Dental Problems
Dental Problems
Teeth Can Last Forever
The camera clicks at your high school reunion, and your lips slam together like cymbals. Why are you greeting the world with a little Mona Lisa smile when you really feel like flashing a great big grin?
Few things can age a woman's appearance more quickly than bad teeth. When you were young, a little dental neglect might have led to an occasional filling. But as you get older, ignoring your teeth can set you up for more serious problems, such as periodontal disease. And if not arrested promptly, long-term neglect can eventually cause you to lose teeth entirely.
But what if you've always been conscientious about dental care? Age still brings changes in the appearance and health of your smile. Years of chewing wears down tooth surfaces and actually shortens your teeth. Gums recede with age and wear. And even careful brushing has its downside if you've used the wrong technique for decades. Hard scrubbing wears down the translucent enamel coating of your teeth so that the yellowish material underneath, called dentin, begins to show through. Many otherwise lovely women as young as age 40 are frustrated by dingy-looking teeth.
As you age, your teeth will also show the telltale signs of years of indulgences. Coffee, red wine, tobacco and food dyes can work their way deep into microscopic cracks in the tooth enamel, resulting in brown or yellowish stains.
Know the Score
When you were an adolescent, the dreaded cavity count might have been foremost in your mind when you went to the dentist. But these days, your dentist will tell you that the greatest enemy to your mouth is not cavities but gum disease.
There's a little moat around each tooth that forms a tiny crevice between tooth and gum. When bacteria get in and linger, they cause inflammation, which over time deepens the crevices into pockets. As the inflammation simmers, bones, gums and connective tissue may get eaten away, leaving you with less foundation to hold your teeth in place. All that simmering can also cause soreness and bleeding as well as bad breath.
The other enemy is cavities (yes, they still count). Cavities start when a sticky film called plaque builds up on your teeth, trapping bacteria and breeding decay. Even though you may not have gotten many new cavities in your first years of adulthood, hang on to that toothbrush. Many women approaching middle age begin to get cavities along with gum disease. That's because as gums recede with age, the root (which has no protective enamel) is exposed to decay.
Facing the Fear
If you'd rather face a hundred bad hair days than go to the dentist, you are not alone. Plenty of grown women quail at the thought of a session in the dentist's chair. Wild fears about dentistry abound, says Mark Slovin, D.D.S., director of the Dental Phobia Clinic at the State University of New York at Stony Brook. But most of these fears are unfounded, he adds. Modern dentistry, while not always entirely painless, is no reason for panic. If you do panic, here's how to calm yourself. Open up before you open wide. If you're afraid of the drill, share your feelings. "A good dentist is able to understand the feelings and thoughts of a patient," says Arthur A. Weiner, D.M.D., associate clinical professor at Tufts University School of Dental Medicine in Boston. Don't be shy about shopping around for a dentist you're comfortable with. Ask for a demo. Ask your dentist to explain unfamiliar procedures step-by-step and to demonstrate how he'll use the instruments. Ask what kind of sensations to expect while the work is being done. Plan to communicate. Ask your dentist to alert you to any upcoming pinching or pressure, so you can relax in the meantime, Dr. Weiner says. And agree on hand signals that will tell her when you want to sit up for a minute, pause or rinse. Use relaxation techniques. Try deep breathing, concentrating on a pleasant image such as a day at the beach or listening to your favorite tunes on a headset to soothe your stay in the chair, says Dr. Slovin. Ask for more pain relief. If you need extra anesthesia, go ahead and ask. Sedatives aren't a permanent solution, but they can get you through a procedure you need. Seek professional help. If your fear is overwhelming, call your state dental society for help in finding a dental phobia clinic close to you. Or ask your dentist to recommend a psychological counselor who is familiar with dental phobias. |
A Daily Plan for a Perfect Mouth
If you want to keep a dazzling, healthy smile as you get older, it will take a new commitment to daily preventive care. That may mean spending more time brushing and flossing than you used to--and being more aware of the foods you eat. The first step is to catch up with the latest cleaning methods and keep an educated eye on what goes in your mouth.
Brush often, brush right. Brushing is your number-one defense against dental problems as you get older. "At a very minimum, be sure to brush after breakfast and before you go to bed at night," says Hazel Harper, D.D.S., associate professor of community dentistry at Howard University in Washington, D.C., and vice president of the National Dental Association. Of course, it's best to brush after every meal--with the right technique.
Done correctly, brushing removes the bacteria and plaque responsible for so many dental woes. Correct brushing, says Dr. Harper, means holding the brush with the handle in your palm and your thumb extended to act as a brace. This palm-thumb grasp tilts the brush at an angle, so bristles reach the gums and just underneath the gums as well as the tooth surfaces. Gently vibrate the brush in a small back-and-forth motion, covering only three teeth at a time. Then with a flick of the wrist, roll the brush against the sides of your teeth to sweep debris and bacteria away from the gum line. Finish up by brushing your tongue--your best antidote to bad breath, Dr. Harper says.
Use the right brush. Banish that hard-tufted, frayed thing from your toothbrush holder, says Dr. Harper. You need to use a soft-bristle toothbrush, and you should replace it every three months--sooner if the bristles start to fray, she says.
Pick a proper paste. Any toothpaste with the American Dental Association's seal of approval will do the job with a minimal amount of abrasion. If you tend to build up tartar, try a tartar control toothpaste. Tartar, or hardened plaque, feels like a rough coating on your teeth, says Richard Price, D.D.S., clinical instructor of dentistry at Boston University's Henry Goldman School of Dentistry. "These pastes reduce the amount of tartar you get, and the tartar that does build up will be softened and easier to remove," he says.
Don't forget flossing. Floss daily to be sure of complete cleaning and healthy gums, says Dr. Price. Toothbrush bristles simply can't get into the crannies around teeth. It doesn't matter what type of floss you use--waxed, unwaxed or flavored; just pick one that feels most comfortable to you, he says.
If you have a touch of arthritis in your fingers, a small mouth or a dexterity problem, try flossing one-handed. Wrap floss around the thumb and index finger of one hand, like you're forming a little slingshot, Dr. Price says. Or ask your dentist about flossing devices.
Watch out for sticky surprises. The foods that cling to your teeth are the foods that decay them, experts say. But it's hard to be sure which edibles in the following pairs are stickier: caramels or crackers? Hot-fudge sundaes or bread? Dried figs or puffed-oat cereal? Believe it or not, crackers, bread and cereal are the most likely to cling for long periods. Your best defense is to brush after every single snack, sugary or not. But if you can't get to a toothbrush soon, it's best to avoid the stickier foods.
Say cheese for dessert. It's an old custom in some cultures to serve cheese for dessert, and it might help cut cavities when you can't brush your teeth right after a meal. A few studies indicate that certain cheeses, particularly hard, aged ones such as cheddar and Monterey Jack, may reduce cavity-causing bacteria. Just a small slice will do the job--and not add much fat or cholesterol to your diet.
Swish, swish. Regardless of what you've just eaten, if you can't brush right away, the next best thing is to find a sink and swish a mouthful of water around your teeth, says Andrew M. Lewis, D.D.S., a dentist in private practice in Beverly Hills. Swishing will remove most debris and also dilute the acids formed by food particles.
   Break off about 18 inches of floss and wind most of it around one middle Þnger. Wind the rest around the middle Þnger of your other hand. Using your thumbs and foreÞngers, slide about an inch of taut þoss between your teeth. Gently curve the þoss in a C shape around the tooth at the gum line. Gently slide the þoss up and down between the tooth and gum, making sure you go beneath the gum line. Repeat on the rest of your teeth with clean sections of þoss. |
Heavy-Duty Home Care
If your dentist has noticed new cavities or early signs of gum disease, don't give up on your teeth--take charge. There's a lot you can do to turn the tide at any age. Try these home treatments, with your dentist's guidance.
Use a fluoride rinse. "If you're prone to cavities, use an over-the-counter fluoride rinse every night," says Dr. Lewis. "You want to rinse and spit it out so that it's the last thing in your mouth just before you go to sleep." Fluoride actually remineralizes teeth, making them stronger and less prone to cavities and root sensitivity.
Plug in your toothbrush. Try an electric toothbrush if you have trouble brushing thoroughly by hand or you have gum problems, says Dr. Harper. The gentle vibration of the brush head massages gums as it cleans the teeth, she says. And research at the University of Alabama School of Dentistry in Birmingham has proven that electric toothbrushes can significantly reduce gingivitis. Before you do your shopping, check with your dentist. Many professionals recommend the newer breed of electric toothbrush, with bristles that rotate rather than vibrate. There are several brands for sale, including Interplak and the Braun Oral-B Plaque Remover.
Try an irrigator. An oral irrigator such as the Water Pik can help clean debris from between teeth and under gums, but use it cautiously, Dr. Harper says. "Sometimes irrigators aren't adjusted right, and the flow of water is strong enough to damage gum tissue," she says. Slow the flow if your gums feel sore or irritated after using your irrigator.
Help from the Pros
No amount of zeal at the bathroom sink can substitute for regular dental checkups, Dr. Harper says. To keep your teeth looking younger, see a dental hygienist twice a year for cleaning and your dentist at least once a year for an exam.
Your first stop is at the hygienist's chair for a professional cleaning to remove plaque and tartar, says Dr. Lewis. Once your teeth are squeaky clean, your dentist will examine your mouth. If cavities are cropping up more than they used to, you may be given a fluoride treatment at the office and a fluoride rinse or gel to use at home. But first, your dentist will fill any cavities.
And quicker than you might expect. With new, faster drills, your dentist can usually fill a cavity in about 15 minutes, a procedure that would have taken an hour 20 years ago, Dr. Harper says. What about pain? If reruns of the dental torture scene in Marathon Man are running through your head, don't worry--you won't need to outrun anything that awful. Modern dental procedures are light-years ahead of your worst dental memory.
On rare occasions, you may need a root canal to remove the pulp or nerve of a rotted tooth and fill the hole. Despite its painful reputation, a root canal done right can be no more uncomfortable than any other dental procedure, says Dr. Lewis.
For advancing gum disease, your dentist will refer you to a periodontist, or gum disease specialist. Treatment may involve oral antibiotics, antibacterial ointments squeezed into the gum pockets or, in severe cases, surgical removal of part of the infected gum or diseased bone.
And if stains or crooked teeth are your greatest dental problem, a cosmetic dentist can help. Bleaching whitens stains, and a variety of other techniques can restore the youth and beauty of your smile. (For details, see Cosmetic Dentistry, chapter 81.)
Facts about Fillings
Your dentist tells you that you have a few cavities. "Whoaaaa," you say. "Have you inhaled too much of that laughing gas? I'm too old for cavities." Sorry, sister, but you're never too old for cavities. Lots of women get them well into their later years, says Richard Price, D.D.S., clinical instructor of dentistry at Boston University's Henry Goldman School of Dentistry. One reason is that old fillings wear out. Although some may last decades, the average life span of silver fillings is about nine years. Beyond that, they tend to chip, crack and wear out. "They're just replacement parts," says Dr. Price. "Any time you get a tooth drilled and filled, it will need to be drilled and filled for the rest of your life. It's like your warranty wearing out." Sometimes adult women, even champion brushers and flossers, may acquire new cavities as well. The most common spot for these black holes is at the base of the teeth, where gums receding with age have exposed the sensitive roots to decay, says Dr. Price. If you do need a filling--either a replacement or a new one--get ready to choose from a number of alternative materials. Silver is by far the most common of the lot, because it's durable and affordable. The silver is mixed with mercury, which makes it easy to shape. The question has arisen from time to time whether this mercury, a poisonous metal, could leach into the body. Some women have even had perfectly good fillings removed because of the mercury scare. That's a shame. Yes, some mercury is released from silver fillings when you chew, but only minuscule amounts. Even less is actually absorbed by your body. "Nothing to worry about," says Joel M. Boriskin, D.D.S., chief of the Division of Dentistry at Alameda County Medical Center in Oakland, California. A number of studies measured the release of mercury from silver fillings and came to the same conclusion: There's no reason to be concerned unless your mouth can hold 1,000 fillings. But just because silver is safe, that doesn't mean it's always best. Gold, though pricy, is super strong and especially good for jumbo cavities. Fillings made from porcelain, quartz or acrylic, though not as durable as the metals, may be preferable for more visible fillings. They can be colored to match your own teeth. |
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