Gum Problems and Tooth Loss

Gum Problems and Tooth Loss

A dreadful myth persists that tooth loss is an inevitable part of aging. Years ago, in Ireland and other European cultures, this belief was so pervasive that brides would have all their teeth removed and get dentures prior to marriage in order to spare their husbands the expense of it later in life, says Eric Z. Shapira, D.D.S., dentist in Half Moon Bay, California, and spokesperson for the Academy of General Dentistry in Chicago.

But these mass extractions were hardly warranted. Aging, dentists say, has little impact on the health of your teeth. “If you take proper care of your teeth and gums and get regular dental checkups, you should be able keep your teeth throughout your life,” Dr. Shapira says. “In fact, I have a 98-year-old patient who still has all of her natural teeth. They’re absolutely beautiful.”

More people than ever before are preserving their natural teeth throughout adulthood, rapidly making toothlessness and full dentures relics of the past. In 1960, nearly half of all Americans 65 and older were toothless. By the mid 1980s, only about one in three seniors were wearing full dentures, says Stephen K. Shuman, D.D.S., associate professor of preventive sciences at the University of Minnesota School of Dentistry in Minneapolis. But while progress has been made, the typical American still only retains 16 to 19 natural teeth out of 32 after age 60.

The best way to ensure that you’ll keep your full complement is by brushing and flossing at least twice a day to prevent cavities and receding gums (periodontal disease). These two tooth attackers are the top two causes of tooth loss in people over age 60, Dr. Shuman says.

Even if you’ve slacked off in your oral hygiene habits in recent years, perhaps because of a disabling ailment like arthritis or stroke, it still might not be too late to save your teeth, Dr. Shuman says. You just need to find ways to get back into the routine. Here are a few tips to help you take the bite out of tooth decay and gum disease.

Try This First

Plug in. Electric toothbrushes like Sonicare, Braun Oral-B, or Interplak will generally clean your teeth better than hand brushing, particularly if you have dexterity problems that make it difficult for you to brush and floss, says Jeffrey Astroth, D.D.S., chief of dentistry at the University of Colorado Center on Aging in Denver. “They have larger handles that make them easier to grip, and they clean between the teeth almost as well as dental floss. I wouldn’t say they’re better than flossing. But I’ve recommended these types of brushes to several of my patients,” he says.

Other Wise Ways

Get a grip. If you have trouble holding on to a toothbrush, wrap the handle with aluminum foil or modeling putty, suggests Dr. Astroth. The foil or putty will enlarge the handle and make it easier to grasp. Or cut a small hole in opposing sides of a tennis ball or handball. Then stick the toothbrush handle through the holes. This, too, can make hanging on to the brush easier.

Brush up on your technique. Although you’ve been brushing for decades, here are a few reminders from Dr. Shapira.

• Use a soft-bristled brush unless directed otherwise by your dentist.

• Look in a mirror while you brush. If you can see what you’re doing, it will help you clean your teeth more effectively.

• Place your toothbrush at a 45-degree angle against your gumline and massage in place in a circular motion.

• Move the brush back and forth gently in short (toothwide) strokes, four or five times on the outer, inner, and chewing surfaces of all teeth.

• For the inside surfaces of your front teeth, move up and down gently with the tip of the brush.

• Brush your tongue and gums to scrape away any odor-causing bacteria that accumulate.

• Replace your brush when the bristles become frayed, which is about every three to four months.

Be gentle. Don’t clean your teeth the way you’d clean your kitchen sink, Dr. Shapira warns. Constant, forceful scrubbing can wear away tooth enamel and gums, making your teeth more sensitive and exposing the roots of your teeth to infection and other problems. To get an idea of how lightly you should be brushing, take your index finger and gently press it onto your palm until the skin on your palm underneath your finger blanches. It shouldn’t take much pressure to do that, Dr. Shapira says.

Name that tune. Many people brush for less than 20 seconds. That’s hardly enough time to adequately clean your teeth, says Nick Russo, D.D.S., vice president of the Academy of General Dentistry in Chicago. He recommends brushing for two to three minutes. If necessary, set an egg timer, or turn on a radio and brush for the duration of one song.

Some electric toothbrushes also have built-in timers, Dr. Shapira says.

Stick with gum. Chew sugarless gums, like Trident, or gum made with baking soda or hydrogen peroxide, like Arm and Hammer Dental Care or Biotène Gum, for 5 to 10 minutes three times a day. They can help control plaque buildup and prevent cavities, Dr. Shapira explains.

Be nutty about cheese. Eat a handful of peanuts or an ounce of aged Monterey Jack or Cheddar cheese after a meal or sugary snack to neutralize acids in the mouth that damage teeth and gums, Dr. Astroth suggests.

Follow the pyramid. The same nutritious foods that help build strong muscles and bones also strengthen your teeth and make them more resistant to cavities, Dr. Astroth says. Cavities are more common among seniors than you might suspect. Up to 68 percent of Americans 65 to 69 and more than 70 percent of those over age 70 may have root cavities at any given time, according to studies.

So eat a balanced diet daily that includes 6 to 11 servings of breads, cereals, and pastas; 3 to 5 servings of vegetables; 2 to 4 servings of fruits; 2 to 3 servings of yogurt, milk, and other dairy products; and 2 to 3 servings of fish, poultry, and nuts.

Don’t be too sweet. Limit your consumption of chocolate and other sweets, Dr. Shapira says. Remember that each time you eat sweets, harmful bacteria produce acids in your mouth for at least 20 minutes. It is this acid that causes tooth decay.

Snack on foods like nuts, popcorn, raw fruits, vegetables, and sugar-free drinks that don’t promote decay. If you insist on eating sweets, do it just once a day, after you eat a well-balanced meal. And remember to brush immediately afterward to cleanse your mouth of bacteria and acids, Dr. Shapira urges.

Wash out your mouth. Gargle and rinse for 30 seconds just before bedtime with mouth rinses such as Viadent or Biotène. Or use a rinse like Fluorigard or ACT, which contain fluoride. They can help prevent cavities and flush harmful plaque and bacteria away from your gums, Dr. Shapira says. Avoid drinking any beverages for at least 30 minutes after using a fluoride mouth rinse, so that the fluoride can be properly absorbed by the teeth surfaces.

Tweak your gums. Flossing is fundamental at any age, Dr. Shuman says. If you can, at least once a day:

1. Break off about 18 inches of floss and wind most it around one of your middle fingers.

2. Wind the remaining floss around the same finger of the oppo site hand. This finger will take up the floss as it becomes dirty.

3. Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth using a gentle rubbing action. Never snap the floss into the gums.

4. When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.

5. Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up-and-down motions.

6. Repeat this method on the rest of your teeth. Don’t forget the back side of your last tooth. If you wear a bridge, be sure to floss the teeth around it.

If dexterity problems are making it difficult for you to use floss, consider using proxy brushes, Dr. Astroth suggests. These tiny, inexpensive brushes are easier for many older people to use, and they clean between the teeth almost as well as floss.

Get out and about. Without daily contact with others, the incentive to brush and floss your teeth can quickly fade. This is particularly true of seniors who have recently lost spouses or moved to new communities, Dr. Russo says. Join a jewelry-making, woodworking, or other hobby group. Get a part-time job. Volunteer at your church or synagogue. Dive into the outside world at least once a day, Dr. Russo urges. It will encourage you to maintain good oral hygiene.

Bar the drinks. Alcohol dries out your mouth and increases your likelihood of gum disease and tooth loss, says Dr. Shapira. If you drink, cut back to no more than one 12-ounce beer, 4-ounce glass of wine, or 1-ounce serving of liquor a day, Dr. Shapira urges.

Snub smoking. People over age 60 who continue to smoke are twice as prone to tooth loss as nonsmokers, says Elizabeth Krall, Ph.D., epidemiologist and associate professor at Boston University School of Dental Medicine.

Smoking causes bone loss that weakens a tooth’s underlying support and promotes gum disease. In fact, smokers are five times more likely than nonsmokers to have gum disease, according to the National Institute of Dental Research.

In addition, smoking and chewing tobacco stain your teeth. These stains are a perfect place for plaque to hitch a ride on a tooth, causing cavities and aggravating periodontal disease.

Don’t play dentist. Some drugstores sell over-the-counter devices that resemble scalers (instruments used by dentists and dental hygienists to remove tartar and other deposits from teeth). Although they may be tempting, leave them on the shelf, advises Heidi Hausauer, D.D.S., assistant clinical professor at the University of the Pacific School of Dentistry in San Francisco.

“I’ve had people come into the office who have used these over-the-counter dental instruments and chipped their front teeth with them. I’ve seen patients gouge roots and chip enamel off lower incisors,” Dr. Hausauer says. “It’s particularly unwise for an older person to use them, because he or she probably doesn’t have the proper training or dexterity to use these products well. The person could take the device, inadvertently shove tartar farther down under the gum, and cause a severe infection.” Instead of trying to do extensive cleanings yourself, get dental checkups twice a year, she urges.