Myths About Senior’s Dental Health

added on: August 15, 2013


Many misconceptions and false stereotypes, both positive and negative, about older people may be held by health providers of any age, and these may inadvertently and incorrectly influence assessment, diagnosis, and management approaches. I will discuss certain incorrect beliefs or “myths” about America’s elderly that need to be set right in order to understand the dental needs of seniors.

Myth 1: “Most Seniors Have Lost Their Teeth”

As recently as 1971, about 50% of Americans over age 65 were edentulous (no teeth). But as people who were children in the 1920’s and 1930’s have become “the elderly,” a striking number of them have retained some or many of their natural teeth. The latest nationwide data, collected 1998-2004, showed that only about 23% of Americans age 65-74 were edentulous. The members of this age group with teeth have an average of 19 teeth; over age 75, this figure was over 16 (which represents nearly 60% of the intact adult dentition) in 1994; by 2006 the figure was over 18 (64%). Dental professionals do not assume that tooth loss is inevitable with advancing age, nor believe that edentulousness will be acceptable to their older patients. As a result, we discuss the advantages of preventive and restorative services and recommend appropriate conservative, feasible, needed treatment for older patients. Of all the times in life to enjoy the simple pleasure of eating, it should be our golden years.

Myth 2: “Seniors with Teeth Generally Have Severe, Destructive Periodontal Disease”

Periodontal disease, or gum disease, is a progressive inflammatory condition which affects the tissues and bone supporting the teeth. There are well known warning signs of periodontal disease. However, periodontal disease can progress without any signs or symptoms. Gingival inflammation and bone destruction are often painless, and many individuals experience little or no discomfort in the early stages of periodontal disease. Often the disease has progressed significantly before an individual realizes there is a problem or seeks treatment. Periodontal disease can exist as mild, moderate or severe.

Signs and Symptoms of Periodontal Disease:

  • Bleeding gums
  • Sore or swollen gums
  • Loose teeth
  • Gum recession
  • Chronic bad breadth
  • Pus around teeth
  • Pain upon chewing
  • Recent bite change
  • Spaces between teeth

Current understanding of periodontitis (gum disease) is that most adults are affected by periodic, localized bouts of gum disease, ultimately resulting in some loss of bone and gum. Because older people have been exposed to these episodes of bone loss for more years than their younger counterparts, there is unquestionably more loss of gum/bone on average in older patients than younger ones. However, most research shows a leveling-off of pocket depth and bleeding on probing – the currently accepted clinical signs of active periodontal disease – in the elderly, although subgingival calculus, recession, and loss of attachment were more pronounced in this group than at earlier ages.

There are several important implications of these findings in the caring for gum disease for seniors. First, the presence of calculus and the absence of severe pocket depth indicate that the major periodontal treatment needs in most of these patients will be conservative non-surgical treatment (scaling and localized root planing). Second, the tendency for recession of the gums in this group suggests that interproximal oral hygiene measures other than floss – such as interproximal brushes – should receive serious consideration even for patients who have not undergone periodontal surgery due to the wider spaces between and around teeth to trap food and plaque. Finally, this same recession makes the likelihood for root caries (decay) to be greater in this group than in any other (as discussed below).

Myth 3: “A Dry Mouth is a Normal Part of Growing Old”

This myth is absolutely incorrect; studies on well controlled populations of all ages, with measures repeated over time, reveal minimal salivary flow and composition changes in healthy adults as they grow older. Nevertheless, dry mouth is quite common in advanced age, often because of disease frequently affecting older people or, more likely, medications taken to control those diseases. The seriousness of a dry mouth must not be underestimated, because saliva is a key and indispensable protector of the oral cavity. When salivary flow is modified, the acidity of the mouth rises; remineralization of incipient caries is impeded; oral microbial counts climb; and taste, swallowing, speaking, chewing, and use of oral prostheses are impaired. The fact that a dry mouth is not a normal part of aging means that when a patient notices, or a dental provider sees evidence of, reduced saliva, steps must be taken to identify the cause of the hypofunction and measures introduced to protect the dentition. Patients whose salivary status cannot be returned to normal should be educated about the possible consequences of the dryness and placed on a more frequent dental recall schedule. An aggressive program of high-potency home fluoride gel is required, and salivary substitutes may be recommended as well to address soft tissue complaints.

Myth 4: “Most Seniors Are Sick and Poor and Live in Nursing Homes”

An important lesson to learn about older Americans is that they are a uniquely diverse group. Their age group spans over forty years -more than two generations – and they have lived through a century (or more) that has arguably seen more change than any other in human history. An important key to building a positive working relationship with older clients is to recognize – as one should for patients of any age- the individuality of each person. It is true that over 50% of people over the age of 65 carry a diagnosis of at least one chronic disease, usually arthritis or hypertension, but possibly cardiovascular disease, diabetes, or others. Yet due to improved health styles and medical therapies, most elders enjoy a greater level of activity and abilities than similarly diagnosed people of earlier generations could achieve. Even among people who report total inability in at least one necessary daily activity or who report their own health as only fair, annual dental services are obtained at 60% of the rate expected for healthy, fully abled people. Most older patients can be expected to continue to seek dental services as they age, although their homecare may become more challenging through medication-reduced salivary flow or problems with visual acuity or manual dexterity.

It is true that several million elders live near to or below the poverty level, and there are populations of elders (notably, single females and minorities of either gender) who suffer from poverty to a greater extent than most. The impoverished state is more concerning for older people because most have finite or diminishing resources and growing health costs. But over 70% of the discretionary spending in America is done by those over age 50. Dental professionals should avoid drawing conclusions about the importance that an older client will place on costs related to dental care; only the patient can determine that. Less than one and a half million elders (under 4%of all people over the age of 65) reside in nursing homes. The number is less than one-half percent of those aged 65-74, 6% of 75-84, and about13% of those aged 85 and older. In addition, for each person residing in a nursing home, there are two to three equivalently disabled persons residing in the community through the help of relatives, friends, and public and private services. However, as described above, a lifetime habit of regular dental care does not disappear with advancing age. Community-dwelling seniors continue to obtain dental services despite frailty.

The trend of seniors keeping their teeth longer is expected to increase, and the number of seniors is expected to keep growing as the “Baby Boomers” begin to cross the threshold out of middle age. Dentistry for older adults will increasingly become focused on prevention, restoration, and maintenance, rather than on replacement.