The Unknown Importance of Dental Exams

Poor oral care can lead to infection, chewing/swallowing problems, even heart, lung, and brain diseases, and inability to enjoy our favorite foods!

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Helpful Highlights

  • Oral health encompasses much more than teeth and affects many things that we don't think about being connected to oral health.

  • Many older adults ignore signs and symptoms of poor oral health, and caregivers don't think to look or ask.

  • Dentists are trained to evaluate all existing and potential oral health complications and make referrals to other specialists as needed.

  • Oral conditions and systemic problems are interrelated. Therefore, routine dental exams are imperative for early identification and intervention.

Oral Health and Hygiene

Your loved one should be seeing a dentist at least once a year, preferably twice (every 6 months).

Proper dental care is about much more than teeth, though clean and healthy teeth are an essential start. Many people don't realize that issues with the teeth and gums lead to far greater problems than what is seen or felt on the surface, and more can go wrong with the mouth and jaw than just tooth decay. Advanced oral health issues can cause serious problems throughout the body.

Caregivers who assist frail elders in carrying out activities of daily living should be educated and trained in providing oral care, especially those who care for elders living in nursing homes.

Some facts

  • Older adults should still brush and floss daily!

  • Adults aged 50 years and older who smoke are less likely to get dental care than people who do not smoke.

  • People with chronic diseases may be more likely to develop gum (periodontal) disease, but they are less likely to get dental care than adults without chronic conditions. 

  • Potential physical, sensory, and cognitive impairments associated with aging may make home oral health care and education challenging.

  • Older adults may have increased sensitivity to drugs used in dentistry, including local anesthetics and analgesics.

Regular dental exams detect oral health problems in older adults

Dry mouth (xerostomia). Dry mouth is caused by reduced saliva flow, which happens gradually as we get old, though is made worse by chronic conditions and multiple medications. Dry mouth affects 30% of people 65 years and older and up to 40% of people 80 years and older. Preventing dry mouth is essential in avoiding multiple oral health problems:

  • foul breath (halitosis)

  • mucositis (inflamed soft tissues of the mouth)

  • gingivitis (inflamed gums) and gum recession

  • tooth and root decay

  • cracked lips and tongue

  • altered sense of taste

  • thrush or other infections

  • difficulty speaking, eating, or swallowing

Gum disease (periodontitis). Gingivitis can lead to gum disease, which is why gingivitis should not be ignored. 2 out of 3 adults aged 65 or older have gum disease. It is not only an oral health threat, it is also a risk factor for both heart and lung disease.

Darkened teeth. Sometimes darkened teeth are caused by changes in the bone-like tissue under the tooth enamel (dentin), and because thinning enamel lets the darker yellow dentin show through. These are backed by a lifetime of consuming foods and beverages that stain enamel. Darkened teeth, however, may be a sign of a more serious problem - like loss of blood flow - and should be checked by a dentist.

Tooth decay (caries or cavities). 1 in 5 adults aged 65 or older has untreated tooth decay (cavities, or worse). Cavities oftentimes go unnoticed until they are advanced. Cavities do not resolve on their own, and at advanced stages can cause problems in deeper tissues and structures. Tooth decay, just as with any other condition, is best addressed early. Once tooth pain is felt, drilling and filling are a certainty, though more may be required depending on the extent of the decay and damage.

Root decay (caries). The same decay that happens to tooth enamel can happen to the root of the tooth. Root decay can lead to the need for a root canal, as well as cause infection and breakdown of surrounding tissues - including the bone.

Tooth loss. Nearly 1 in 5 adults aged 65 or older have lost all of their teeth. Complete tooth loss is twice as prevalent among adults aged 75 and older. Broken or missing teeth are a gateway to the tissues, vessels, nerves, and bone beneath. These are direct pathways to the ears, throat, heart, and brain. Therefore, if an infection occurs beneath the teeth, it could travel to any of those locations and cause hearing loss, problems swallowing, heart disease, and even irreversible angina (chest pain caused by reduced blood flow to the heart).

Uneven jaw bone. This is caused by broken or missing teeth that are not replaced, allowing the remaining teeth to drift and shift into open spaces, resulting in a crooked bite and eventually an uneven jaw. An uneven jaw can cause considerable discomfort or pain in the jaw, ears, and neck, as well as trigger headaches. It also causes problems with chewing and speaking and frequently leads to further dental damage.

Denture-induced stomatitis. This is inflammation of the tissue underlying dentures caused by ill-fitting dentures. It is often coupled with poor dental hygiene or a buildup of the fungus Candida albicans. It can be very painful, prevent eating and speaking, and lead to more serious oral health problems.

Thrush. Thrush is an overgrowth of the fungus Candida albicans. Thrush can cause great discomfort in the mouth, and make eating and drinking difficult. Untreated thrush can spread infection to other parts of the body, namely the lungs, liver, and skin.

Oral cancer. Cancers of the mouth are primarily diagnosed in older adults (median age at diagnosis is 62 years). Older adults also suffer a higher risk of oral cancer because of their thinner, weakened oral mucosa (the moist, pink tissues lining the mouth and teeth).

Dental problems can also affect speech, which can be frustrating and upsetting for your loved one, as being understood is an important part of their quality of life.

Effects on eating

Poor oral health, especially decayed, broken, or missing teeth can cause difficulties with chewing or swallowing, leading to poor nutrition and aspiration risk (liquids or foods pass into the lungs).

And probably most important to our loved ones... Poor dental care can prevent them from enjoying their favorite foods. It takes healthy teeth and gums to chew and break down meats, fibrous foods (most fruits and vegetables), and crunchy snacks.

Oral changes

If your loved one is having problems, do not wait to go to the dentist. Get your loved one checked if any of these symptoms persist for 2 weeks or more.

  • A spot in the mouth, on the lip, or in the throat that feels uncomfortable or sore

  • A lump or thick area in the mouth, on the lip, or in the throat

  • A white or red patch in the mouth

  • Trouble chewing, swallowing, or moving the jaw or tongue

  • Numbness in the tongue or mouth

  • Swelling in the jaw

  • Pain in one ear without hearing loss

Your loved one should be seeing a dentist at least once a year, preferably twice (every 6 months).

RESOURCES

American Dental Association (ADA)

CDC

Harvard Medical School

Health in Aging (*contains a great list of DON'Ts and DOs)

Leung, K. C-M., & Chu, C-H. (2023). Dental care for older adults. International Journal of Environmental Research and Public Health, 20(1), 214. doi: 10.3390/ijerph20010214

Medicare

Oral Health Foundation

US DHHS Office of Disease Prevention and Health Promotion (OASH)

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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