped. Fortunately, due to the reduced nerve tissue, little if any pain is experienced when even severe fractures occur.

Teeth wear because of the grinding action of chewing. Tooth enamel becomes thinner. In severe cases, the hard enamel covering is completely worn away leaving a softer part of the tooth (dentin) exposed. Dentin can be dissolved by acidic oral fluids. Teeth with only a fragile enamel shell may result. These teeth are easily chipped or broken.

Tolerance to dentures
If you wear a complete or partial, removable denture, you want it to be comfortable and work well. Your satisfaction with dentures depends largely on the ability of the remaining ridges in your mouth to provide the necessary support.
After teeth are removed, the remaining bone (ridge) continuously shrinks to a smaller size. The gum tissue covering the ridge becomes thinner and is more easily irritated. The rigid, non-changing dentures become progressively less adapted to the ridges in the mouth. As a result, chewing hurts and you don't chew as well. It is estimated that nearly half of the dentures worn by elderly persons are ill-fitting and potentially harmful. Hence the importance for the senior patient to see their dentist every two years for denture fit evaluation.

Other factors can cause additional dental problems and affecting dentistry for seniors

Oral cancers
Screenings by your dentist for early changes in the oral tissues can help detect cancer at a stage where it can be more successfully treated.

The incidence of oral cancer appears to increase with age. About 3 percent of all cancers detected are found in the jaws, lips, tongue and palate (roof of the mouth). The effect of oral cancers and their treatment can be devastating. Surgical treatment often results in loss of a portion or all of the jaws, tongue or palate. Facial disfigurement and serious impairment of chewing ability accompanies treatment of more extensive cancers.

Radiation (x-ray) therapy used to treat some oral cancers generally results in a reduced amount of saliva. The cleaning and lubricating effect of saliva is diminished, leaving the mature adult tissues easily irritated and teeth subject to rapid decay.

Systemic diseases
Evidence of a disease occurring elsewhere in the body is sometimes noted in the mouth. Disorders such as those of the blood system (anemia) or diabetes are sometimes accompanied by inflammation and reduced healing capacity of the gums.

Drug therapy
Treatment of some diseases (heart disease, high blood pressure, depression, Parkinson's disease) uses a regimen of many medications taken by seniors. A common side effect of these medications is a decrease in the amount of saliva, which results in a very dry mouth. Dry mouth (xerostomia) is a condition that adversely affects senior dental care. An increase in the incidence of decay, periodontal disease, and an inability of gums and ridges to tolerate dentures can be expected. It is important when you visit your dentist to bring a list of names, doses, and frequency of any medication you’re currently taking - whether prescription or over-the-counter products.

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