Wisdom Teeth: Aging Population Provides New Challenges for Dentists

Pictured above: As baby boomers reach retirement age in mass, dentists are responding to growing age-related concerns.

 

Of all the things that a tidal wave of aging Americans have brought to society, the impact on the health care system is arguably the most far-reaching. As seniors continue to proliferate in huge numbers nationwide, their myriad health needs are piling on to a health care system already thinned by COVID-19 attrition and the departure of health care professionals who themselves have reached retirement age.

 

While all of that is well understood, one aspect of health care complicated by the aging process has flown relatively under the radar — elder dental health. Just like with heart disease or orthopedic care, senior dental patients make up an overwhelming majority for local dentists.

 

“We see everybody in our practice, but I tell people that lately, I specialize in baby boomers,” said Dr. John Dean, owner of Dean Dental Solutions in Little Rock. “Not just baby boomers, either; I’m 55, so even people in my generation all have their expectations for quality of life and what they expect is to like their smile and not be afraid to smile and to keep their teeth. They don’t want to have to put something in and pull something out and drop it in a glass of water at night.”

The issues facing elder dental patients are not just due to the demographic anomaly of the baby boomer generation all getting old at once but is also a byproduct of longer lifespans in general. Life expectancy in the United States roughly doubled between 1880 and 2020, Statista states, from 39.4 to 78.8, and added nearly a decade of life just since 1970.

 

Dean, who will mark 30 years in practice this fall, said as lifespan has extended, health care technology and treatment have traditionally been challenged to keep up, dentistry included. More recently, however, advancements in materials and treatment techniques have taken a quantum leap forward.

 

“Dentistry in the ’60 and the ’70s and the ’80s was good dentistry, but it really wasn’t service oriented or comfort oriented a lot of times,” he said. “People have had a lot of bad experiences. Even during the time I have been in practice, I didn’t used to do a whole lot of cosmetic or full-mouth reconstruction because [products then] looked like fake teeth. It didn’t look natural, and materials would come off, which was a problem.

 

“Today, the materials have gotten to where they don’t come off, they don’t break, and you can’t tell that they’re not natural teeth. You just think somebody has a great smile.”

 

According to the National Institutes of Health, senior dental issues are not limited to the cosmetic variety. Elders are susceptible to a range of issues brought on by age of teeth and oral structures, poor lifelong dental care habits and maintenance, and as a side effect of medications.

 

“Developing diseases in older age is the consequence of both environmental risk factors and genetic factors. It is known that chronic exposure to certain risk factors and the alteration of genetic material can lead to numerous chronic comorbidities,” a NIH study from 2022 states. “Oral health is often not at the center of attention when discussing health problems among the elderly, a category of population where numerous comorbidities appear, especially cardiovascular or neoplastic pathologies, that severely impact the quality of life of this population.”

 

In other words, physicians and patients are so focused on other chronic conditions that dental health often gets ignored as less important. In fact, tooth loss, or edentulism, can cause a variety of problems, from declining organ health due to malnutrition as people avoid eating fresh fruits and vegetables due to difficulty chewing.

 

“Something we have to realize is that as people are living much longer than they were even 20 years ago, we have to keep our dentition up,” said Dr. Ethan Erwin at Smile Hot Springs. “We have to be aggressive with our restorative techniques, in how we protect the teeth, in how we restore people back to function so that they can keep their teeth or keep a functional dentition for a lifetime. Being able to enjoy a meal with your loved ones later in life is something that should not be taken for granted.”

Erwin said materials are not the only element of dental care that has improved dramatically; the tools and technology available to dental physicians are also light years ahead of what was available just a few years ago.

 

“With the digital technology that we have today, general dentists and oral surgeons are able to take a three-dimensional scan of the patient,” he said. “You’ve actually got their jaw bone and their teeth in this three-dimensional CT scan, and you’re able to mesh it with the digital scan that you took of the three dimensions of their teeth with the scanner.

 

“We can mesh that together and do guided implant placement. We can make guides that fit on the teeth or bone that guides the placement of the implant. That part has changed drastically as the cost of CT scanners has come down and the cost of digital 3D scanners has come down for making impressions. It’s allowed more general dentistry offices to be able to do those types of things.”

 

Whether human teeth were meant to retain full function for eight decades is a matter for some debate, but what is true is that attitudes among dental professionals regarding senior patients have made an about-face over a relatively recent history.

 

“It used to be in the 1970s, I’d say close to 40 million people wore dentures at that particular point in their lifetime,” said Dr. Monty Heathman, founder of Heathman Family Dental in Little Rock. “No. 1, their parents probably didn’t go to the dentist, so they didn’t take their kids. It was just understood that they were going to lose their teeth. Education was key to changing that, but it still normally takes about three generations, and that’s what the studies have proved worldwide. The first generation, they lose their teeth. They tell the second generation ‘Take care of your teeth.’  The second generation tells the third generation ‘You are going to take care of your teeth, and you’re going to go to the dentist.’

“That’s led, through better education, better knowledge, better diet and longevity, to people keeping their teeth a lot longer, and the options got a lot better, whether you do single implants or a traditional crown and bridge.”

 

Another factor at play with baby boomers in particular is a general willingness to invest in their teeth at a later age, something their parents likely wouldn’t have done, as well as having the financial resources to do it.

 

“People living longer today want to invest money in their teeth, whether it be a single implant or, instead of conventional dentures, doing implant dentures that are just as good as teeth,” Heathman said. “It’s not necessarily just a teeth thing; it is an overall systemic health issue. That’s very important.

 

“My job as a clinician is to help educate patients and say, ‘There’s something else better out there for you, and the money that you spend in your mouth is a very important health care decision.’ It’s not, ‘This tooth’s bad — let’s pull it,’ anymore. It’s more along the lines of, ‘We’ve got a problem, but we can fix it.’ We have more options to keep that tooth so that the patient is able to function, meaning better nutrition intake, better lifestyle, more longevity.”   

 

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