Teeth in old age

That teeth fall out in old age is not a biological necessity. Teeth do not grow old and then give up; they are lost because caries or periodontitis has gone untreated for years. People who go for regular check-ups and look after their teeth very often keep them into advanced age.

What actually changes over the years is the kind of threat. Prevention therefore has to shift — not become less, but become different.

The gums recede

Over the years the gum margin recedes, partly through age, partly as a consequence of earlier inflammation, partly through brushing too hard. The teeth look longer, and the root surface is exposed.

This surface has no enamel. It is softer, more sensitive and is attacked at a higher pH than the crown of the tooth. Root caries thus becomes the typical caries of later life — it arises faster and is often noticed late, because it lies below eye level.

Less saliva

The salivary glands themselves work reliably in old age too. What reduces the flow of saliva is the medication that accumulates over the years: blood pressure tablets, diuretics, antidepressants, drugs for an irritable bladder, painkillers. The effect adds up with every further preparation.

With the saliva the most important protection the body has of its own is lost — the rinsing, the neutralising of acids and the return of minerals. That is one of the main reasons why several new caries sites can arise in a short time in old age.

More margins, more niches

Crowns, bridges, implants and partial dentures bring with them transitions where plaque finds a hold. Beneath a crown the tooth can develop caries without it hurting, because the nerve reports more faintly. The clasp teeth of a partial denture carry an additional load and are statistically the teeth that are lost next.

The hands become less dexterous

Arthrosis in the fingers, declining strength, trembling, limited shoulder mobility, poorer eyesight — all of this has a direct effect on oral hygiene, and it is rarely mentioned, because it does not look like a dental problem.

Yet a great deal can be solved precisely here:

• An electric toothbrush takes over the movement and has a thicker handle.
• Manual toothbrushes can be thickened with a foam grip or a bicycle grip.
• Interdental brushes with a long handle reach the back teeth better than dental floss, which demands both hands and fine motor skills.
• A mirror with good light in the bathroom helps more than one would expect.

What follows from this

• Shorter intervals between check-ups and cleanings, not longer ones.
• Fluoride in a higher concentration: a gel once a week, and where the risk is high a highly concentrated toothpaste on prescription.
• Clean the tooth necks specifically — that is where most of it arises.
• Soft brush, little pressure: on exposed tooth necks, pressure quickly does damage.
• Clean dentures mechanically every day and have the fit checked regularly.
• Raise the subject of a dry mouth instead of putting up with it.