Comprehensive Dental Hygiene

“60" is the new "40”

Americans 65+ have increased by 183% in the last 50 years!  By the year 2030 this number will double!  This has created a “Sandwich Generation” in which people are caring for their elderly parents and their children at the same time.

For people 60-65 years old before retirement and/or in the early stage of retirement, dental needs are completely predictable.  However, in general, health care providers are not as aware of the true benefits of oral health and yet see the increase of good health and well-being that a healthy mouth brings, including increased lifespan.  How?  Gum disease greatly increases the risk of heart attack and stroke because the bacteria in the plaque on teeth releases toxins into the bloodstream, and toxins inflame the arteries causing small blood clots.

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Understanding the Importance of Dental Hygiene

Our aging dental population presents today’s dentists and hygienists with unique and often challenging dentistry, in some cases “heroic”.  It is important to understand that the oral cavity is a reflection of total body health.

1.  PREVENTION:  The aging population has not had the benefit of fluoride or the increased understanding of the causes of decay and gum problems.  They often present with more decay, more dental work and increased periodontal disease.  Patients who have had dentistry will always need dentistry!

2.  MEDICATIONS:  Unfortunately, medications sometimes have a serious impact on oral health:  e.g. those prescribed for depression and Parkinson’s disease which directly affect the salivary gland center of the brain, as well as diuretics and even seasonal allergy and asthma medications.  Xerostomia (“dry mouth”) causes increased tissue irritation and decay.  People with “dry mouth” should be cautioned not to suck on hard candies, cough drops or mints, but instead drink plenty of water.  Beware of “sport drinks” which can be high in sugars and citric acid as well as “gourmet coffees”, and of course, sodas (even diet soda can have acidity factors).  The best treatments for “dry mouth” are water / Biotene / Oasis products or gum chewing.  Recent evidence shows that gum chewing for about 20 minutes following a meal neutralizes acids, dislodges food particles, and ultimately decreases decay.  One “X” Factor is Xylitol, the artificial sweetener in Trident, which has been shown to actually work in preventing decay.  Another potential problem is tissue overgrowth which can be caused by calcium channel blockers and chemotherapy.

3.  GUM RECESSION / ROOT DECAY / SENSITIVITY:  As gums recede, naturally as we age or accelerated due to overzealous tooth brushing or disease, there is an increased risk of root decay know as gum line cavities.  The root has no enamel protection so there is an increased risk of decay which can be very challenging to arrest.  All three of these problems are best treated with fluorides that seal the root surfaces.  Note:  Flourides have been linked to irritation of rosacea skin problems.

4.  MEDICAL CONDITIONS – the “head and body connection”:  Dentists and Hygienists must have a thorough awareness of the patient’s medical condition which may alter the course of treatment.

  • Patient’s medical condition must be coordinated with dental treatment regimen:  i.e. Parkinson’s and diabetes sufferers may need to eat and time to allow medication to kick in; arthritis patients are stiffer in the morning; diuretics patients need a break during their appointment; patients with curvature of the spine problems need to alter their chair position or use a pillow; the gag reflex can be more sensitive for some patients in the morning or afternoon.

  • Patients taking blood thinners require attention to clotting time to know when to stop and when to watch: i.e. Coumadin (Warfarin) 3 days, Plavix 5 days, aspirin 7 days.

  • Patients with joint and heart valve replacements require antibiotic pre-medication one hour before their visit for a minimum of two years, perhaps for a lifetime.

  • Patients with diabetes, controlled or uncontrolled, oral or insulin-dependent, have increased risk of infection and delayed or poor wound healing.

  • Osteoporosis – 35% of post-menopausal women have some level of osteoporosis.  Bone loss is a common thread in periodontal disease and osteoporosis, and there is evidence to indicate an association between the two.  Note:  Foxamax/Aridia have been related to osteomyelitis.

  • Cancer patients (chemotherapy and/or radiation) have a decreased immune system and decreased saliva leading to an increase in decay which may require increased fluoride treatment.  Oral cancer screenings are performed at exam and hygiene appointments.

  • GERD or acid reflux results in demineralization of enamel similar to etching the surface with acid resulting in erosion or decay at the gum line.

  • Snoring or sleep apnea appliances are available for treatment.

  • High blood pressure or cardiovascular – limit stress and epinephrine.  The incidence of heart disease is two times higher in patients with periodontal disease.

  • Nutrition – Eat whole foods.  Limit snacks.  Increase calcium and vitamin C.

  • Angular chelitis refers to the irritation at the corners of the mouth due to decreased muscle tone – saliva puddles in the creases and allows for a fungal-like infection which can be treated with Nystatin cream.

  • Crackled tooth syndrome can result from over-treatment or “tired teeth”.  As age increases, brittleness due to loss of calcium increases to cracks.

  • Physical limitations as with strokes, arthritis, fatigue, poor vision and hearing, limit self-care in old age.  Good homecare is vital to a healthy mouth and even the finest professional care will ultimately fail without it.  Homecare needs to be tailored to meet the needs of the individual patient.  Power brushes, waterpiks, Quad Grips, floss alternatives and magnifying mirrors may be helpful.

  • Cognitive impairment.  It should be kept in mind that the elderly have altered pain threshold changes especially patients with dementia, Altzeimer’s, etc.

  • Nursing home.  Because the “Baby Boomer” is a strong consumer of dental services and has the advantage of advanced dental treatment, they have more teeth saved and fewer dentures – more natural teeth.  The financial means of an individual will affect the amount of dental care a nursing home resident will receive.

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GOOD NEWS

The GOOD NEWS here in Hot Springs Village is that these challenges that the aging patient often faces are offset by the fact that our seniors are better educated, healthier, and have had more health care than any generation preceding them. 

1.  PROACTIVE – partnership with dental professionals to find solutions and follow through with good regular maintenance.  The “best patients on the planet”!

2.  BETTER DENTAL IQ – Increased education results in less fear, phobias, and emergency treatments.

3.  SOCIOECONOMIC FACTORS – Better overall financial support or affluence, and some insurance now or in the past, means that usually treatment is not decided on by dollars alone.

4.  DECLINING HEALTH ISSUES – Our seniors are healthier and more physically active than average.  There is a decrease in joint replacements due to interceptive treatments and few cardiovascular events due to increased exercise, and use of stents before bypass is imminent.