December 2009 Issue

Delay the Decay
By Mary Ellen Young, RDH, MHA
Today’s Dietitian
Vol. 11 No. 12 P. 14

As more Americans live into their golden years with their own teeth, oral health needs for older adults have become more critical. In 2008, the Institute for Oral Health presented a conference centered on Oral Health in Aging America. Findings revealed that in 2011, nearly 76 million baby boomers will start reaching retirement age, adding to the largest growing population segment.

Science indicates that inflammation can increase the risk of many medical conditions that accompany aging and increase the complications related to those that already exist; inflammation in the mouth is detrimental to the rest of the body. Gingivitis and periodontal diseases both involve inflammations in the mouth. Proper home care and yearly visits to oral healthcare providers can prevent, control, and eliminate inflammation in the mouth. These seemingly simple steps may reduce the risk for cardiovascular and Alzheimer’s disease and have shown to be helpful in controlling blood sugar in type 2 diabetes, reducing the need for medications and helping control medical costs.

Bacteria in the mouth cause gingivitis, periodontal disease, and dental cavities. Such bacteria colonize into an organized mass called a biofilm. This biofilm is actually very complicated and promotes the survival of the oral bacteria. Brushing and flossing the teeth—known to dental professionals as home care—disrupts the biofilm, eliminating the bacteria that cause oral diseases. Dental professionals can recommend the best home-care tools for patients, dependent on individuals’ personal circumstances and needs. Routine daily dental hygiene is the most important and the least expensive way to control mouth bacteria and eliminate inflammation. It’s never too late for clients to begin an oral healthcare regimen.

Far-Reaching Influence
Oral health has a significant effect on overall health. Oral healthcare providers have long been aware that the mouth serves as a window to the body’s health, and scientific research has resulted in broad acceptance of the concept. Research indicates that older adults with periodontal disease and diabetes have more difficulty controlling their blood sugar and periodontal disease increases the risk for heart and vascular diseases. Heart and vascular diseases compromise circulation throughout the body, leading to a variety of complications. Such complications increase the use of medications among older adults. Medications themselves can produce conditions that are detrimental to older adults.

Numerous medications commonly used by older adults cause dry mouth, or xerostomia. Dry mouth makes home care not only more important but also more difficult. The condition makes bacterial biofilm stickier with limited saliva, and the natural lubrication and rinsing action in the mouth is reduced. This increases the risk for periodontal disease and dental cavities.

Additionally, the teeth are in a continuous state of demineralization and remineralization. The pH or acid levels in the mouth influence this action. The mouth’s biofilm and the types of food older adults eat affect the mouth’s pH levels. The bacteria in the biofilm digest sugars and carbohydrates and produce acids. This process results in dissolving or demineralizing the enamel of a tooth, causing cavities.

Promoting Oral Health
With the established link between oral health and overall health, what can professionals do to ensure that patients’ and clients’ mouths are healthy and contribute to overall health in a positive way? Prevention is key. Daily home dental care provides the best insurance against dental problems. It’s important to disrupt the biofilm daily. Older adults need to brush and clean between teeth with dental floss or even a toothpick. It’s also important to visit a dentist or hygienist once per year to be sure there’s no periodontal disease present or cavities that have started. Both are easier and much less expensive to treat when they’re detected early.

Another way to prevent cavities is to use a toothpaste and/or mouth rinse with fluoride. If older adults have dry mouth or a history of cavities, it’s a good idea to obtain a prescription-strength fluoride gel for use at home or to have a fluoride varnish professionally applied to the teeth. Fluoride rinses and gels help rematerialize tooth enamel, making them stronger and less likely to decay. Fluoride in drinking water also helps but not as much as the concentrated fluoride applied directly to the teeth.

There are many over-the-counter rinses and toothpastes that contain fluoride. Most are inexpensive, and older adults can brush them on or rinse with them when teeth are clean and able to absorb the minerals. Fluoride also interferes with the bacteria in the biofilm and their ability to reproduce, which reduces the amount of biofilm in the mouth.

The mouth and teeth represent the start of the body’s digestive process. If food isn’t chewed effectively because of tooth loss or can’t be swallowed efficiently because saliva is lacking, it can affect older adults’ overall health and well-being. Tooth loss is not a natural part of aging. Proper oral hygiene and dental care can keep gums and the bone supporting the teeth healthy. It really is as simple as brushing and flossing or using an alternative method to disrupt the biofilm.

Daily tooth brushing, flossing, and the use of over-the-counter fluorides are the first line of defense against disease. Regular visits to dental healthcare providers ensure that older adults are taking the necessary precautions to keep their mouths healthy and to access additional recommendations for meeting individual needs.

— Mary Ellen Young, RDH, MHA, is executive director of the Institute for Oral Health in Seattle.