Dental disease isn't just about cavities or sore gums. Research has linked poor oral health to serious chronic illnesses, including heart disease, diabetes and dementia.
And in Florida, where the senior population is growing faster than almost anywhere else, the effects are hard to ignore.
Pensacola dentist Dr. Scott Dickinson said he sees the same problems again and again among older patients.
"Periodontal disease is very prevalent in that population and relatively unaddressed," Dickinson said. "And then tooth loss."
He said research increasingly shows how oral bacteria may affect the rest of the body.
"The bacteria that cause gum disease are also the same bacteria that cause cardiovascular disease, diabetes, and dementia," he said. "I'm cautious to say if you've got gum disease, you're going to get coronary artery disease. I'm not saying that. But the links are all there."
At the University of West Florida, Shelley Diviney, interim dean of the Usha Kundu, MD College of Health and a former dental hygienist, said the science supports those connections.
"One in three adults over the age of 65 has periodontal disease," Diviney said. "If you raise the age to 75, 81% of adults have it. The leading causes of death in this country are chronic diseases like cardiovascular disease and diabetes, and there's a link to all of them with oral health. It's very difficult to manage diabetes if you have active periodontal disease that's not being managed."
Diviney said the tissue lining the gums is similar to the tissue lining the arteries. When gums are inflamed, bacteria can enter the bloodstream, where it may harden and build up inside the arteries the same way it does on teeth.
She said her son, a cardiology surgical technologist, once noticed the connection firsthand.
"He said, 'Wait, that hard, white, crunchy stuff we're pulling out of arteries; that's the same thing that's in the mouth?' " Diviney recalled. "I pulled up pictures and he said, 'Yes. That's exactly what it looks like when we clear out the arteries.' "
Diviney said the same process may also explain how dental disease relates to dementia.
"Toothlessness is related to dementia," she said. "The younger you are when you lose teeth, the stronger the connection. The bacteria that cause inflammation in the gums can cross into the bloodstream and even the blood-brain barrier."
Beyond health risks, Diviney said oral problems can also take an emotional toll.
"When people feel embarrassed about their mouth, they don't want to talk, they don't want to be in public, they don't want to eat in public," she said. "Social isolation can lead to depression and difficulty even with employment."
Back in his office, Dickinson recalled a patient he called "Nancy," who asked not to use her real name because she was too embarrassed to be identified. He said her story represents what many seniors face.
"Nancy had gone decades with dental pain and had found herself very slowly without most of her teeth," Dickinson said. "She'd lost a lot of weight and felt unhealthy. When we replaced her missing teeth with false teeth modeled after her smile from 20 years ago, she loved the way she looked."
Dickinson said advances in dental materials are helping patients like Nancy regain confidence.
"It's incredible because dentures are not thick and bulky anymore," he said. "The newer acrylics are so strong they only need to be a millimeter or two thick."
He said modern dental implants also offer a secure, simple fit.
"They snap in the same way Legos do," Dickinson said. "They're not your grandma's dentures."
Still, Dickinson said cost remains a major barrier for many seniors. He recommended options to make care more affordable.
Dr. Joseph-Charles Mardini said his clinic at Community Health Northwest Florida sees many seniors with advanced dental problems.
"Usually they come from a long history of neglect," Mardini said. "We see a lot of senior patients with missing teeth, infections and abscesses. We operate on a sliding scale based on income, which helps us provide care at a greatly reduced cost."
Community Health is a nonprofit that provides health care to the medically underserved in the Pensacola Bay area.
Mardini said Medicaid limitations and low reimbursement rates often make his clinic a "last stop" for many patients.
Despite the barriers, Dickinson said prevention remains the most effective approach.
"Addressing it in the mouth is one of the easier ways," he said. "It doesn't usually involve surgery or medication. If that's a healthy environment, we typically see a healthier patient systemically."
He said the hardest part for many seniors is just making that first appointment.
"Getting through the front door is the first step," Dickinson said. "Don't avoid it because you're afraid it's going to be bad. It's probably not as bad as you think."
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