Gum Health And Aging

Introduction 

Oral health involves the ability to eat, speak, smile, and socialize comfortably, without pain, or embarrassment, which are important aspects to overall health and wellbeing.¹ Despite being preventable, oral diseases are common across all ages, but even more in the elderly.^1,2 For example, gum disease is a chronic inflammation that affects the gums and impacts 60% of people aged 65 or above, impairing oral function and quality of life.^1,2,3

Understanding gum health

What is the function of the gums and what do healthy gums look like?

The gums around your natural teeth have important functions. They:⁴

• Help hold the tooth firmly in place in the jawbone 
• Act as a barrier, protecting the tooth and surrounding tissues from harmful bacteria that can be present in the mouth
• Stabilize the teeth against the pressures of chewing.

Healthy gums usually:⁵

• Have a "salmon" or "coral pink" colour. They also might have some pigmentation, depending on the ethnic background
• Feel firm to the touch and are firmly attached to the jawbone
• Have a tough surface and may have a texture that looks like the skin of an orange, called “stippling”
• Vary in width from one person to another and even within the same person's mouth, ranging from as little as 1 mm to more than 10 mm

Common gum diseases 

Gum disease is an infection that affects the tissues holding your teeth in place. It's usually caused by poor oral hygiene, allowing plaque - a sticky film of bacteria - to build up on your teeth and harden. It can be classified into two stages, gingivitis and periodontitis:^6,7

• Gingivitis is the mildest form of gum disease and is very common, affecting up to 90% of people. It happens when bacteria and debris build up between your gums and teeth, causing inflammation. Your gums look swollen, and red and may start to bleed. If you improve your brushing and flossing habits, it can be reversed.
• Periodontitis is a more advanced stage of gum disease where the inflammation becomes chronic and destructive. Bacteria can penetrate deeper into the tissues surrounding your teeth, triggering a response from your body's defences. However, this response can also damage the tissues, impairing the attachment of the tissues to the bone. If you don't treat it, it can spread to the bones around your gums, making it painful to chew. In severe cases, your teeth might become loose or need to be removed.

Factors that influence gum health 

Several factors can contribute to gum disease, including:^2,6,7

• Genetics: Some people may have a genetic predisposition to gum disease, making them more susceptible even with good oral hygiene practices
• Age: Older individuals tend to have higher rates of gum disease. One explanation may be that inflammatory processes are aggravated with ageing. Besides, neurogenerative disorders associated with ageing reduce the ability to care for the mouth, leading to an increase in poor oral hygiene and consequently, gum disease
• Pregnancy: During pregnancy, hormone levels in the body change, which can lead to inflammation in the gums and increase the risk of gum diseases
• Other systemic diseases: Conditions that affect the body's inflammatory system can worsen gum health. For example, gum disease has been associated with diabetes, rheumatoid arthritis and cardiovascular disease
• Medications: Certain medications like oral contraceptives, anti-depressants, and heart medicines can impact oral health
• Stress: It can weaken the body's immune system, making it harder to fight off infections, including gum diseases
• Clenching or Grinding Teeth: These can put excessive force on the supporting tissues of the teeth, accelerating gum tissue damage
• Alcohol and smoking: Alcohol and tobacco users are at increased risk for gum disease, along with oral cancer
• Poor nutrition or obesity: A poor diet, lacking essential nutrients weakens the immune system, making it harder to fight off infections like gum disease. Additionally, obesity has also been associated with an increased risk of gum disease
• Inadequate oral hygiene: Not taking good care of your mouth can contribute to gum disease. When you don't brush and floss your teeth properly, bacteria and plaque can build up, leading to gum inflammation and periodontitis if untreated

Ageing and its impact on gum health

Changes in gum tissue with age

Ageing leads to various alterations in the periodontal tissues, which include:⁸

• The gingiva - the layers of cells that line your gingiva get thin and decrease in the normal formation and accumulation of keratin in the epithelial cells of this tissue. This reduction in keratin can lead to changes in the structure and function of the gingiva.
• Periodontal ligament - this soft tissue serves to anchor the tooth to the bone and functions as a cushion between hard tissues goes through a structural transformation with ageing and its fibre and cellular contents are decreased.
• Cementum - a calcified connective tissue covering the roots of teeth. As we age, the removal and addition of cementum on our teeth increase, which can result in more uneven surfaces on the tooth roots.
• Alveolar bone - essential for tooth support, undergoes decreased bone formation and loss of bone mass.

As you get older, you may experience moderate loss of periodontal attachment and alveolar bone. However, just getting older doesn't mean you will have serious problems with the support for your teeth. While it's common for older adults to have some minor loss of bone around their teeth, severe gum disease isn't something that simply comes with ageing.⁸

Relationship between ageing and gum disease

Besides the changes in gum tissue that naturally occur with ageing,⁸ as you get older, your oral health may worsen due to various reasons, such as:^1,2,9

• Developing diseases that affect the mouth (for example, diabetes),
• Having difficulties chewing and swallowing, 
• Experiencing dry mouth possibly because of taking many medications, 
• Having reduced ability to move the mouth, 
• Struggling with self-care due to physical or neurological problems. As they progress into advanced stages of dementia, taking care of their mouth becomes harder, leading to poorer oral hygiene and gum disease, or
• Challenges in accessing dental care due to reduced mobility and transportation issues. This results in fewer dental check-ups and treatments.

Therefore, the elderly in those conditions may need more dental care. Otherwise, they may experience pain or discomfort while eating, or have issues with their dentures. Poor oral health can also impact their social life, causing loneliness, and leading to nutritional problems later on.¹

How to maintain gum health in older (or any) age

Proper oral hygiene practices and regular check-ups.

Since gum disease is caused by a build-up of plaque on the teeth, you need to remove it by brushing and cleaning in between them regularly. To prevent gum disease:^9,10

• Brush your teeth (or dentures) with toothpaste containing fluoride, at least 2x a day
• Floss your teeth or clean them in between using interdental brushes, every day
• Replace your toothbrush after 3 months
• See your dentist for regular check-ups, especially if you have type 2 diabetes
• Do not smoke

Signs and treatment options for gum disease

The signs and symptoms of gum disease are:¹¹

• Persistent bad breath or a bad taste in the mouth
• Red or swollen gums
• Gums that bleed easily or feel tender
• Pain while chewing
• Sensitive teeth
• Loose teeth
• Gums receding (pulled away) from the teeth
• Any change in how your teeth align when you bite
• Any alterations in the fit of partial dentures

Treatments for gum disease

In the initial stage (gingivitis) gum disease can be controlled and treated with oral hygiene and professional cleaning. However, when it advances to periodontitis, more extensive treatment may be required, including:^10,11

• Thorough cleaning of the tooth roots below the gums
• Taking medications orally or applying them directly under the gums
• In some cases, undergoing corrective surgery
• Teeth removal if necessary

Summary

Oral health is important to our overall health and well-being. Gum disease, a chronic inflammation that affects the gums, impacts a high percentage of people aged 65 or above, reducing their oral function and quality of life.

The initial stage, called gingivitis, can be reversed with improved oral hygiene practices such as brushing and flossing. However, periodontitis is a more severe form of gum disease where inflammation damages the tissues surrounding the teeth and can lead to bone loss, loose teeth, and even tooth removal if not treated.

Some factors influencing gum health are genetics, age, pregnancy, systemic diseases, medications, stress, habits like teeth grinding, alcohol and smoking, poor nutrition, and inadequate oral hygiene.

Ageing is already associated with changes in gum tissue, including thinning of the gingiva and structural transformation in other tissues. Added to that, challenges faced by older adults affect good oral health, including developing other diseases that affect the mouth, dry mouth, struggling with self-care and reduced access to dental care.

Maintaining gum health includes proper oral hygiene practices, regular dental check-ups, and recognizing signs of gum disease like bad breath, swollen gums, bleeding, and loose teeth. Treatment options for gum disease range from oral hygiene and a professional cleaning to medications and surgery, depending on the severity of the condition.