Keeping tooth decay at bay

By Kathy Henderson

After decades of regular dental visits that required nothing more than routine teeth cleaning, I was flabbergasted when my dentist announced, “You have a cavity.”

Each time I’ve told my tale of woe to a person in my age group, they’ve responded by telling of their own shock at receiving a similar report from their dentist.

What’s going on! After years of routine checkups where our dentists would say, “Keep on doing what you’ve been doing,” why are older adults, who haven’t needed a cavity filled since the ’60s, suddenly needing a filling in their 60s?

Who knew that as we aged, a new round of cavity-prone years was out there waiting for us! Well, apparently lots of knowledgeable people did know — and have been trying to wake us up to this for years.

Keep reading and you’ll find explanations and advice from a trio of experts on how to prevent and/or minimize teeth decay:

• Dr. Prasida Khanal, oral health director, Minnesota Department of Health.

• Dr. Paul Kirkegaard, St. Anthony Park Dental Care.

• Dr. Mary Owen, clinical professor, University of Minnesota School of Dentistry.

Swish and spit

First up, Dr. Owen offered an easy, economical and effective preventative tip. After you eat, snack, chew gum, take medications or consume sugary drinks, swish your mouth with water and spit it out.

That’s it. Swish — with good ol’ St. Paul Regional Water Services’ fluoridated tap water — and spit. The spitting part is essential. Swallowing can cause its own set of bacterial-related health problems.

This is also a beneficial habit to develop because although many of us are familiar with not brushing our teeth until a half hour after we’ve eaten, despite our good intentions, we can become distracted by other tasks and fail to get the brushing done.

Of course, the swish-and-spit routine doesn’t offset tooth brushing, flossing and regular dental checkups. However, this nearly effortless practice can be a significant way to reduce the acid in the mouth, which can wear away the enamel and create a cavity. Swishing can keep bacteria from feasting on the sugar that food and drink have left behind.

But just to make things a bit more complicated, do not rinse-and-spit after brushing your teeth. That practice washes away the fluoride protection.

Using a breath-fresher type mouthwash right after brushing also negates the fluoride protection. Instead, substitute a fluoride dental rinse. Look for one that lists fluoride as the first ingredient, recommends Owen. Yes, swish and spit that one, too.

Cavity-prone years, round 2

Now that baby boomer readers have been urged to swish and spit, it’s time to find out why those cavities are showing up in our third stage of life.

Turns out, it is all about what’s going on inside our mouths, as well as what’s going into our mouths.

There are many variables in taking care of the teeth, said Dr. Kirkegaard. Some changes naturally come with age, and some come from external sources.

Gums recede as we age, Owen said this makes the roots, which are receptive to decay, more accessible.

Teeth nerve chambers are also receding, making teeth less sensitive. Older adults may not feel the pain a cavity produces as much as or as soon as they would have when they were younger.

Saliva, too, decreases as we age. It plays an important but sometimes overlooked role as a natural tooth-protection component, Kirkegaard noted. Saliva’s secretion (quantity) and lubrication properties (quality) help maintain a cavity-preventing, acid-base balance and provide bacterial cleansing, he said.

Meanwhile, medications are a really big issue when it comes to trying to minimize cavity problems, Owen said. Some contain hidden sugar and others may lead to increased candy consumption.

Watch for hidden sugars in common over-the-counter medications and supplements, including chewable antacids, like Rolaids and Tums, and gummy vitamins. Owen recommends looking for sugar-free alternatives.

Then there is the dry-mouth side effect that some prescription medications bring. That discomfort is known to send people reaching for candy and lozenges to stimulate the saliva and reduce the irritation.

Owen tells of a very conscientious patient who appeared for her regular checkup with six cavities, one so serious that a tooth needed to be extracted.

The patient’s previous x-rays showed no signs of decay. It turned out that this patient had started a new medication, and the pairing of dry mouth and candy were the suspected cavity-producing culprits.

Owen ruefully added that when her patient mentioned to her physician that she was concerned because she had a piece of candy in her mouth all day long, she was told not to worry — it wouldn’t make her fat.

Remedying the disconnect between physicians and dentists is on Owen’s wish list.

Dental fear and anxiety

Besides what’s happening inside our mouths and what’s going into our mouths, cavity prevention can also be about what’s going on in our heads: dental fear and anxiety.

Dr. Khanal discussed dental fear on an “MPR News with Angela Davis” radio program. Among the numerous examples she provided, three especially stand out: seeing the dental equipment, hearing the sounds (especially the drill), and experiencing the smells can trigger memories of personal dental trauma or scary stories told by others.

Closely related is anxiety that, once at the dentist, a problem will be discovered, which correlates with the fear of what it might cost to fix that problem.

Look to build open communication and trust with your dentist to help alleviate emotional anxiety. However, don’t look to Medicare to cover most dental service. Although reimbursement rates have improved, it can be a challenge to find a dentist who accepts public insurance coverage.

Even with private dental insurance, dental work can still take a hit in one’s budget.

City of St. Paul retiree Jerry Hendrickson found that out when a sudden tooth ache signaled immediate care was needed.

“It was late in the year,” he said, “and I had already used most of my dental insurance benefits, leaving only about $40 left. I paid the balance out of pocket.”

There’s no place like home

While the University and public health officials often lead in endeavors focused on older adults and dental health, the U generally considers, your local dentist’s office the first contact for dental information.

The dental office’s role in cavity prevention begins as soon as the patient walks through the door and a health and medication history is updated or established, Kirkegaard said.

Taking into account the expertise of Khanal, Kirkegaard and Owen, imagine a dental health timeline for older adults:

The one I’m picturing no longer has a space for flabbergasted, surprised or stunned older adults when a cavity is discovered. Of course, spaces for those crucial dentist appointments remain, but they are relatively small, representing maybe an hour or so, perhaps a couple times a year.

The key is that those important dental appointments are bracketed by much larger spans of time consisting of awareness — what’s going on inside the mouth and what’s going into the mouth — and personal daily dental care routines. 

Kathy Henderson lives in St. Paul and is a Twin Cities freelance writer.

Photo caption Hygienist Janice Ettle provides dental care to St. Anthony Park Dental Care patient Sheila McGill, of St. Paul. “Our dental hygienists are at the front line of dental care for our patients,” said Dr. Paul Kirkegaard, DDS. Photo by Lily Sanchez, St. Anthony Park Dental.

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