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WHAT ARE THE DENTAL CHANGES THAT WE FEEL WITH AGING?

The significance of AGING, in humans, is an eroding process of the body (or cells), after adulthood is reached. The causes of aging have yet to become fully known, because there are theories out there which justify aging (with the accumulate damage mutations in the DNA, for instance) that lead to an increase of failures of the organism. Other theories suggest that aging can be genetically programmed.

Aging is part of a natural process and should be regarded as a biological and unavoidable phenomenon. In Portugal, the average life expectancy until 1960 was 64 years old and in 2015 increased to 81 years. Aging leads to a series of oral changes which may seriously hinder the quality of life of the elderly.

Aging opens the door for several changes and alterations in our body. This can be attested by the lines of the face and skin, the reduction of our elastic capacity, as well as in our ability to hastily execute an activity. And our mouth will not be spared by the aging process and the risk of gingival diseases, tooth decay and tooth loss increases.

In aesthetic dentistry, we need to consider not only the intent of patients of having a younger appearance, but the effects of aging should also be considered in the aesthetic assessment. The effects of aging are manifested not only in the teeth and periodontal tissues, but also on the lips and the surrounding tissues. The tone of muscles around the mouth will decrease with aging, and these variations keep changing the aesthetics.

The upper lip, with aging, becomes longer, loosened, and so the exposition of upper teeth decreases during the speech. The ratios of dental exposure through the upper and lower lips will vary with age, in other words, the exposure of the upper teeth decreases and the lower teeth increases.

The expectation of patients to keep a younger appearance is what takes them to seek aesthetic dental treatments and so they “lift” their smile.

DENTAL WEAR

Teeth are incredibly strong but not indestructible. A life that is spent chewing leads to wear of the outer layer of enamel and flats the cusps of the teeth.

Tooth surfaces are also affected by the exposure to acidic foods, such as citrus and carbonated drinks, which dissolve the protective enamel. The enamel worn can set the stage for more serious dental problems. A crack or break in the outer surface of the tooth makes it more susceptible to irritation and inflammation and may lead, in the most extreme situation, to tooth loss.

MEDS, DRY MOUTH AND TOOTH DECAY

Many people believe that cavities only affect younger people. The presence of cavities in older adults may not be directly related to bad habits of oral health

Often these cariogenic diseases are related to the daily consumption of meds for chronic diseases. Many of these drugs cause xerostomia (dry mouth), creating an ideal environment for bacterial proliferation responsible for cariogenic diseases. Nonetheless, the problems of a dry mouth also result in changes in salivary glands and salivary secretion, which decreases with aging, and the elderly also drink less water, which reduces the salivary production.

The lack of saliva is more than just uncomfortable, because it makes swallowing more difficult, causes bad breath and the irritation and infection of the periodontal tissues. It also increases the risk of gum disease and tooth decay.

The ways known to control xerostomia is based on an adjustment in the dose of medication or its change (under medical guidance), drink more water, and use artificial saliva. In these cases, it is recommended the placement of sealants to protect your teeth from decay.

GINGIVAL DISEASES IN AGING

Gingival diseases have a higher prevalence in older people. About 70% of the population with more than 65 years of age has, in some way, gingival diseases that can range from mild to severe. An effective treatment can reverse this situation. The most appropriate treatment will depend on the severity of the gingival disease. Some patients recover after a thorough oral hygiene, whilst others require surgical options, as gingival or bone grafts.

TOOTH LOSS

Tooth loss is generally associated with aging. Even though older people have greater loss of teeth and are more prone to have treatment with implants or dentures, there is no reason for a person to lose their teeth with aging.

One of the reasons due to which people are more prone to lose teeth as they grow older, it is because teeth become less sensitive. The pulp of the tooth (where the tooth is innervated) decreases its size, being more susceptible to cause pain due to the presence of caries or periodontal diseases. Often, these situations are only detected at a later stage, leading to tooth loss.

Fortunately, as we speak, it is much easier to avoid tooth loss, having oral hygiene habits and regular dental appointments. The solutions currently available to address tooth loss, the dental implants, are much more comfortable and natural than those in the past.

SMOKERS AND AGING

Smoking increases the possibility of someone struggling with periodontal disease and other oral health issues, such as oral cancer. Current smokers with more than 65 years of age had on average a bit more than 15 teeth, while non-smokers with more than 65 years of age have an average of 19 teeth. Near 50% of the current smokers over 65 years of age have no natural teeth.

In my personal view, the dentist should identify the best treatment plan and its most critical points, and the order according to which they are carried out, to achieve the ambitioned aesthetic results. If there is a huge gap between the clinician and the expectations and desires of patients, in terms of aesthetics, irreversible procedures may be forced on teeth and periodontal tissues, and so it is important to make decisions together, ensuring that both parts are on the same track.

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