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Getting to the root of geriatric dental myths.


At age 61, Shirley was adamant. "All my teeth hurt,' she told her dentist. "I want you to take them out and give me dentures.'

Shirley's dentist wasn't surprised by her request. "It's not uncommon for an older person to come in with pain and ask to have all their teeth removed,' says Dr. Marvin Block, president of the American Society for Geriatric Dentistry. "This is because they're under the misconception they're going to lose their teeth eventually anyway. So at the first sign of pain, they want dentures, thinking in this way to avoid the expense and discomfort of future dental treatments.'

Shirley didn't need dentures. Instead, Dr. Block made her a hard plastic device to slip over her teeth at night.

The cause of Shirley's pain? It is called bruxism--grinding the teeth together during sleep.

Getting Long in the Tooth Doesn't Mean No Teeth

Not every older person's dental pain can be eased as readily as Shirley's. Sometimes cavities need to be filled, or periodontal diseases treated, or abscesses drained. The thing to remember is that although dental pain is a symptom something is wrong, it doesn't necessarily mean the teeth are no longer useful or functioning properly.

"It's important to reeducate older people,' Dr. Block explains. "This is because far too many elderly believe the myth that when you get old, you lose your teeth. This is not true. The majority of elderly who have lost their teeth have lost them due to neglect. With good dental and oral care, most individuals can retain their teeth for their entire lifetime.'

Equating advanced age with loss of teeth is not the only misconception passed down from generation to generation. "Another myth,' says Dr. Harold Loe, the director of the National Institute of Dental Research, "is that you get periodontal disease because you're growing old. We now know that gum diseases start early in life and, if not treated, progress slowly, and usually without any pain. Unless there is a systematic check-up by a dentist, a patient will end up with loss of bone and loss of attachment to the teeth.'

Periodontal disease, probably the most destructive of all oral disorders, is the primary cause of tooth loss in persons over age 65. If periodontal disease is not stopped by good oral hygiene and dental treatment, teeth will eventually fall out or have to be removed.

Want More Problems? Give 'Em a Good Dose of Neglect

The American Dental Association says other prevalent dental problems affecting the elderly include tooth-root cavities, oral cancer, recurrent decay around fillings, and denture adjustments. Unfortunately, one condition left untreated can provoke another. For example, poor brushing and flossing may lead to periodontal disease, which in turn results in receding gums. As the gums pull away from a tooth, its root becomes exposed. This root is covered by a substance called cementum, much softer than enamel and more easily decayed by the attacking bacterial plaque constantly being formed in the mouth.

Statistics show that seven of ten Americans over 60 with their own teeth will suffer from tooth-root cavities. "Root cavities are closer to the nerve of the tooth than crown caries,' Dr. Block explains. "The time element is very important in stopping the rate of decay, which is progressive. If left untreated, you can lose the entire tooth.'

Yet another frequent "Catch-22' in older adults is tooth decay resulting from dryness in the mouth. "There are many types of medications that impact on salivary function and on the health and disease of the teeth and gums,' Dr. Loe says. He cites antihistamines, painkillers, decongestants, and antihypertensive drugs as just a few of the commonly prescribed medications that may, as a side effect, cause reduced salivary flow, or dry mouth, in an elderly patient.

"Reduced salivary flow is almost always synonymous with the development of tooth decay,' Dr. Loe says. "This is because saliva contains components that cleanse the teeth and inhibit bacterial growth and plaque development.' Saliva is also necessary for denture retention. Without enough moisture in the mouth, dentures may slip or fall down.

Dental experts recommend that elderly patients bring all their medications with them to the dentist. "This way if there are any questions regarding the medications, the dentist can consult with the patient's physician,' Dr. Block says. Sometimes the medication causing the dry mouth can be changed, the dosage reduced, or moistening oral rinses prescribed to help alleviate the problem. This information is also important because certain conditions and drug combinations may affect the type of anesthesia used or alter the dentist's treatment plan.

Dentures Are Forever

Once a tooth is lost, it's lost forever. "The frequency of toothlessness in the geriatric population is many times that of middle-age adults,' Dr. Loe says. Most of these older adults choose dentures. Unfortunately, other studies have shown that dentures, no matter how well made, are mediocre substitutes for natural teeth. The chewing ability of ordinary denture wearers is only one-quarter that of people with their own teeth.

"The effectiveness of the natural teeth is far superior than any kind of dentures, whether it be in biting power, in comfort, or in fit,' Dr. Block explains. "Many people have the misconception that by having dentures their problems are solved. This is not true. Gums shrink. The underlying bone shrinks. When this happens the dentures become loose and have to be relined or refitted.'

Dr. Loe says too many people with dentures accept pain and discomfort in the mouth as part of aging. "This is wrong,' he says. "The pain could be caused by inadequate dentures that need to be refitted or reshaped.'

Having dentures does not mean you no longer need to see the dentist. "It's extremely important that people with dentures see their dentists at least once a year,' Dr. Loe says--not only to determine that the dentures are still fitting correctly, but also to check salivary functioning and to examine the delicate tissues lining the mouth for abrasions and oral cancers. Checking the oral tissues is necessary, because poorly maintained prosthetic devices, such as crowns, bridges, and dentures, can cause oral irritations that can in turn lead to oral cancers.

Dental Breakthrough of the Century?

Some dentists are calling implants, a new alternative to dentures, the dental breakthrough of the century. Implants are artificial porcelain teeth permanently anchored, via lightweight titanium screws, into the jawbone. The multistep procedure takes several weeks to six months to complete. "Implants are fixed to the jaws,' Dr. Loe explains. "Unlike dentures, they are not removable. More and more people are opting for dental implants, as they offer better chewing ability, a more natural feel than dentures, and a solution to the cosmetic problem.'

Still, implants are not for everyone. "In order for implants to work,' Dr. Loe says, "an individual must have enough jawbone to place the implant into, must be in good general health, and must not have any major health complications.'

The bottom line, though, is that dental techniques and treatments have changed dramatically in the last decade. To tolerate toothaches, bleeding gums, clicking dentures, or sore spots in the mouth is to court oral disaster unnecessarily. Eating nutritionally balanced meals, brushing and flossing daily, and visiting your dentist regularly are still mandatory for a lifetime of good oral health. Remember, your dentist can help you--but the responsibility for your oral health begins with you.
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Author:Senz, Laurie S.
Publication:Saturday Evening Post
Date:Jan 1, 1988
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