At birth, though it takes a bit of time for them to put in an appearance, we are gifted with 32 pearly whites.

It’s up to us to keep them in good working order. If we don’t, in later life we risk getting oral diseases that cause mouth, jaw and face pain and tooth loss that can impair speech, food intake, and self-esteem.

Lately, the evidence has been growing that poor oral health plays a major role in poor overall health, too.

In a recent presentation to the Senate Committee on Aging, Surgeon General Richard Carmona said that the development and progress of many of the body’s diseases is strongly associated with the amount of plaque-causing bacteria a person has in his/her mouth and/or the severity of his or her gum inflammation. Both problems, he said, show links to major health problems that affect seniors, including diabetes, heart disease, stroke, and respiratory pneumonia. He also noted that there was a strong link between a person’s oral health and the robustness of his or her immune system. Government scientists are also investigating what many see as a link between hormonal changes and the increased incidence of gum disease and tooth loss in post-menopausal women.

The big four

In general, says Dr. Marsha Pyle, DDS, the director of the training center for geriatric oral health at Case Dental School, as we age we face four oral health problems:

Out-of-control plaque build-up Oral plaque is a gummy and corrosive mix of bacteria, food particles, and protein molecules found in saliva. "The more [plaque] you have, the worse your total oral health," says Dr. Pyle.

Dry mouth (xerostomia) Caused by decreased output from the salivary glands—which also produce antimicrobial agents that prevent plaque from forming—dry mouth often comes with aging. "But," says Dr. Pyle, "there are about 400 medications—for everything from depression to high blood pressure to Parkinson’s Disease—that can cause it or make it worse."

Receding and inflamed gums When gums are inflamed, routine brushing or flossing may create skin breaks that allow oral bacteria to enter the bloodstream and cause problems; when they recede, they expose teeth roots and cause cavities. "These are the same kinds [of cavities] that develop on a biting surface but they advance faster and are more destructive, and they can also be more difficult to deal with," says Dr. Pyle.

Problems doing routine mouth care This is usually due to a combination of the above-cited factors and a decline in function due to a chronic disease, such as arthritis.

Geriatric dentists are the ones who can put all the pieces of the dental care puzzle together for the elderly, says Dr. Pyle. "There is a lot of variability in that population," she says, "so geriatric dentists are trained to look at patients on a highly individual basis—at their medical history, their medications, their functional status—and make their dental care appropriate for their special needs."

Prevention is key

Whether a person is 25 or 65, prevention is the best weapon in the battle for oral health, says Dr. Pyle.

Regular check-ups are a given. "If you catch something when it’s a small problem it’s a lot easier, and often less costly, to remedy than later on," says Dr. Pyle.

So are flossing and brushing, with a hand-held or electronic soft-bristle toothbrush.

So is using products—toothpastes and mouthwashes—with fluoride. "They are proven effective in strengthening tooth enamel and increasing resistance to development of gum-line cavities," says Dr. Pyle.

So is using products, such prescription-based chlorhexidine-gluconate-based rinses that help reduce plaque-causing bacteria in the mouth.

So is chewing gum to stimulate the salivary glands. "The best gums," says Dr. Pyle, "are made with xylitol."

And so is giving up smoking. Tobacco, says Surgeon General Carmona, "is responsible for half the cases of periodontal disease in the United States."

For more information on senior oral health, check out the following Internet sites:

Diet and Oral Health (American Dental Association)
www.ada.org/public/topics/diet_faq.cfm

Mouth and Teeth (National Library of Medicine) www.nlm.nih.gov/medlineplus/mouthandteeth.html

Oral Changes with Age (American Dental Association)
www.ada.org/public/topics/oral_changes_faq.cfm

Oral Health for Older Americans (Centers for Disease Control)
www.cdc.gov/OralHealth/factsheets/adult-older.htm

Taking Care of Your Teeth and Mouth (National Institute on Aging)
www.niapublications.org/engagepages/teeth.cfm