Harvard Health Letter

Hidden dental dangers that may threaten your whole body

Tooth decay and gum disease can lead to serious health problems, including brain or heart infections.

A growing number of older adults have something to smile about: research shows they’re keeping their teeth longer. While that makes chewing and talking easier and staves off malnutrition and the discomfort of dentures or missing teeth, it also means you need to be more vigilant than ever about preventing dental problems — including some that can have life-threatening complications.

Tooth decay

One in five adults ages 65 or older has untreated tooth decay (a cavity). This develops when food and bacteria form plaque that sticks to teeth and produces toxins that break down a tooth’s outer layer (enamel).

Bacteria also can infect the root of the tooth and form a small pocket of pus (an abscess). “If the infection doesn’t find a way out, it may travel to another space in the head. It wants the path of least resistance, so it may infect the jaw. But it can also travel to the brain and cause death, although this is fortunately rare,” warns Dr. Lisa Thompson, a geriatric dentistry specialist at the Harvard School of Dental Medicine.

Gum disease

Two out of three adults ages 65 or older have gum disease (also called periodontal disease). This is inflammation of the gums that can lead to tooth loss and many other problems. The disease starts with plaque buildup that irritates the gums. This early stage (gingivitis) causes swollen gums that bleed easily.

If untreated, gingivitis can extend below the gum line. The body’s own immune system is thought to fuel the condition, as white blood cells — called to attack the bacteria — eventually damage gum tissue as well. “It can infect the gums all the way down to the ligament that holds the teeth in the bone, penetrate the ligament, destroy bone, and cause tooth loss and abscesses,” Dr. Thompson says. At worst, bacteria from gum disease may get into the bloodstream and infect the heart valves, a potentially deadly complication.

People with gum disease are more likely to have high blood pressure, diabetes, rheumatoid arthritis, osteoporosis, Alzheimer’s disease, and pneumonia — although it is not proven that the gum disease actually causes these conditions.

Older adults face increased risks

Maintaining good oral health gets harder as we age. Sometimes that happens because we’ve suffered declines in other abilities. “You might have arthritis and decreased manual dexterity. That can make it difficult to brush or floss your teeth or properly care for dentures if you have them,” says Dr. Thompson.

Another challenge: age-related physical changes in the mouth. The gums start to recede, exposing more of your teeth and creating new spaces that floss doesn’t always reach. The teeth become less sensitive as the nerves inside them shrink and a secondary layer of dentin (porous material beneath the enamel) develops.

“You may not feel the same amount of pain in the tooth if there’s a problem, and it can progress before you realize it,” Dr. Thompson points out. And years of wear and tear can leave your teeth weakened or cracked and vulnerable to dental problems.

Chronic conditions also play a role in oral health. Uncontrolled diabetes can make gum disease worse. And many medications cause dry mouth. “You need saliva — which contains fluoride and electrolytes [like sodium and calcium] and moistens the mouth — to help clean and protect the teeth,” Dr. Thompson says. A lack of saliva can lead to tooth decay in as little as three months after dry mouth begins.

What you can do

By staying on top of oral hygiene, you can ward off cavities and even reverse gingivitis. But it’s going to take extra effort now. These steps can help keep your mouth — and the rest of you — healthy:

  • Brush your teeth at least twice a day and floss at least once. If you’re still not removing enough debris, Dr. Thompson recommends adding an interdental brush to your routine. “It has a little cone-shaped bristle that fits between the teeth,” she explains. “You can find it in the toothbrush aisle of any pharmacy.”
  • If you have dry mouth, ask your dentist about a prescription toothpaste or mouth rinse with fluoride to help protect against cavities. Chewing gum with xylitol may also stimulate saliva production, which can help protect against cavities.
  • If you find brushing difficult because of arthritis, try an electric toothbrush or a toothbrush with an ergonomic handle.
  • Avoid smoking, which is a risk factor for gum disease.
  • If you have dentures, be sure to brush them daily and soak them overnight in a denture cleaner.
  • Don’t skip check-ups and cleanings at your dentist’s office (at least two to four times per year, depending on your gum health).
Image: aldomurillo/Getty Images

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