Dentistry as We Age
One of the biggest challenges I face every day is how to treat the aging population. Here on the Space Coast the locals are living longer, and other older folks are moving in from out of town to our slice of heaven. Generally, once a person reaches their eighties changes start to occur within the mouth. It is easier to get cavities in areas that previously were better cleaned and more well-protected. People that have had no cavities their whole lives start to have problems, seemingly out of the blue. This is due to many factors, and a large one is gum recession which can expose a tooth’s softer root. Almost every medication causes dry mouth, and without the body’s protective saliva, tooth decay happens much quicker and is harder to prevent. Also, arthritis and dexterity concerns of the hands and fingers impair the ability to brush and floss. By the time a person reaches this age, there has typically been a lot of dental work done already, and it also easier to get cavities around the margins or edges of existing crowns and fillings. Teeth also have had a lifetime to shift and get crooked, again making it harder to clean.
Combine all these factors with the simple fact that as we age, overall health generally diminishes and dental treatment can be more strenuous and complex and expensive.
The challenges really start to mount when a person starts to decline from dementia or Alzheimer’s. There are so many factors in play here, I like to sit down with as many of their caregivers as possible and hammer out a very conservative plan. Obviously, when there are memory issues it becomes very hard to deal with change. Often I will see a case where an adult son or daughter brings in an assisted living facility resident for an evaluation, and no one realizes how bad Mom or Dad’s teeth have become recently. The difficulty then becomes whether or not to even begin treatment. In this situation, if they have never had a denture or partial denture in the past, adjusting to such a prosthesis can be almost impossible late in life. Usually, we focus on removing teeth that are likely to suffer from infection, and kind of “making do with what we have”. Replacing teeth with implants is often too complex and expensive and sometimes require the unenviable task of calculating a person’s lifespan and practicality. These cases make me wish I had a magic wand, but I do not have one.
A very interesting phenomenon I see when someone reaches their late 90’s into the 100’s is that the teeth will just start to break apart. Even in someone with great cognitive function and a full healthy set of teeth. Cavities are generally not to blame, but the teeth just become brittle at this age and have had their share of meals on them and just wear out and snap. This can be frustrating for someone trying to eat food they enjoy in their last few years, and sad to watch. I suspect this will become more and more of a problem as lifespans continue to soar.
Despite these challenges, I enjoy the privilege of having an older patient base. They tell great stories, are appreciative of our care, and need our help the most.
I think every single day I have someone tell me, “Don’t get old” or “Not sure why they call these the golden years”. The most proactive advice I can give is to keep a healthy mouth in your younger years, to minimize the challenges late in life. It’s not cheap, and takes a lot of work, but think about how much you use your teeth every day.
