New treatments give old teeth reasons to smile

When you're done reading this, you may want to brush and floss. Or better still, make an appointment with your dentist. That's because while most people will do all they can to keep their teeth, after age 50, there are conditions that can make that goal more challenging.

But today, at least there are more options to help better maintain what you have to avoid wearing dentures.

While more adults are able to keep their teeth longer due to advanced technology and access to dental care and early intervention work, anyone who is 50 or older is likely "a victim of pothole dentistry," says New Hyde Park dentist Howard Golan.

"The old dental practice when we were kids was to prepare the tooth for a filling by taking away a lot of the tooth structure," he says. "So a lot of older adults have more silver fillings and amalgam, causing teeth to be more likely to crack and break. And when they do, they do so catastrophically, leading to root canals, crowns and extractions."

Adding to that are specific dental conditions that tend to affect seniors, says Bellmore dentist Randy Geller. "For one, as people get older we see a reduction in oral hygiene," he says. "The older population doesn't brush as often and as efficiently in part because of a loss of dexterity in their hands."

Another common issue of aging is dry mouth, or a decrease in salivary flow, which can also be a side effect of medication. This makes it more difficult for saliva to produce the antibodies that fight bacteria.

Older teeth can decay faster
"For both reasons, an older person's teeth are more prone to decay, specifically on root surfaces. This is referred to as 'senile' cavies or cavities,'" Geller says. "Add to that a lifetime of wear and tear on the teeth, and periodontal disease [loss of gum and bone support], and we find it challenging to maintain a bright, healthier smile in the geriatric patient."

Medical conditions such as diabetes and osteoporosis can affect oral health as well, says Marion Ryan, a professor at the SUNY Stony Brook School of Dental Medicine.

After age 65, there's also an increased risk of oral cancer, says Mary R. Truhlar, chair of the Department of General Dentistry and director of the geriatric program at SUNY Stony Brook. "Most people don't realize how common it is, nor that they need to have their gums, cheeks, lips and any sores that don't heal within 10 days checked by a dentist," she says. "And they should do so even if they don't have teeth."

Treatment options have changed for many dental issues, and the goal now is to retain the patient's teeth as long as possible. Lidia M. Epel, a Rockville Centre dentist, says that not so long ago, if you hit 50 and had trouble with your teeth that couldn't be fixed with crowns, they were pulled and replaced with dentures.

"Today, the emphasis in on preservation of the teeth and the bone structure," she says. "There's an understanding that if you have an extraction, the bone recedes more and you end up in some cases having dentures pressing up against a nerve; your profile changes; your speech changes. So you want to save the teeth as long as you can."

Geller says there's one thing that hasn't changed: dentures are still a challenge for patients, particularly the lower one, which is less stable than an upper. "Dentures are 20 percent as efficient [as natural teeth] at chewing and grinding food, and therefore have lots of ramifications on health and socialization," he says.

Another traditional option for patients who have lost a tooth is a bridge. Geller says the tooth on either side of the space are used as anchors for the bridge. "But this can have a negative effect on the other teeth," he says. Today's implants, long-term replacements that are surgically placed in the bone, are the standard of care - though they're a hefty investment - and can be used in combination with a denture or bridge.

 Pros and cons of implants
Geller says, "Depending on a person's health, quality of their bone, two implants can be used to support that lower denture, which makes it 60 to 70 percent more stable than a lower denture without an implant."

Patients can have as many as six to 10 implants per arch (the upper and lower gums). But they are a substantial investment: each implant costs about $4,000, compared to a denture, which is about $1,600.

Epel says there are credit card plans, such as CareCredit, to help people finance their implants. And discounted dental services are available at the Dental Care Center at Stony Brook Medical Center, where students who perform the work are supervised by attending faculty. (Call 631-632-8989 or visit stonybrookmedicalcenter .org/dentalcarecenter)

Epel says that for those who can afford dental implants, it's often a lifestyle choice.

Geller's patient, John DiFonzo, 65, of Seaford, has half of his own teeth and is in the final stages of six implants that will total about $25,000.

"Over the years, I had a bridge on the upper teeth. But that loosened the tooth it was anchored to. I tried to take care of my teeth. It's important to me," DiFonzo says. "The route of dentures isn't acceptable for me. To me a pleasant smile is the first thing people see. I'm in sales, and I worry about my appearance for work. I worked hard enough to pay for implants. Some people spend their money on a vacation, for me it's . . . teeth."

Decay prevention is still the best course of tooth care, but Epel says many older people have bad memories of the dentist so they stay away, postponing the inevitable. "But times have changed," she says. "Dentists can use anti-anxiety medication as well as different techniques with anesthesia. The mouth happens to be a difficult area psychologically for people to have work done."

Don't be afraid to change dentists, advises Maureen Tsokris, assistant professor of the Department of Dental Hygiene at Farmingdale State College. While most people age with their family dentist, she says, dental schools increasingly are recognizing that older patients have different needs, so the demand for geriatric dentistry is growing.

Older patients, she says, should "get a new dentist if yours doesn't routinely ask about your medical history, what medications you're taking, or help you with your changing needs."