Oral Health & Tooth Loss Within America’s Aging Population

Posted on Sep 18, 2023 by William J. Claiborne, DDS MS

There are currently 54.1 million U.S. adults ages 65 and over; a number that is expected to grow to 95 million by 2060.

In 1900, the percentage of American adults over the age of 65 was just 4.1%. Today, that number has grown to nearly 16%. By 2040, the elderly adult population is estimated to be more than double the senior population of the year 2000.

https://www.aplaceformom.com/caregiver-resources/articles/elderly-nursing-home-population

Many baby boomers (Americans born between 1946 – 1964) will keep their teeth longer than any generation before, yet they continue to experience a preventable decline in oral health.

Common risk factors such as smoking, poor diet, a reduced capacity to care for one’s teeth and obtain professional dental care, and biological mechanisms – such as low salivary flow caused by medications – may contribute to tooth decay and tooth loss.

Periodontitis (advanced gum disease) is a prevalent oral disease in older adults. It is typically marked by inflammation of the gums and supporting structures of the teeth, resulting in sore and bleeding gums as well as painful chewing problems. Loss of the supporting structures of the teeth (including supportive bone) results from an imbalance of bacteria that exist in the space between the teeth and the gums. This leads to an inflammatory response that develops into periodontal disease.

As teeth lose support from their diseased foundation, mobility and tooth drifting can occur in addition to abscesses, which can ultimately result in tooth loss. As the disease intensifies, bone loss around affected teeth can advance with a worsening infection that can lead to serious health problems far beyond the mouth.

Periodontal disease is associated with chronic diseases such as cardiovascular disease, diabetes, respiratory disease, and dementia. Along with other challenges to maintaining good health, the prevalence of any periodontitis among older adults is high. Three in five older adults are affected, with prevalence higher in men and persons with low incomes. Four in five older adults who smoke cigarettes have some form of periodontitis.

The loss of all natural teeth, known as edentulism, reduces quality of life because it interferes with the ability to eat, speak, and feel comfortable among other people. Tooth loss also affects a person’s ability to consume nutritious food and can impact social involvement with others while consuming food.

Overall, 17% of adults 65 and older are edentulous. Fortunately, edentulism has declined over the years among older adults aged 65 to 74, from about 50% in the 1960s to 13% today.

https://www.cdc.gov/oralhealth/pdfs_and_other_files/Oral-Health-Surveillance-Report-2019-h.pdf

Prevalence of total tooth loss among adults ages 65 and over is higher in both North and South Carolina than many other states, which is in the 16.6 – 26.3 percentage range. This compares to states like Illinois, Wisconsin and Utah, which are some states in the 6.2 – 11.3 percent range.

https://www.ncbi.nlm.nih.gov/books/NBK578296/figure/ch6.fig6/?report=objectonly

Having fewer than nine teeth is considered severe tooth loss and can cause major difficulties in eating a healthy diet of fresh and nutritious fruits, protein-rich meats and sufficient fiber. Without chewing comfort, strength and stability, food choices can result in either weight loss or obesity. Extensive tooth loss also detracts from physical appearance and impedes speech, another challenge to social contact and job prospects. This can also inhibit intimacy, lower self-esteem, and impact overall quality of life.

https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf

Another challenge for older adults is orofacial pain. Orofacial pain in older adults can originate inside the mouth from tooth-related or gum infections. It may also originate outside the mouth, such as pain in the jaw joint area, or face and cheeks. Orofacial pain often results from ill-fitting dentures or a microbial infection causing an inflammatory reaction known as denture stomatitis (an oral yeast or fungus condition)

Older adults also struggle with “dry mouth.” Dry mouth is surprisingly common – an estimated 35 million U.S. adults may have this condition, known as xerostomia. Common causes include medications, autoimmune disease, systemic diseases, and as a result of head and neck irradiation.

Drugs are by far the most common risk factors for chronic dry mouth. Nearly 9 in 10 (89%) adults aged 65 and older take prescription medicine. More than half (54%) report taking four or more prescription drugs. The drugs most consistently implicated in “dry mouth” are antidepressants, diuretics, beta blockers, bronchodilators, and antihistamines.

High-risk behaviors are generally less common among older adults than in younger age groups. About 9% of those 65 years and older reported that they were current smokers, and 8% reported excessive alcohol consumption (having five or more drinks in one day at least once in the past year). Cannabis use also is on the rise among seniors although it remains less than 5%.

The problems associated with poor oral health and tooth loss extend greatly to other areas of the body. Oral bacteria and their toxins can spread into the bloodstream through ulcerated or inflamed tissues during chewing, routine oral hygiene, and dental procedures. In weakened gum tissues, even the act of tooth brushing can open up entry points for bacteria plaque and gingival inflammation in the bloodstream.

In addition, the presence of oral bacteria or their toxins may induce inflammatory responses, which can prompt insulin resistance. Oral bacteria can reach tissues in the lung, heart, gut, placenta, joints, and even the brain. They have been associated with infective endocarditis, and chronic inflammation may contribute to systemic conditions such as cardiovascular disease and diabetes.

Obviously, there are many causes for oral health challenges, all having a detrimental effect on quality of life to some extent. We want to help the residents of Western North Carolina enjoy their retirement years with a healthy, confident smile and oral health that supports good overall health.

First, know the signs and symptoms of periodontal (gum) disease, which include:

• Swollen or puffy gums
• Gums that turn red, dark red or dark purple gums
• Gums that are tender or bleed easily
• Seeing blood when brushing or flossing
• Persistent bad breath
• Pus pockets that form between teeth and gums

When periodontal disease exists, it is important to know that this will not go away without treatment. Once this infection is underway, it will only worsen, leading to more painful symptoms and even eventual tooth loss.

If you have signs of gum disease, see a periodontal specialist as soon as possible. In addition to lowering the risk of tooth loss, a periodontist can help you lower the risks of gum disease’s infectious bacteria in the bloodstream, which research has linked to serious (and even deadly) health problems.

Call our Asheville periodontal dental office to schedule a consultation. If fear or anxiety has prevented you from regular dental visits, we can discuss several options (including oral or IV sedation) to provide comfortable, relaxed appointments. Call 828-274-9440.

 

 

Common Contributors to Tooth Loss

Posted on Sep 11, 2023 by William J. Claiborne, DDS MS

Our natural teeth seem hard and solid, able to endure much over the span of a lifetime. However, as we all know, teeth can be knocked out due to accidents or injury and lost due to becoming overly decayed, fractured, infected and – the leading cause – periodontal (gum) disease.

Your gum tissues serve as protection for the tooth structures you cannot see – the tooth roots and bone and tissues supporting the roots. And, teeth need these bone structures to stay healthy and vice versa; the bone structures beneath the gums need the presence of the roots to stay healthy.

The jaw bones are kept healthy by tooth roots that provide stimulation to the bone as well as nourishment that runs through the tooth’s interior.

When a tooth is removed, so is the stimulation and nourishment to that area of the jaw bone. Without it, the bone begins to shrink. As it declines in height, adjacent teeth are more vulnerable to loss. Statistics show that teeth adjacent to areas where natural teeth are missing will be the most likely to be lost next.

According to the Center for Disease Control & Prevention (CDC), 69% of adults between ages 35 – 44 have lost at least one permanent tooth. By age 50, Americans are missing an average of 12 teeth. For adults between the ages of 65 – 74, 26% are missing all of their natural teeth. That’s over one-fourth of the adult population over age 65.

Because of the strength and seemingly rock-solid presence of teeth, it may be assumed they’ll last for a lifetime. And, they can. Natural teeth can and should last a lifetime with proper maintenance and care. However, certain things can contribute to tooth loss; some of these may not be well known.

These include:

GUM DISEASE – Signs and symptoms of gum disease are:

• Red, swollen or tender gums
• Seeing blood in the sink when brushing
• Receded gums
• Loose or separating teeth
• Pus pockets on gum tissues
• Sores in the mouth
• Persistent bad breath

When these indications exist, it is important to seek periodontal treatment as soon as possible. Gum disease only worsens without treatment, requiring more time and expense to rid this serious, even deadly, inflammatory disease.

NOT FLOSSING – While tooth brushing helps to keep oral bacteria levels in the mouth to manageable levels, daily flossing is also recommended as a preventative way to keep cavities and gum disease at bay. Still, 70% of the American adult population do not floss daily. Even worse, about a third of Americans admit to never flossing (39% of men and 27% of women who do not).

SMOKING – According to the Centers for Disease Control & Prevention (CDC), a smoker has twice the risk for gum disease compared with that of a nonsmoker. (https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html)

AGING – With age, the body becomes less efficient in maintaining itself. Due to hormone changes and being less hydrated, joints wear down, skin loses subtlety and muscle mass and strength declines. The same is true with teeth, especially as gum tissues dry out. This means their tight, protective grip around the base of teeth loosens and pockets can easily for between teeth. All these factors contributor to higher risks of gum disease and tooth loss.

ORAL DRYNESS – The tissues inside the mouth need to be kept moist. Saliva flow is designed to do this. However, with age, the flow of saliva is less plentiful. Just as the skin and hair get drier with age, the mouth endures this same consequence. When saliva flow is less efficient at rinsing bacteria from the oral cavity (inside of the mouth), bacteria grow at a more rapid rate. This means bacteria accumulation occurs more frequently than twice-a-day brushing can control.

MEDICATIONS – The average adult in the 65-79 age group has over 27 prescriptions filled each year. (https://www.statista.com/statistics/315476/prescriptions-in-us-per-capita-by-age-group/). Many meds have the side effect of oral dryness or increased bleeding, including some herbal supplements. For example, Ginkgo Biloba and Vitamin E can act as blood thinners. When combined with aspirin, the combination may cause difficulties in blood clotting.

To halt the potential for tooth loss if you are already missing teeth, dental implants are recommended. They actually protect the health of neighboring teeth. In addition to helping the supportive bone structures retain bone mass, teeth supported by implants do not rely on the support of crowned (or ‘capped’) teeth on both sides. This means the integrity of adjacent teeth is preserved.

Dental implants come in over 40 different types designed to accommodate various challenges and preferences. This is one reason (of many) that a periodontist is an ideal choice for the diagnosis and placement of your implants. Our speciality understands the complete spectrum of implant systems. While some implant systems may be ideal for your needs, others may not. And, the choice of which will achieve your goals is not limited to just those types a non-specialist knows how to place.

For example, some dental implants provide you with a non-removable (“fixed”) option while others may involve removable teeth. Additionally, the proper selection of your dental implants may greatly save you in treatment fees.

For example, the All-On-4 dental implant system needs only 4 implants per arch, and can be placed in shallow bone. The treatment fees are less since the number of implants is low and the need for bone regeneration for severe bone loss may not be required. For these reasons, a periodontist may be able to help you achieve your tooth replacement goals within a budget you can manage.

Our Western NC periodontal dental office features some of the industry’s most advanced technology, which helps to optimize success rates, shorten treatment time, and enhance comfort. This includes 3-D Cone Beam imaging, which is ideal for diagnoses and treatment planning. These amazing images provide a clear view of the upper and lower jaw (including nerve canals) in a process that is quick, painless and at minimal radiation levels.

We also have a computerized Dental Implant Placement system for pre-surgical positioning of dental implants. Using a 3D model of the patient’s jaw, a template is developed for the most conservative treatment process needed, even for complex cases. This minimizes disruption of gum tissues and targets implant placement at ideal depths and angles.

Because we make patient comfort one of our highest priorities, we offer several sedation options, including oral and IV sedation. Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward. I.V. sedation (also known as “twilight sleep”) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a Medical Doctor (MD) who is a board certified Anesthesiologist.

If you have lost teeth (or struggle with a denture or partial) and are considering dental implants, begin with a consultation appointment. Call 828-274-9440. New patients are always welcome.

Don’t Allow Dental Fear or Anxiety To Ruin Your Smile

Posted on Aug 23, 2023 by William J. Claiborne, DDS MS

It’s a proven fact that your oral health – the wellness of your teeth and gum tissues – is an influencing contributor to your overall health. For decades, researchers have studied the concerning risks, and alarming connections, between oral health and a number of serious diseases in the body.

The leading culprit in this scenario are the bacteria of advanced gum disease, known as periodontitis. Gum disease breeds bacteria that are inflammatory in makeup. Once they enter the bloodstream (through tears in disease oral tissues), studies have found these potent bacteria can trigger the onset of serious diseases, such as:

• Heart disease
• Stroke
• Alzheimer’s disease & Dementia
• Some cancers (including lung and pancreatic)
• Pre-term babies
• Diabetes
• Arthritis
• High blood pressure
• Erectile Dysfunction (ED)

As research continues, more and more findings are bringing to light just how connected the mouth is to the efficient operation of the immune system. During the Covid pandemic, it was well publicized that those most vulnerable to the virus were those who were immune compromised.

One study, conducted between February and July 2020, analyzed two groups of 568 total patients with severe COVID-19 complications (death, ICU admissions or assisted ventilation). Periodontal conditions in the two groups were analyzed. Of the patients studied, those with periodontitis were three times more likely to experience COVID‐19 complications including death, ICU admission, and the need for assisted ventilation.

https://www.perio.org/press-release/new-study-links-periodontitis-and-covid%e2%80%9019-complications/

For years, the cost of dentistry has been credited for preventing millions of American adults from having regular dental care. This was recently studied in a nationally representative survey of 5,682 adults. In this, researchers looked at knowledge, attitudes, experiences, and behaviors related to oral health.

Results from the survey show that lack of insurance is a leading reason for avoiding dental care or delaying recommended care (often until something becomes so painful that the individual is forced into a dentist’s chair seeking relief).

The study showed that 16% of adults without dental insurance admitted that they had not seen a dentist in more than five years compared to just 5% of adults with dental insurance. Forty percent of adults without dental insurance reported cost was the reason they hadn’t visited the dentist in the past two years, compared to 14% of adults with dental insurance.

https://www.dentaleconomics.com/macro-op-ed/article/14284116/new-data-show-that-americans-are-still-not-getting-the-dental-care-they-need

Yet, excruciating pain from a dental problem can be the impetus for setting aside the cost. The same is true for people who have fear or anxiety associated with dental care.

About 36% of people in the U.S. have a fear of dental treatment, with 12% having an intense fear, known as dentophobia. Dental phobics are people who avoid going to the dentist at all. Dental fear is more common in females than males, with an estimated 3% of men and almost 5% of women having dentophobia.

Reasons for these fears include:

– Fear the anesthetic will not work or be sufficient to fully numb the pain
– Blood makes some people feel afraid or panicky about bleeding during a dental procedure.
– People may fear choking or gagging and not being able to breathe or swallow.
– For individuals who have had a poor experience with a dentist in the past, they may associate negative feelings with their dentist.
– Feeling pain from the procedure or recovery
– Some people are highly fearful of needles.
– The noise from drills and dental instruments used by a dentist or dental hygienist can create high levels of anxiety for some people.
– The same is true when it comes to certain smells that arise during dental treatment.

New Study Links Periodontitis and COVID‐19 Complications

At our Asheville NC periodontal dental office, we take patient comfort very seriously, and that goes for all patients at every appointment. We find that many patients have developed severe gum disease or had tooth loss because they were afraid of going to a dentist. This prevents people from having regular dental care, which allows small problems to become worse ones.

Many with dental fear or dentophobia avoid going to the dentist for years. And, these feelings may be more common than you know. When dental anxiety, dental fear and dentophobia are combined, it affects an estimated 70% of American adults. This unfortunate statistic is a likely reason for the high percentage of adults who suffer with some level of periodontal (gum) disease – over 47%.

As a Periodontist, my staff and I work diligently to pamper patients from the moment they enter. For certain procedures as well as for patients who prefer the addition of sedatives, we offer oral sedation as well as I.V. sedation (twilight sleep).

Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward.

I.V. sedation places the patient in a deeper sleep state, also erasing memory of the procedure. It is administered by a doctor of anesthesiology, overseen by Dr. Brad Stone, a Medical Doctor (MD) and a board certified Anesthesiologist & Pediatric Anesthesiologist.

https://www.biltmoreperiodontics.com/comprehensive-care-team/

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

If fear has caused you or someone you know to avoid dental visits, please arrange a consultation with us. In our Western NC periodontal dental office, you’ll find a warm, respectful atmosphere where your concerns are understood. During this time, we can discuss comfort options that may be best for your individual needs along with estimated costs.

Call 828-274-9440.

Beware of Hidden Contributors to Gum Disease, Tooth Loss

Posted on Aug 19, 2023 by William J. Claiborne, DDS MS

Decades ago, oral health was something many people took lightly, often waiting until something hurt to see a dentist. The fierce pain of a cavity or abscess or the sharp jolt of something hot or cold on an area of gum recession were motivators to for a dental visit.

However, Americans are now realizing how very important their oral health is in how it relates to overall health.

The correlation lies with bacteria that live within the gum tissues. While all mouths contain “good” and “bad” bacteria, research has determined that the bad type can cause problems within and outside of the mouth.

The bad bacteria are inflammatory. An accumulation of these inflammatory bacteria are what lead to periodontal (gum) disease. Gum disease is the nation’s leading cause of adult tooth loss. Additionally, advanced periodontal disease – periodontitis – can trigger or even worsen serious health condition far beyond the mouth.

Although gum disease can begin without any obvious symptoms, once it exists, progression occurs in three stages, which are:

• Gingivitis – As the initial stage of gum disease, inflammation is triggered by plaque buildup at the gum line. When daily brushing and flossing fail to thoroughly remove plaque, toxins form that cause irritation to the gum tissues. Once signs emerge, they may include seeing blood in the sink when brushing or having sore, swollen gums. At this stage, however, damage may be reversed with prompt response.

• Periodontitis – As the disease advances, the bone structures and fibers that support teeth are damaged by the destruction of infectious oral bacteria. At this stage, inflamed gums form pockets below the gum line, filling with bacteria-laden plaque.

• Advanced Periodontitis – In the advanced stage of gum disease, fibers and bone supporting natural teeth are destroyed. This can cause teeth to shift or loosen, requiring aggressive treatment to prevent tooth loss. Eventually, some teeth may require removal.

As devastating as tooth loss can be to one’s overall health, the bacteria of gum disease can enter the bloodstream. Research has shown this infectious bacteria can trigger inflammatory reactions elsewhere in the body, correlating to heart disease, stroke, high blood pressure, some cancers (including lung and pancreatic), diabetes, arthritis, impotency, preterm babies, Alzheimer’s disease and more.

Obviously, people should be highly-committed to the care of their oral health. Yet, statistics in America along these lines are not impressive. The Center for Disease Control’s Division of Oral Health cites that 1 out of every 2 American adults 30 and over has periodontal disease. They also shared that periodontal disease is higher in men than women (56.4% vs. 38.4%) with high prevalence rates among smokers (64.2%) and adults 65+ (70.1%).

In addition to your twice-a-year dental check-ups and cleanings, there are other ways to support oral wellness between visits. One is in keeping the mouth moist, supporting sufficient saliva flow.

When saliva flow is insufficient, bacteria are able to accumulate and multiply rapidly. In addition to oral dryness as a part of the aging process, contributors can be consuming alcoholic beverages, caffeine, and as a side effect of many medications (both OTC and Rx).

One reason to keep your dental professionals aware of ALL the medications your take is in how they can interact with certain procedures, including numbing agents. For example, medications to reduce blood clotting, which lowers your risk for stroke and heart disease, can cause bleeding problems during oral surgery or periodontal treatment.

For those who take medications that help to strengthen bones, these have been associated with a rare but serious condition called osteonecrosis of the jaw. Simply put, it refers to death of the bone. The risk of these prescriptions is greater for those administered by injection or intravenously.

Osteonecrosis of the jaw commonly occurs after dental procedures (tooth extraction, implant placement). Over 90% of those who have experienced osteonecrosis are those who have taken the medication in repeated high doses due to cancer or other diseases.

However, 10% who experienced osteonecrosis were taking much lower doses, mostly intended to treat osteoporosis.

Certain medications also affect the ability to taste, including cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatory drugs, respiratory inhalants and nicotine skin patches.

Some medications can also cause the development of oral sores, inflammation or discoloration of gum tissues in the mouth. These oral sores or discolorations may arise from taking medications for blood pressure, oral contraceptives and chemotherapy agents.

Dry mouth is a common side effect of a wide variety of medications, including prescriptive and over-the-counter. These include antihistamines, decongestants, painkillers, high blood pressure medications, muscle relaxants, drugs for urinary incontinence, anti-depressants and many others. Drying causes the soft tissues in the mouth to become inflamed and makes you more susceptible to infection. When saliva flow is depleted, your risk for tooth decay and gum disease increases.

Supplements that may seem unconnected to your oral health can actually effect your care more than you realize. It is important for your dentist to know if you take…

• Ginkgo biloba or evening primrose –  These herbs can reduce your blood’s ability to clot, possibly leading to excessive bleeding during and/or after a dental procedure.

• St. John’s Wort – This herb, which is often taken to reduce anxiety, can interfere with the metabolism of other medications, including sedatives, antibiotics and anti-inflammatory drugs such as prednisone and Decadron. When combined with St. John’s Wort, these drugs can be less effective. On the other hand, narcotics such as codeine, Vicodin and oxycodone can become more potent when taken with St. John’s Wort. This can lead to sleepiness, lethargy and dizziness.

• Valerian – This herb has mild sedative effects. If your dentist prescribes drugs for anxiety or painkillers containing codeine, the effects of both together are greatly accentuated. This can lead to severe sleepiness, lethargy and dizziness that can last into the next day.

• Calcium and magnesium – When these supplements are combined with certain antibiotics, they can decrease the antibiotics being properly absorbed. This can compromise your ability to fight off infection.

As a periodontal specialist, I find that most cases of dry mouth are due to factors that can be easily controlled with simple changes. If you have delayed or avoided dental care, call 828-274-9440 to request a consultation, or begin with a thorough examination in our Asheville periodontal office.

And, if you are experiencing signs of gum disease, please know this disease will only worsen without treatment. The sooner you have treatment, the less involvement your treatment will likely be.

We offer the latest techniques, technology, and skills while always making patient comfort a top priority. If dental fear or anxiety are concerns, please make us aware of this when you call or at your initial appointment. In addition to our standard comfort features, we offer Oral and I.V. sedation (“twilight sleep”).