Teeth: Dental health over 50Posted on: 19 November 2012 by Gareth Hargreaves
As dental health improves, the generation now reaching their 40s and 50s will have received more dentistry than their children at the same age.
As dental health improves, the generation now reaching their 40’s and 50’s will have received more dentistry than their children at the same age.
Many people in this age group suffer from unnecessarily poor appearance of their teeth due to various factors such as: discoloured fillings, crowns that do not match in colour or shape or with black margins, uneven teeth, gum recession and spacing between teeth, grey or black amalgam fillings in their back teeth, worn down or thin edges of the front teeth.
Filling materials and techniques have advanced tremendously over the last 20 to 30 years so that it is now possible to create a better result than previously. We often lag behind the US where fashion dictates that it is essential to have a designer smile. Teeth also get darker as we age due to changes in the properties of the enamel and dentine, so bleaching can help to regain a more youthful look.
Nowadays, dental implants, which are titanium screws that are fixed into the jaw bone similar to the roots of teeth, have become increasingly popular and predictable and are often the first choice to replace a tooth which needs to be extracted because they do not damage the adjacent teeth. However, the timing of placement after extraction is very significant because implants need to be surrounded by bone.
In the last 10 years techniques for replacing lost bone have become more predictable, but too much delay can make the procedure more complicated and involve extra surgery. Also, new implant designs allow better bone healing and aesthetics than previously possible so the choice of implant system can affect the result. There are a handful of well known and researched implants and many copies which are less certain.
Many people reluctantly wear dentures having lost teeth because of trauma, gum disease or decay. When teeth are lost the gum and bone shrink away and this often leads to the artificial teeth being placed over the gum, in a different position to the natural teeth, resulting in sunken in lips and a more aged appearance. This can be avoided by the dentist placing the new teeth back in their original position, however, this also requires that the dentures are well designed and well fitting. In these cases people can easily look 10 years younger and without having to resort to surgery.
Dental implants and mini-implants have dramatically improved the quality of life for denture wearers. Previously when all the teeth had been lost there was no way to stabilise a loose and uncomfortable lower denture. Now this is a straightforward procedure that can be carried out in 1 or 2 sessions regardless of age, although a certain degree of medical fitness is required.
Avoiding Gum Disease
Gum disease is a rather insidious process because it is rarely painful until the late stages. Although a small percentage of people are affected by hereditary factors, bone loss is often due to inadequate cleaning in between the teeth over a lifetime. If a patient only brushes the teeth on the front and back surfaces, they are only cleaning half way around the tooth. The surfaces which are never cleaned, in between teeth, will develop problems over a long period of time unless that person is unusual and has high resistance to this disease.
It is a common misconception that the gums bleed from brushing too hard, whereas usually this indicates that the gums are inflamed from inadequate oral hygiene and need to be cleaned more to allow healing. Often as we age the gum will tend to recede but this can also be a consequence of incorrect brushing technique. Recent minor surgical techniques allow the appearance to be effectively corrected.
Inevitably a number of people reach a point when spaces start to develop between their front teeth or they become loose. These can be treated in various ways to stabilise the teeth and improve appearance. When the teeth have little bone remaining and need to be replaced most people would like to have a fixed restoration. Apart from the added confidence of fixed teeth there is often improved appearance of man- made ceramic teeth, individualised to the patients smile, whereas dentures usually have resin teeth from a range of prefabricated shapes and colours.
Many people grind or clench their teeth at night, and sometimes also during the day. This is thought to be related to stress or discrepancies in the biting contacts of the teeth, with very few individuals having a naturally ideal bite. The grinding causes the teeth to wear down over a period of years but can also cause unexpected fracture of the teeth and roots as well as muscle and joint symptoms. It is usually advised that root treated back teeth are crowned to protect them. Nightguards can be used to prevent wear on the teeth.
Apart from harming the body, smoking has a number of adverse effects on the mouth. As well as staining and discolouring the teeth, smoking causes changes in the mucosa (the skin lining the mouth) and has been linked to oral cancer, particularly when associated with increased alcohol consumption. Many people do not realise that dentists are well trained in examining the structures around the mouth and checking for cancer or other pathological areas as part of a routine examination.
Limit your Sugar Intake
The amount of sugar intake needs to be controlled to prevent further decay occurring especially around new restorations. Often people are unaware that the tooth under a new crown is still susceptible to further decay in a poor environment of plaque and sugar. It is the time that sugar is in the mouth which is damaging rather than the quantity of sugar. A further effect of diet is the erosion caused by ‘fizzy drinks’ which if taken regularly tend to wear away the enamel leaving a rather shiny worn surface. Lemons are particularly acidic and regular use in drinks tends to cause erosion and sensitivity.
There is worldwide a huge amount of dental research carried out every year so that dentistry is constantly changing with new materials and techniques. With the current interest in cosmetic dentistry there have been important changes in the ability to cast and mill ceramic crowns and bridges without a metal substructure. These stronger materials mean that there is more light transmission through the restorations making them look more natural and that unsightly dark lines can be avoided at the gum margins. There has also been much research into what represents a beautiful smile and how this can be created on an individual basis. This is really a blend of art and science.
By Dr Keith Cohen, Dentexcel
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