It is important for the aging population to pay attention to certain scenarios that may present in the oral environment with age.  The saying, “He’s a bit long in the tooth,” originates from the fact that gum recession over time tends to expose more and more of the root surfaces of one’s teeth.  Often associated with this root exposure is increased sensitivity to cold and hot liquids and air brought in through the mouth.  A simple solution to this problem is to have your dentist bond a desensitizing agent to the tooth or to place a filling on the exposed surface.  These treatments are incredibly effective at eliminating tooth sensitivity both painlessly and immediately.  Patients are thus free to enjoy ice cream, coffee and cold beverages that same day.

            Exposed roots are also more predisposed to cavities, or “root caries” as we call them.  This is because the tooth structure below the gum line consists of a softer mineral than the more resistant enamel on the outer portion of a tooth.  Routine cleanings and check-ups, sometimes with even greater regularity than the typical six-month recall, can serve to head off at the pass any cavities that may otherwise run amuck.

            Decreased salivary flow can result with age as well.  Our saliva contains a buffer against the acids that result when foods breakdown in our mouths.  The absence of this saliva leaves our teeth more susceptible to tooth decay.   Certain medications can interfere with normal salivary production as well.   A dentist may elect to counteract this decreased salivary flow with other medications.  The best defense against the harmful effects of low salivary flow is the same as that for most age-related dental challenges: immaculate oral hygiene and regular visits to the dentist!

            Despite the popular thinking that sugar is the enemy in soda, the key ingredient responsible for the majority of tooth destruction is the acid in these drinks.  This fact supports the line of reasoning that diet soft drinks can be just as harmful to the oral environment as sugar-laden beverages.  The introduction of energy drinks to the market and the overwhelming number of teens enjoying them have led to the increased incidence of decay in this demographic. 

            Adults would be wise to follow the same advice and limit the intake of these beverages.  Diligent oral hygiene practice and rinsing with water after drinking soda or energy drinks can help to reduce potential damage to tooth structure.  As always, be sure to maintain regular dental check-ups for diagnosis and cleaning.  These things all assist in the relegation of the dental drill to the mouths of other people, a principle desired by the overwhelming majority of my patient population!

                The particular material used to fill the tooth plays a role in the equation as well.  Though dental amalgam, or silver fillings, has been used for over 200 years and is still backed by the American Dental Association, I have not placed an amalgam filling in over a decade.  This material is currently banned in many European countries and the packaging in which it comes outlines various health risks that may be associated with the mercury it contains.  My concern about dental amalgam is more related to the cracks that it tends to place in teeth.  When mercury expands and contracts with thermal changes, similar to what happens with a thermometer, craze lines and cracks can develop in teeth.  The larger the filling and the more stress a patient puts on the teeth, the higher incidence of cracked tooth syndrome we see.  This syndrome necessitates a crown and at times root canal therapy, and is characterized by biting pain and cold sensitivity.

                Another factor contributing to a filling’s longevity is the dentist’s ability to meticulously apply the attention to detail necessary when placing the fillings.  Varying materials demand different protocol which must be followed precisely in order to extend the lifespan of a filling. The tooth-colored materials are particularly technique sensitive.

                An obvious contributor to early breakdown of any dental restoration is poor oral hygiene and heavy forces placed on these restorations, mainly in the form of clenching or grinding.  Though the majority of adults grind their teeth at night, most people are completely unaware of it.  It is very obvious to a dentist when a patient grinds, however.  A night guard made at the dentist can be a highly effective, inexpensive and conservative solution to this problem.  Ask the dentist if a night guard is right for you and help extend the life of your dental work.

WebMD outlines the following signs and symptoms of oral cancer which should be investigated further by your dentist or doctor: 

Unexplained bleeding in the mouth,

Persistent sores in the mouth that bleed easily and do not heal within two weeks,

Velvety white, red or speckled patches in the mouth,

Swelling, bumps and rough spots in the mouth or on the lips,

Unexplained numbness or discomfort in any part of the mouth,

Difficulty chewing, swallowing, talking or moving the jaw or tongue,

Soreness or feeling like something is caught in the back of your throat,

Dramatic weight loss,

Change in the way your teeth or dentures fit together.

Some of these symptoms have other more common causes like decay and gum disease.  Regular checkups with a dentist can help recognize unusual symptoms which may indicate oral cancer.  As with any cancer, early diagnosis and treatment is best.

The following sources contain more information on common signs and symptoms of oral cancer.

http://www.webmd.com/oral-health/guide/oral-cancer

http://www.ohancaw.com/hanca-education/

http://www.oralcancerfoundation.org/facts/

http://www.livestrong.com/article/10332-spot-signs-oral-cancer/

     When tooth decay is not leading to tooth sensitivity, gum recession is often the cause of the problem.  The gums cover the roots of teeth like a protective blanket, but when gums recede the underlying roots may be exposed.  The three most common causes of gum recession are brushing teeth too hard, poor dental hygiene and the aging process.  It has been estimated that over half of people brush their teeth with too much pressure which can remove significant gum tissue, thereby exposing the tooth roots.  We recommend using a soft bristled toothbrush and brushing gently at the gum line.

      If gum recession is due to brushing too hard, a small amount of the same material used in tooth colored fillings can be placed to fill in areas where the gum has receded.  These bonding agents close the pores of the tooth root.  This simple treatment effectively eliminates sensitivity to cold or hot liquids immediately, pain-free and without the need for anesthetic or the dental drill.  If you have been plagued by tooth sensitivity with no underlying decay issues, this simple bonding procedure may end your discomfort.

     Poor oral hygiene can lead to plaque build-up around teeth and gums.  Over time this plaque hardens into tartar.  Bacteria in this tartar is responsible for gingivitis and periodontal disease that causes gum recession.  The exposed roots contain small pores which lead directly to the nerve of the tooth.  Pain, pressure and cold stimuli can travel down the pores and trigger pain in the tooth nerve.  Often this pain makes it uncomfortable to brush or floss this area of the mouth which can exarcerbate the problem.  When oral hygiene is the cause of sensitivity, a person may need a more frequent schedule of thorough cleanings and periodontal health check-ups.  Often this can relieve pain and sensitivity that have caused problems for years.

1.  Eliminate tobacco use.

2.  Limit your intake of coffee, tea and soda.  It is common for people to sip these beverages throughout their entire day exposing teeth to these stain causing agents for hours at a time.  A better practice is to drink one or two servings and then brush afterwards rather than exposing your teeth to these beverages throughout the day.  Cold liquids can be sipped through a straw to better protect teeth’s exposure.

3.  Brush after eating dark berries, soy sauce and curry.  Dark berries like blueberries are wonderful for your overall health so I would not advise eliminating these foods. 

4.  Limit your intake of wine.  Red wine is a known culprit of teeth staining, but recent studies have shown that white wine can also effect tooth color by wearing down the enamel.

5.  Brush your teeth after every meal and after consuming stain causing foods.

6.  Floss your teeth daily.  Teeth can display a great deal of staining at their edges where teeth meet.  This is due to a build-up of plaque that can be avoided by flossing between teeth.

7.  Have your teeth professionally cleaned at least twice a year.

8.  If you are concerned about the color of your teeth, talk to your dentist about safe and effective teeth whitening options.

Acidic drinks like fruit juice and soda, even diet soda, can also cause problems.  Many of my patients assume that diet soda will not harm their teeth because it is sugar free, but the acidic nature of it can cause damage.  I recommend keeping these drinks to a minimum, but if you are a serious soda addict who can’t kick the habit, try using a straw to help the liquid bypass the teeth more effectively.  A recent study in the Journal of Periodontology, demonstrated that green tea may have a beneficial effect on teeth and gums. 

Another sometimes surprising problem is tooth decay in children’s front teeth when a sippy cup is used for a prolonged time, especially when the child drinks a considerable amount of juice or sugary substances.  With the design of a sippy cup, children often purse their lips around the cup but do not open their teeth around it.  This can cause the front teeth to be directly exposed to the acids in the juice on a regular basis.  Some sippy cups are being designed with straws now which causes children to open their teeth to take a sip.  As an aside, open cups or cups with straws are better for speech development in young children as well. 

Young children often have more snacks throughout their day as their bodies require this frequent refueling.  Frequent snacking can set teeth up for constant exposure to decay causing substances.   While brushing teeth each time a snack is eaten may not be a reasonable expectation, drinking or swishing water in the mouth to dislodge and remove decay causing substances is a good habit to establish for children and adults.