As with many other advances in medicine and health, the rate of complete tooth loss or edentulism is declining in the United States. Gone are the days when the dental profession would expect to provide dentures for most persons over age 65. Now only about 27% are edentulous.¹ The average number of teeth that seniors retain has been steadily rising as our first fluoride generations mature. And it is not that most people have at least a few teeth, the average number of teeth for those over age 65 is nearly 19.

However, as all persons involved in the field of geriatrics know, the sheer number of older adults is on the rise. Therefore, 27% of this growing number is truly an issue to be addressed. As a dental professional, my ultimate goal has always been to keep patients chewing, speaking and smiling with natural teeth as far into life as possible. While dentures are a good answer to the problem of having no teeth, they are not a substitute for natural teeth.

Cavities and periodontal disease are the culprits often cited as the reason to remove natural teeth. And in truth, these two diagnoses are the ones that account for most extractions of natural teeth. However, other issues underlie the decision to extract a tooth versus save it as well as a person’s decision to attend or disregard their oral health in the first place.  Two studies published in 2010 looked at cultural biases that may contribute to choosing removal of all teeth and the reason for tooth loss at various times in life by some but not all people.

Sussex et al, looked at a large cohort of older persons in New Zealand who were edentulous and reasons behind the initial decision.² Several interesting factors were highlighted. They found that while most of the group stated they valued natural teeth over dentures, when faced with diseases such as caries and periodontal disease, they noted that many of their peers and elders had dentures, and did not see this as a burden or a lesser outcome. Once a few teeth were compromised, it was easier to remove the rest.  Those in rural settings were more likely to choose removal of teeth versus saving them. Finally, if they had experienced past toothaches or loose teeth due to periodontal disease, their thought was that from an overall health standpoint they were better off without their teeth.

Thorstensson et al looked at reasons for tooth loss at varying ages.³ Interestingly, these changed as the age groups changed.  The study found that becoming edentulous early in life was closely related to social class. Loss of all teeth during mid-life was more closely associated with achieving a lower educational level. Finally, only in late life, was becoming edentulous significantly linked with self-reported poor life style choices.

As a provider, this information is a key to how I approach my discussions with patients. Obviously, some groups of patients still require education on the benefits of good oral health, with the cornerstone being healthy natural teeth. Prevention can prevent, stop or delay both caries and periodontal disease, but if a patient believes that dentures are as good as natural teeth, there is no motivation for a life style change.

Although far from true, many of our older patients still believe that extraction of teeth is just part of normal aging. While tooth extraction is at times necessary when the oral infectious burden becomes too high, this should not be the norm. Thorstensson et al state that “improved understanding of the underlying causes of tooth loss are still needed to improve interventions and especially to improve prevention,” a primary goal in the practice of dentistry.

References:

1. Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. National Center for Health Statistics. Vital Health Stat 11(248). 2007.
2. Sussex PV, Thomson WM, et al. Understanding the epidemic of complete tooth loss among older New Zealanders. Gerodontology. 2010;27:85-95.
3. Thorstensson H, Johansson B. Why do some people lose teeth across their lifespan whereas others retain a functional dentition into very old age?Gerodontology. 2010;27:19-25.