Oral Health for Older Adults: Common Changes and What Helps

Teeth are not meant to wear out with age. The National Institute on Aging (NIA) notes that today’s older adults keep their natural teeth longer than earlier generations, thanks to advances in oral health research. But later life brings its own challenges: medicines that dry the mouth, gum changes, harder-to-grip toothbrushes, dentures and a higher risk of oral cancer. This guide covers the changes older adults most often face and what helps, based on guidance from the NIA and the National Institute of Dental and Craniofacial Research (NIDCR).

Tooth decay doesn’t stop at 60

The NIA explains that plaque bacteria make acids that harm enamel and cause cavities at any age. Brushing and flossing help prevent decay, but once a cavity forms, a dentist has to fill it.

The NIA advises using fluoride toothpaste, especially if you are at higher risk of decay, for example because a health condition or medicine dries your mouth. Your dentist or hygienist may recommend an in-office fluoride treatment or a fluoride gel or rinse at home.

Gum disease

According to the NIA, gum disease begins when plaque builds up along and under the gum line. The mild form, gingivitis, can make gums red, tender and likely to bleed, and it can often be reversed with daily brushing and flossing. The severe form, periodontitis, must be treated by a dentist and can lead to sore, bleeding gums, painful chewing and tooth loss.

The NIA’s prevention steps:

• Brush twice a day with fluoride toothpaste.
• Floss or clean between teeth once a day.
• See your dentist routinely for checkups and cleanings.
• Tell your dentist about your medical conditions and medicines.
• Eat a well-balanced diet.
• Don’t smoke. Smoking raises the risk of gum disease.

Dry mouth and medicines

Dry mouth is common in older adults, but NIDCR says it is not a normal part of aging. The NIA notes that many common medicines can cause it, including some medicines for high blood pressure, depression and bladder control. Dry mouth makes it harder to eat, swallow, taste and speak, and the NIA says it raises the risk of decay and fungal infections of the mouth.

What may help, according to the NIA and NIDCR: sipping water or sugarless drinks, chewing sugarless gum or sucking sugarless hard candy, and avoiding tobacco and alcohol. The NIA also suggests limiting caffeine, soft drinks, acidic juices and spicy or salty foods. Ask your dentist or doctor about artificial saliva, and never stop a prescribed medicine without talking to your doctor. Our guide to dry mouth and your teeth goes into more detail.

When hands make brushing hard

Arthritis and other conditions can make a toothbrush or floss hard to hold. The NIA suggests:

• an electric or battery-operated toothbrush
• a toothbrush with a larger handle
• a wide elastic band to attach the brush to your hand
• a floss holder, or other tools such as pre-threaded flossers or a water flosser

The NIA notes that people living with Alzheimer’s disease or a related dementia often need help caring for their teeth and mouth. NIDCR publishes caregiver tips for that situation.

Replacing missing teeth

The NIA lists several options to discuss with a dentist: crowns to cover and strengthen damaged teeth, bridges (fixed partial dentures) to fill gaps, dental implants, and full or partial dentures. Our comparison of full vs partial dentures explains the tradeoffs.

Living with dentures

The NIA advises:

• Expect frequent dentist visits at first to check fit. As gums change shape, dentures may need to be adjusted or replaced. Let your dentist do the adjusting.
• Take care with hot foods and hard bits like bones, which can be harder to feel with dentures.
• When learning to eat, start with soft, non-sticky food cut into small pieces, chew slowly on both sides, and avoid small crunchy foods like popcorn kernels.
• Brush dentures daily with a denture-care product, soak them overnight in water or denture cleanser, and keep them out while you sleep to prevent swollen gums.

Oral cancer checks

NIDCR says the risk of oral cancer rises with age, and the NIA notes it is more likely after age 40. The NIA recommends regular oral cancer exams even if you have lost all your natural teeth, and describes the exam as quick and painless. Not using tobacco, drinking alcohol only in moderation, and using lip balm with sunscreen all lower the risk. See what happens at an oral cancer screening.

Joint replacements and antibiotics

Many older adults have a hip or knee replacement and wonder whether they need antibiotics before dental work. The ADA says that, in general, they do not, but some people with weakened immune systems may. Ask your dentist and surgeon about your own situation.

Paying for care

Coverage often changes at retirement. For how Medicare handles dental care, see our guide to Medicare dental coverage.

Frequently asked questions

Is tooth loss a normal part of aging?

The NIA notes that older adults today are keeping their natural teeth longer than previous generations. Gum disease, a major cause of tooth loss, can be prevented and treated.

Do I still need checkups if I wear full dentures?

Yes. The NIA says to keep seeing your dentist for oral cancer exams even without natural teeth, and dentures may need adjusting as your gums change.

My new medicine makes my mouth dry. What should I do?

Tell your doctor or dentist. They may adjust the medicine or suggest artificial saliva, and NIDCR lists self-care steps such as drinking water often and chewing sugarless gum.

Sources

• National Institute on Aging: Taking Care of Your Teeth and Mouth
• NIDCR: Dry Mouth
• NIDCR: Oral Cancer
• ADA MouthHealthy: Joint Replacement

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Dental hygienist at work” by Flickr user baskyes, via Wikimedia Commons, licensed CC BY 2.0. Resized and compressed for the web.