Aging changes in teeth and gums

Certain changes occur slowly over time in our bodies as we age:

• Cells renew at a slower rate
• Tissues become thinner and less elastic
• Bones become less dense and strong
• The immune system can become weaker, so infection can occur more quickly and healing takes longer

These changes affect tissue and bone in the mouth, which increases the risk for oral health problems in later years.

DRY MOUTH

Older adults are more at risk for dry mouth. This can occur because of age, medicine use, or certain health conditions.

Saliva plays an important role in maintaining oral health. It protects your teeth from decay and helps your gums stay healthy. When the salivary glands in your mouth don't produce enough saliva, it can increase the risk for:

• Problems tasting, chewing, and swallowing
• Mouth sores
• Gum disease and tooth decay
• Yeast infection in the mouth (thrush)

Your mouth may produce a bit less saliva as you get older. But medical problems that occur in older adults are more common causes of dry mouth:

• Many medicines, such as some used to treat high blood pressure, high cholesterol, pain, and depression, can reduce the amount of saliva you produce. This is probably the most common cause of dry mouth in older adults.
• Side effects from cancer treatment can cause dry mouth.
• Health conditions such as diabetes, stroke, and Sjögren syndrome can affect your ability to produce saliva.

GUM PROBLEMS

Receding gums are common in older adults. This is when the gum tissue pulls away from the tooth, exposing the base, or root, of the tooth. This makes it easy for bacteria to build up and cause inflammation and decay.

A lifetime of brushing too hard can cause gums to recede. However, gum disease (periodontal disease) is the most common cause of receding gums.

Gingivitis is an early type of gum disease. It occurs when plaque and tartar build up and irritate and inflame the gums. Severe gum disease is called periodontitis. It can lead to loss of teeth.

Certain conditions and diseases common in older adults can put them at risk for periodontal disease.

• Not brushing and flossing every day
• Not getting regular dental care
• Smoking
• Diabetes
• Dry mouth
• Weak immune system

CAVITIES

Dental cavities occur when bacteria in the mouth (contained in plaque) changes sugars and starches from food into acid. This acid attacks tooth enamel and can lead to cavities.

Cavities are common in older adults these days in part because more adults are keeping their teeth for their lifetime. Because older adults often have receding gums, cavities are more likely to develop at the root of the tooth.

Dry mouth also causes bacteria to build up in the mouth more easily, leading to tooth decay.

ORAL CANCER

Oral cancer is more common in people older than age 50 and is almost three times greater in men than in women.

Smoking and other types of tobacco use are the most common cause of oral cancer. Drinking alcohol in excess along with tobacco use greatly increases the risk for oral cancer.

Other factors that may increase the risk for oral cancer include:

• Human papillomavirus (HPV) infection (same virus that causes genital warts and several other cancers)
• Poor dental and oral hygiene
• Taking medicines that weaken the immune system (immunosuppressants)
• Rubbing from rough teeth, dentures, or fillings over a long period of time

No matter what your age, proper dental care can keep your teeth and gums healthy.

• Brush twice a day with a soft-bristle toothbrush and fluoride toothpaste.
• Floss at least once a day.
• See your dentist for regular check-ups.
• Avoid sweets and sugar-sweetened beverages.
• Do not smoke or use tobacco.

If medicines are causing dry mouth, talk with your health care provider to see if you may be able to change medicines. Ask about artificial saliva or other products to help keep your mouth moist.

You should contact your dentist if you notice:

• Tooth pain
• Red or swollen gums
• Dry mouth
• Mouth sores
• White or red patches in mouth
• Bad breath
• Loose teeth
• Poorly-fitting dentures

Dental hygiene - aging; Teeth - aging; Oral hygiene - aging

Hartshorn JE, Gibson G, Niessen LC. Geriatric patients. In: Stefanac SJ, Nesbit SP, eds. Diagnosis and Treatment Planning in Dentistry. 4th ed. St Louis, MO: Elsevier; 2024:chap 18.

Needleman I, Clark DR. Aging and the periodontium. In: Newman MG, Klokkevold PR, Elangovan S, Hernandez-Kapila YL, eds. Newman and Carranza's Clinical Periodontology and Implantology. 14th ed. Philadelphia, PA: Elsevier; 2023:chap 13.

Schrieber A, Alsabban L, Fulmer T, Glickman R. Geriatric dentistry: maintaining oral health in the geriatric population. In: Fillit HM, Rockwood K, Young J, eds. Brocklehurst's Textbook of Geriatric Medicine and Gerontology. 8th ed. Philadelphia, PA: Elsevier; 2017:chap 110.

Updated by: Jacob Berman, MD, MPH, Clinical Assistant Professor of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.