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Monday, March 8, 2021

Senior Dentistry

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Fighting decay as we age

Seniors can be at risk for several oral health issues, according to WebMD. corn: darkened teeth, root decay, gum disease, tooth loss, jaw issues, dry mouth and a diminished sense of taste.

According to Shreveport dentist Ronald C. Hermes, DDS, most elderly dental issues have a common source: saliva, or lack thereof, called xerostomia.

"Dry mouth is the number one issue, hands down. And most of it is medication-related, and it doesn't even matter the medication," Hermes said. The more medications a patient is on, the more likely and severe the dry mouth symptoms. He said basically everything dentists contend with in older people boils down to saliva.

"Saliva is like oil to an engine," Hermes said. "It keeps everything going. It obviously has digestive capability, but it also bathes the teeth with the nutrients it needs. When you lose that, your decay rate goes up exponentially."

The progression of dry mouth can be apparent, he said. A patient who has been coming to the office for years and has never had issues can gradually face a mouth full of decay. "Then you get into a situation where you are trying to save their teeth."

Patients with limited mobility or who are confined to a nursing facility can have a very difficult time seeing the dentist, but it's more important than ever, according to Dr. Hermes. "They really need to be seen more often than less often, even though that's usually more difficult for them. We like to see those people every four months rather than twice a year."

However, dentistry has been working on the problems of our longer lifespans. Silver diamine is a relatively new treatment option in the United States. It was first approved for use in Japan over 80 years ago, but the FDA just approved it in 2014. "If a person comes in and you see decay everywhere, you're just trying to keep them out of pain," Hermes explained. "A lot of times, we'll treat those back teeth at the gums with silver diamine. Literally, you don't have to numb; you don't have to drill." He said it takes about a minute to apply, and it totally arrests the decay. It's good for about six months, and then it can be reapplied. The only downside is that it turns the teeth black where it's applied.

Oddly enough, a lot of dental work at any age requires bonding of material to the existing teeth. But bonding doesn't work well in the wet environment of the mouth. "Even though we talked about dry mouth," Hermes explained, "they still have enough saliva in there to keep it wet. We've come up with some different restorative materials called glass ionomers, which are basically fluoride-releasing fillings that also can be placed in a wet environment."

Hermes noted there are lots of products available over the counter for dry mouth. Products containing xylitol are available, even as chewing gum, and are also anti-cariogenic – they inhibit decay.

He said teeth can become brittle with age, and they usually darken because tooth enamel wears over time. As it gets thinner, the underlying dentin – which is yellowish – becomes more apparent. Bleaching only works on the tooth's enamel. If that layer is thin, the darker underlying yellow dentin will continue to show through.

It's possible to have gum disease at any age, Hermes said, but the elderly can face more challenges due to lack of dexterity. Some folks aren't able to brush and floss as well as they should. He also recommends electric toothbrushes for those with limited dexterity because they can produce better oral hygiene. However, he cautioned over-exuberant brushing can cause the gums to recede, exposing more tooth, hence the saying "looking long in the tooth."

Patients can even give themselves a fluoride treatment with an appliance created in the dentist's office. "We make them fluoride trays which are just like bleaching trays. It's a very high concentration of fluoride, and we have them brush their teeth, just get the toothpaste all over their teeth especially around their gums. Then they put in these trays, and they wear them all night. Greatly cuts down decay at any age."

His advice to those of us getting older: "Electric toothbrush, fluoride trays, seeing the dentist more often – three or four times instead of twice – you're always treating the dry mouth issues. And if things really go south, you're doing the really hard-core stuff like the silver diamine."

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