Dental health linked to eating, brushing habits

But here they are – our teeth. While it was once a given that growing older meant loosing our precious pearly whites, advances in oral health care, including everything from fluoridated water to the newest in dental procedures, have made it likely that today’s middle-agers will grow into their twilight years with the same pointed cuspids and chomping molars they’ve had since braces and Boy Scouts.

This doesn’t mean we can neglect oral health care. Whether it’s brushing our teeth before eating that piece of birthday cake or playing it cool when it comes to whitening, there are ways to ensure our teeth and gums age as gracefully as possible.

BE AWARE OF SMOKING RISKS

The place to start is lifestyle. Day-to-day choices we make affect our teeth and gums in myriad ways. A poor diet, drinking alcohol to excess and smoking are not only detrimental to our cardiovascular health, they can also cause significant problems for our oral health.

Smokers, for example, are twice as likely as ex-smokers to have poor oral health, and four times more likely than those who have never smoked, according to a recent report from the National Center for Health Statistics. They are also at higher risk for cavities, oral cancers and gum diseases.

Marianne Sampson, outreach coordinator and instructor with the dental hygiene program at the College of Southern Nevada, says long-term of tobacco use can rob the mouth’s ability to absorb nutrients and weaken tissue to the point that gums become fibrous or “leathery.”

“For patients that are smokers or long-term smokers, there is just a very high direct correlation between gum disease, between the loss of the bone that surrounds the teeth, to smoking,” Sampson said. “The chemicals involved in the smoke coming right in contact with the oral tissues cause there to be less blood flow in that area, the vessels actually constrict down so that tissue becomes starved for all the nutrients that keep tissues healthy and, therefore, it causes the tissue to become fibrotic, the bone starts to kind of shrink away because it’s not getting the nutrients and the things that it needs to stay healthy as well.”

Smokers, therefore, need to be especially diligent about taking care of their gums and teeth at home to reduce bacteria in the mouth, Sampson said. Because smoking dries out the mouth, it can result in the buildup of acid, and a decrease in the important minerals and antimicrobials normally carried by saliva, she added.

EAT AND DRINK WISELY

When it comes to drinking alcohol and our overall health, the rule of thumb is to use moderation. The same is true when it comes to our teeth and gum tissue. Heavy alcohol use, for example, is a risk factor for oral and throat cancers, according to the Centers for Disease Control and Prevention. Combine it with smoking and the risk is even greater.

Georgia Dounis, a dentist with advanced education in geriatric dentistry, and director of the Interdisciplinary Center for Aging Research and Education at the University of Nevada, Las Vegas, also points to a small pilot study the university conducted looking at patients who had dental implants and the success of the implant surgery based on their social habits.

For those who tended to consume more than a moderate amount of alcohol, the implants did not fuse to the bone as successfully as others, she said.

“What the research and literature suggest is that the alcohol accelerates the breakdown of bone and it slows down the formation that normally happens throughout life,” Dounis said.

In the case of either habitual smoking or alcohol use, experts say, patients should seek a dental care professional’s advice in developing an individual oral care routine.

Finally, cavities are an equal-opportunity nuisance that don’t care whether you’re six or 60, so try to limit sugary, starchy foods, and scale back on those sodas. They can cause bacteria in the mouth to release acids that are harmful to tooth enamel and, in fact, will attack the tooth structure for over 20 minutes, Dounis said.

While Dounis doesn’t necessarily discourage brushing one’s teeth after consuming these kinds of foods and beverages, it is a better idea to brush beforehand as a preventive measure. The idea is to remove as much bacteria from the mouth as possible before it comes in contact with the sugary foods and, therefore, limit the production of acid.

“There is one caveat in brushing right after consuming acidic foods or beverages. The acids may weaken the tooth enamel and brushing may damage the tooth structure. Brushing teeth before eating acidic foods or drinking acidic beverages will help to prevent enamel breakdown,” she noted.

Of course, poor nutrition habits that are left unchecked can lead to gum diseases such as gingivitis and periodontal disease. The experts advise that everyone brush with a soft toothbrush and fluoride toothpaste twice a day, and floss twice a day.

Dounis adds that brushing the tongue every day can remove debris that may build up because of smoking, as well as food and bacteria.

‘LONG IN THE TOOTH’

One of the most common oral health issues as we age is gum recession. Anthony Iacopino, director of the International Centre for Oral-Systemic Health, points to the expression “long in the tooth,” which was coined years ago to refer to someone who has gotten older. It stems from the fact that as we age, the gums often recede away from the enamel-covered crown of the tooth and expose the softer root surfaces.

“This is a problem because the root surfaces are more susceptible to decay and to sensitivity, so it’s not unusual to see an older individual’s decay around the necks of the teeth and around the roots of the teeth near the gum line,” he said.

The causes of gum recession can be a thinning of the gums and a loss of elasticity with age, Dounis said. Chronic, aggressive tooth brushing, teeth grinding during sleep, smoking, gum diseases and even genetics are among the other factors that can be associated with recession.

In some cases it can develop into periodontal disease as bacteria gathers in pockets of gum tissue that have formed around the teeth, and bone and connective tissue that help hold teeth in place start to break down.

To prevent periodontal disease, again it’s important to brush with a soft toothbrush and floss twice a day. Another way to help protect the exposed roots is by using a fluoride rinse, which will actually coat the vulnerable areas and help make the teeth resistant to decay, Sampson said.

“It also has some antimicrobial properties and so it’s getting two effects going on there, but the fluoride rinses are regularly and routinely suggested for patients that are having new cavities forming, especially if it’s on the exposed roots,” she said.

People with significant gum recession may need to have more frequent cleanings, perhaps every three to four months, so the bacteria can be removed from those pockets around the teeth, she added.

DISCUSS YOUR MEDICATIONS

As people age, they tend to take more medications. The average number of medications taken by a 65-year-old, for example, is about six, Iacopino said.

Many drugs, such as antidepressants and blood pressure medications, have side effects that can have an impact on oral health. One of the most common problems is dry mouth, or the decrease in saliva. Saliva is important for preventing decay because it contains antimicrobials, as well as minerals such as calcium and phosphorus that help keep teeth strong, Iacopino said.

“So without the saliva we have less resistance to periodontal disease and decay, and we also have more things like ulcerations, delayed healing, fungal infections and those kinds of things,” he noted.

For those having problems with dry mouth, dentists can recommend salivary substitutes that keep the mouth lubricated and, in some cases, contain the needed minerals and elements to fight off harmful microorganisms. Chewing sugarless gum and lozenges is also a way to stimulate the production of saliva, Iacopino said.

Certain osteoporosis medications can also have implications that should be discussed with one’s dentist. While they do help prevent bone loss, there is some question about their ability, for example, to actually rebuild bone in the jaw after procedures such as extractions, Sampson said.

As a side note, the hormonal changes women experience during menopause can affect oral health due to issues such as changing bone density and an increased susceptibility of soft tissue to periodontal disease, according to the experts. Therefore, it’s important to discuss the issue, including any medications that are being taken, with one’s dentist.

“I think the key to take away from all of this,” Sampson said, “is to understand the medications that you’re taking and when you go to any health care provider, whether it’s your doctor, your dentist, take a list of the medications that you’re taking, how much you take, your dosages, what you’re taking it for, so that they can do a complete history and then tell you if there are some of these medications that may be affecting your mouth, or your teeth, or your ability to heal and fight off infections.”

THE MOUTH-BODY CONNECTION

Addressing issues such as gum disease can have larger implications than many realize. These infections of the gums and other tissues that support the teeth can result in harmful microorganisms migrating downward through what are called “pockets,” or the spaces that develop at the gum line as gums recede and the disease progresses.

“And over a period of time that pocket around the teeth is a portal of entry into the body,” Iacopino said. “There is vasculature there, lots of blood vessels in the tissue around the teeth and the bacteria and their byproducts. And all that inflammatory stuff, inflammatory molecules, actually get into the blood stream, they travel around the body and they have cumulative effects over a period of time on organs and tissues in the body that are far removed from the mouth.”

As a result, there are connections between gum disease and heart diseases such as atherosclerosis, as well as certain cancers associated with the ongoing inflammation and bacteria of conditions such as periodontal disease, according to experts. Yet gum disease is not always obvious and can progress without one even realizing it.

This makes it all the more important to have a good oral-care routine, visit the dentist at least twice a year, have the gums and teeth checked, and bacteria-containing plaque removed.

Iacopino compares a mouth with periodontal disease to an open wound.

“You wouldn’t want it covered with dirt or bacteria, you’d want to keep it clean and obviously want it to go away,” he said.