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                                                        DR. DAN PETERSON

                                                                      1415 SAGE STREET ~ GERING, NEBRASKA 69341 
                                                             
      Call: 308-436-3491       www.dentalgentlecare.com           

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OLDER ADULT'S DENTAL NEEDS

 Good dental health helps you live a healthier life

     "You are never to old to take good care of your gums and teeth."  

Oral-facial tissues "represent the very essence of our humanity.  They allow us to speak and smile; sigh and kiss; smell, taste, touch, chew and swallow; cry out in pain; and convey a world of feelings and emotions through facial expressions".*

     Some areas of your dental health will need to be monitored more often than at other stages of life.  

    The aging process can often create subtle and/or dramatic changes in the condition of teeth, mouth and gums:
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Plaque accumulates more as we get older and it can become more difficult to remove tartar and calculus from our teeth, this is why it becomes even more important to schedule professional cleanings more than twice a year. 

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Teeth may also darken in color due to changes in dentin that is under the tooth enamel. There are new products and procedures that can restore your teeth to a more attractive appearance.

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Gum tissue around the teeth may begin to recede which exposes tooth roots making them vulnerable to decay.  Fluoridated toothpastes and mouth rinses can help strengthen tooth enamel and reduce decay especially on these exposed root surfaces. 

Root Caries are cavities on the root surface of the tooth usually at the gum line
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Older fillings may weaken and/or crack allowing bacteria to accumulate around the edges of these fillings to cause cavities.  Many people over 50 have decay on both their teeth and root surfaces. Now you have a choice of what type of fillings material you would like to use to replace these old fillings.

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Dry mouth, occurs when there  is not enough saliva to lubricate and moisten the mouth to wash away the acids produced by plaque.  This condition will cause tooth damage from decay. Drinking lots of water, avoiding sweets, tobacco, alcohol and caffeine can help you deal with a dry mouth.

Dental caries rate in older adults have increased 31 % in the last 10 years!

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Gingivitis is caused by bacteria found in plaque that attack the gums making them red, swollen and bleed when you brush. If you have any of these symptoms see us immediately.  Gingivitis can lead to gum disease if left uncared for. In fact three out of every  four adults over the age of 35 have some sort of gum disease! 

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In gum disease, if the infection becomes more severe your gums will begin to recede and pull away from your teeth. The b  will weaken and dissolve the bone that holds your teeth in place leading to tooth loss, especially if you have osteoporosis. Treatment for gum disease can reduce recession, bleeding and some treatments can even strengthen the bones to hold your teeth in place.

Surgeon General's Report states: 23% of older adults aged 65-74 have severe periodontal disease with men being more likely to have more severe disease!

 
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Poorly fitted dentures, illness, medications, poor nutrition, and poor oral hygiene can increase the severity of gum disease to create chewing problems and pain in your jaws. By treating gum disease and replacing decayed teeth you can maintain chewing and biting surfaces so you can chew and eat with comfort and ease. 

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Oral cancer occurs most often in people over 40.  If you notice any red or white patches on your gums or tongue or observe sores that fail to heal within two weeks please notify us.  This disease is often painless and difficult to diagnosis in its early stages.  It is especially important see us at least yearly if you wear dentures so an oral exam of the gum tissue can be completed. Early signs of adverse drug reactions, diabetes and/or oral cancer can be detected during a regular dental exam.

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Bruxism-brushing to hard which causes wear and tooth damage. Excessive brushing could particularly be a problem for the elderly. As people age, their gums recede, exposing the tooth's root surface, hence the saying that someone is ``long in the tooth''. The newly exposed teeth's surface, called dentine, is softer than the tooth's normally exposed enamel surface. Brushing too hard and for too long can cause wear patterns on the teeth and injury the gums. Two minutes is a good marker for correct brushing time, but he insisted that it was also important to clean between the teeth by flossing.

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If you find it difficult to brush and floss please inform us so we can make an individualized oral hygiene plan for you.  You may find a light weight electric toothbrush and automatic flosser can help you maintain good oral care.  You may also want to try strapping the toothbrush onto a larger object, such as a ball if you have arthritis to make the brush more comfortable to handle.  

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Cavities at the gum line-try  Prevident 5000 Plus or Gel-Kam or another fluoride toothpaste; fluoride varnish such as Cavishield or duraphat.
Root Caries Prevention Advances

An article in a special supplement to the journal Caries Research reviews the effects of dentifrices with high fluoride contents on the management of root caries. Primary root caries lesions  which are a widespread and often serious problem in older populations, can be difficult to restore. It is generally accepted that fluoride ions promote remineralization of tooth substances and reduce the rate of demineralization. The use of a dentifrice with a high fluoride content may be considered to reverse this condition since more fluoride is required for the remineralization of roots than for enamel.

Woman Dentist Journal April, 2005; 3(4) Author(s) :   Margaret Scarlett  Lynch E, Baysan A. Reversal of primary root caries using a dentifrice with a high fluoride content. Caries Res 2001; 35[Suppl 1]:60-64) ]

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       Early treatment of cavities and gum disease can reduce to need for more extensive and expensive treatments later because early problems were left untreated.

     Remember there is a mouth-body connection.  Your medical condition can have an impact on how you receive dental care.  

     If you have high blood pressure you will need to have your blood pressure monitored.  If you have certain types of heart conditions or joint replacements you may be required to be premedicated before "work" is done.  

How certain medical conditions are now dealt with is very different than how they were handled five or ten years ago.

    The treatments plans that are presented to you are based on your dental needs to restore your teeth to optimum health to enable you to enjoy not only a beautiful smile but also good health.

     A good way to achieve and maintain good oral health is to see us every six months for your recare appointments. 

     Remember  a dentist can often diagnose certain medical problems before they are identified by your doctor. 

 We are here to help you reach and achieve your goal of optimum oral health at every age.

Untreated oral diseases and conditions can have a significant impact on quality of life.

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Updates

AARP has a message board on Dental Decay :

http://community.aarp.org/n/pfx/forum.aspx?msg=7260.1&nav=messages&webtag=rp-health&redirCnt=1Medication Compliance in the Older Adult Patient

AARP Focuses on Access to Dental Care

The September 2006 AARP Bulletin cover story 'Nothing to Smile About' focuses on access to dental care or the lack of it. Dental disease has been called a silent epidemic especially among older people and children who lack insurance or the ability to pay for care.
bulletAn estimated 108 million have no dental insurance more than twice those without health insurance.
bulletAbout three-quarters of people 65 and older are not in dental plans.
bulletIn the 1950s less than half of adults 65 and older kept their teeth, compared with 70% today.

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Self-report questionnaires were distributed randomly to older adults, with the median age range of 76 to 84,
 Of the 115 surveys distributed.Among the respondents, 93% reported taking prescription medication,
63% reported taking over-the-counter drugs, and 23% reported taking herbal medications. Twenty-nine percent took four to six medications daily, and 21 % took more than seven medications daily. Nearly one quarter of the respondents surveyed reported that they had missed a dose, while 15% stated that they had stopped taking medication before their prescription was completed. Similarly, 14% responded that they had forgotten to fill or refill a prescription, while 13% stated they had taken less medication than prescribed. Of significance to oral health practitioners, 35% of respondents indicated that their dentists did not ask them when they last took their medications. (at our office we update your medication list at EACH visit

Medication Compliance in the Older Adult Patient Author(s): Adele Spencer RDH, MS ; Maureen Tsokris RDH, MS Source: Journal of Dental Hygiene      2006;80(1):31

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Online Information Relevant to Treating Older Patients

The dental management and how certain medical conditions and therapies can affect oral health:

bullet Antibiotic prophylaxis
bullet Bisphosphonate therapy and osteonecrosis of the jaw
bullet Diabetes
bullet FDA safety alerts
bullet Help your patients quit smoking
bullet Hypertension (JADA) Link opens in separate window. Pop-up Blocker may need to be disabled.
bullet Periodontal disease
bullet Prescription of dental radiographs
bullet Xerostomia (JADA) Link opens in separate window. Pop-up Blocker may need to be disabled.

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Does Tooth Loss Affect Dietary Intake?

Since the primary function of teeth is mastication, tooth loss can reduce chewing ability that leads to detrimental changes in food selection. This, in turn, may increase the risk of particular systemic diseases since diet and certain health states, such as cardiovascular health, are linked. For example, an increase in dietary cholesterol and saturated fat, and a decrease in fiber have been shown to elevate the risk of heart disease. Since a large portion of the population has missing teeth, the effect on health risks due to tooth loss may have a significant impact.

In what is, no doubt, one of the largest studies investigating a relationship between tooth loss and diet, data were collected on dental status, and food and nutrient intake from over 49,000 male professionals.  After adjusting for age, smoking, exercise and profession, it was found that intake of vegetables, dietary fiber , crude fiber, and carotene was significantly lower, while intake of total calories,cholesterol  and fat  was significantly higher  in edentulous participants compared to participants with 25 teeth or more.

In a follow-up study with the same cohort of professional men, longitudinal analyses between tooth loss and consumption of specific foods and nutrients were performed. It was found that over an eight-year period, participants without any tooth loss had greater reductions in daily intake of saturated fat, cholesterol and vitamin B12, and greater increases in daily intake of fiber, carotene andfruits compared to participants with tooth loss. In addition,subjects who lost five or more teeth were significantly more likely to stop eating apples, pears and carrots compared tosubjects who lost four teeth or less. These studies provide the best evidence to date for an association between tooth loss and a change in food intake, and suggest that it is advisable to incorporate dietary evaluation and nutrition recommendations into dental visits for patients with tooth loss to avoid the health risks of a poor diet.


References

1. Hung HC, Willett W, Ascherio A, Rosner BA, Rimm E, Joshipura KJ. Tooth loss and dietary intake. JADA 2003;134(9):1185-1192.

2. Joshipura KJ, Willett WC, Douglass CW. The impact of edentulousness on food and nutrient intake. JADA 1996;127(4):459-467.

3. Willett WC. Diet and health: What should we eat? Science 1994;264 (5158):532-537.

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Dental caries experience in older people over time.

 The only caries risk factor common to all four studies was the wearing of a partial denture (for root surface caries only). Conclusions Older people are a caries-active group, experiencing new disease at a rate which is at least as great as that of adolescents. Dentate older people should be the target of intensive monitoring and preventive efforts at both the clinical practice and public health levels. There is no easily identifiable 'magic bullet' for preventing caries in that age group, but the use of evidence-based preventive interventions (such as fluoride) should suffice.

Dental caries experience in older people over time: what can the large cohort studies tell us? W. M. Thomson British Dental Journal (2004); 196, 8992

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Oral Cavity Changes

The majority of the elderly suffer bone loss and disease in the tissues around the teeth, as they grow older. As a result:

bullet50 percent of the population over 60 have lost all of their teeth
bulletabout 65 percent have lost all teeth in at least one arch. 

Older people hence tend to choose foods that are easy to chew, leading to reduced consumption of fresh fruits and vegetables high in dietary fiber. Some elderly people may wear ill fitting dentures making chewing difficult.

Compliments Webdietitian

Food Guide Over 70
Nutrition & Aging
Nutrition Resources

Only 15% of the elderly have any type of dental coverage!

*JADA, Vol. 131, December 2000.

February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
                                                                                 308-436-3491 Office number

PLEASE NOTE: The information contained herein is intended for educational purposes only.  It is not intended and should not be construed as the delivery of dental/medical care and is not a substitute for personal hands on dental/medical attention, diagnosis or treatment.  Persons requiring diagnosis, treatment, or with specific questions are urged to contact your family dental/health care provider for appropriate care.
This site is privately and personally sponsored, funded and supported by Dr. Peterson.  We have no outside funding.
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