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Nasser Antonious, DDS, MAGD, FICOI
Master of the Academy of General Dentistry
Fellow of the International Congress of Oral Implantologists

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Geriatric dentistry


Keeping a Healthy Mouth: Tips for Older Adults

As we get older, we all notice the effects of aging — wrinkles, graying hair and a variety of aches and pains that we didn't have before. Our mouth also is affected by advancing age, undergoing both subtle and sometimes pronounced changes. Understanding these changes, and what can be done about them, is important to maintaining good oral health.

Your Changing Mouth

Every Tooth Counts

Preventing Dental Problems

The Importance of Dental Visits

Getting a Grip on Your Toothbrush and Floss
Things to Remember...


 Your Changing Mouth

Why do my teeth seem darker?
One of the changes you may notice as you grow older is that it's harder to keep your teeth clean and white. This is because the sticky, colorless layer of bacteria, called plaque, can build up faster and in greater amounts as we age. Changes in dentin, the bone-like tissue that is under your enamel, may also cause your teeth to appear slightly darker.
Why does my mouth feel dry?
Reduced saliva flow that results in a dry mouth is a common problem among older adults. It is caused by certain medical disorders and is often a side effect of medications such as antihistamines, decongestants, pain killers and diuretics. Some of the common problems associated with dry mouth include a constant sore throat, burning sensation, problems speaking, difficulty swallowing, hoarseness or dry nasal passages. Left untreated, dry mouth can damage your teeth. Without adequate saliva to lubricate your mouth, wash away food, and neutralize the acids produced by plaque, extensive cavities can form.
Your dentist can recommend various methods to restore moisture. Sugar-free candy or gum stimulates saliva flow, and moisture can be replaced by using artificial saliva and oral rinses. 

 Why am I losing my sense of taste?
You may find that you are losing your appetite due to a change in your sense of taste. Several factors can cause this change. Besides an age-related decrease in the sense of taste and smell, certain diseases, medications and dentures can contribute to a decrease in your sense of taste.

 Aren't cavities just kid's stuff?
No. Changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. The majority of people over age 50 have tooth-root decay.
Decay around the edges, or margins, of fillings is also common to older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.

How can I fill the gap?
A bridge — a device used to replace missing teeth — attaches artificial teeth to adjacent natural teeth, called abutment teeth. Bridges can be applied either permanently (fixed bridges), or they can be removable.
Fixed bridges are applied by either placing crowns on the abutment teeth — to provide support for artificial teeth — or by bonding the artificial teeth directly to the abutment teeth. Removable bridges are attached to the teeth by either metal clasps or by precision attachments.

What about dentures?
When most or all of your teeth have been lost, dentures can restore your eating and speaking ability, as well as improve your appearance. Today's dentures are much more effective and cosmetically appealing than they were in the past. A fitting for dentures can take place immediately after your natural teeth are removed or after the extraction sites have healed. Full dentures replace all of the natural teeth, and partial dentures replace only some of the natural teeth.

 Are there other options?
An increasingly successful option to dentures and bridges is dental implants. Instead of attaching artificial teeth to existing teeth, as bridges do, implants attach directly to the jaw bone or under the gum tissues. Because implants attach so securely, they look and feel natural, and offer better chewing ability. Candidates for implants must be in good health and have enough bone with which to secure the implant. Your dentist can let you know if implants are an option for you.

 Preventing Dental Problems
Every time you eat food containing sugars and starches, the bacteria in plaque produce acids which attack your tooth enamel for 20 minutes or more. After repeated acid attacks, the tooth enamel begins to break down and a cavity forms. By limiting the number of times you snack and choosing nutritious foods from the five main food groups (vegetables; fruits; dairy; breads/cereals/grains; meat/poultry/fish), you can help save your teeth from decay. A balanced diet, plus brushing and cleaning between your teeth, can keep your mouth healthier.

Choosing Oral Care Products
Even savvy shoppers can be baffled by the seemingly endless variety of dental care products. Choose products recommended by your dentist. Toothpaste, manual and electric toothbrushes, floss and other interdental cleaning aids, mouthrinses and oral irrigators.

Brushing tips
Thorough brushing twice a day, and cleaning between the teeth daily with floss or other interdental cleaners, remove plaque. Keep these tips in mind when brushing your teeth. Use a soft-bristled toothbrush. Place the brush at a 45-degree angle to the teeth and use a gentle tooth-wide, back-and-forth motion. Remember to clean the inside teeth surfaces where plaque deposits are heavy, and clean the back teeth and tongue. Replace your brush when the bristles become frayed or worn — about every three to four months. 

Cleaning between teeth
Floss and other interdental cleaners remove plaque from between the teeth and under the gumline, areas where the toothbrush can't reach. If you haven't been in the habit, it's never too late to start.
When flossing, keep in mind these tips. Gently ease the floss between the teeth and gumline, never snap it. Form a "c" against the sides of both teeth and gently rub the floss up and down the tooth, moving it from under the gumline to the top of the tooth. Establish a regular pattern of flossing and remember to floss the backside of the last teeth. It's especially important for bridge wearers to floss around the abutment teeth. These teeth must remain healthy if the bridge is to function properly.
If you use interdental cleaners, ask your dentist how to use them properly, to avoid injuring your gums.

The importance of fluoride
Recent studies show that fluoride is just as effective in preventing cavities in adults as it is in children. You should use fluoride toothpaste. Fluoride mouthrinses provide additional benefits and can reduce decay even more than brushing and flossing alone. The American Dental Association recommends that adults use a fluoride mouthrinse daily.  

 Denture care and maintenance
Cleaning your dentures daily helps remove stains and plaque that build up and irritate your gums. First, rinse your dentures. Then, use a soft-bristled denture brush and a denture-cleaning agent. Brush the denture thoroughly, but avoid damaging the plastic parts or metal clasps.
Only your dentist is qualified to diagnose your oral health condition and fit and adjust your dentures. Do-it-yourself kits and use of dental adhesives, without a dentist's advice, can result in increased irritation, bone loss and even infections. Although your dentures were made to fit precisely, they can become loose due to naturally occurring changes in your gums and bones. Your dentist should periodically check your dentures for proper fit.

The Importance of Dental Visits
Regular dental visits are important, regardless of whether or not you have your natural teeth. Checking the condition of your teeth is just one of the many functions your dentist performs.

Why isn't brushing enough?
Although daily brushing and flossing help remove plaque and early tartar formation, once tartar has hardened, it can only be removed by a dental professional. Some people form tartar faster than others and may need to have their teeth cleaned more often.
What else happens in a dental examination?
Besides finding and treating existing dental problems, your dentist also looks for signs of other health problems such as oral cancer. Many oral cancers are treatable if they are discovered early. So, alert your dentist to any sores, swellings or discolorations that you find on your tongue, lips, cheek, throat, jaw bone or salivary glands. Because the majority of oral cancers occur in people over the age of 45, regular dental checkups are important. In addition, other medical conditions often have symptoms that first appear in the mouth.

Are there other ways I can improve my smile?
Looking good continues to be important as we grow older, and a number of new cosmetic dental procedures can help you improve your smile. These new techniques are not just for younger people — many are options that can benefit you. Bleaching whitens stained teeth. Bonding is a technique that "paints" tooth-colored materials onto the tooth to cover stains, to rebuild chipped or cracked teeth and to close gaps. Veneers are tooth-colored materials that fit over the teeth much like a false fingernail. Ask your dentist what procedures would be right for you.

What about nursing home oral health?
When choosing a nursing home for an elderly person, inquire as to whether there is an onsite dental facility. Ask if there are on call dentists and whether staff is trained in oral health care and can recognize problems.

Getting a Grip on Your Toothbrush and Floss
If you have dexterity problems or a physical disability, you may find it difficult to hold onto your toothbrush or dental floss. This can be solved by using a few simple "home remedies" or devices listed below.

  • Use a wide elastic band to attach the brush to your hand.  
  • Enlarge the brush handle with a sponge, rubber ball or bicycle handle grip. Also try winding an elastic bandage or adhesive tape around the handle.
  • Lengthen the handle with a piece of wood or plastic such as a ruler, popsicle stick or tongue depressor.
  • Tie floss into a loop for easier handling.  
  • Use an electric toothbrush or commercial floss holder.


Things to Remember...
Although our mouth goes through many changes as we age, the power to avoid dental decay and gum disease is within our grasp.
Contrary to popular belief, cavities are a common problem among older adults.
Tooth loss isn't inevitable, but if you do lose some or all of your teeth, a number of options can be used to replace them.
Be sure to tell your dentist about any illnesses you have or any medications that you are taking — including those you purchase over the counter.

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Nasser Antonious DDS is licensed as a general dentist in California. Sunnyvale Dental Care established since 1995
Sunnyvale dentist, Nasser Antonious DDS welcomes new patients from all areas including Sunnyvale, Mountain View, Santa Clara, Cupertino, Campbell, San Jose, Saratoga, Los Altos, and Los Gatos
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