The challenges seniors face with ageing teeth.

Did you know? Long-term medications used to treat chronic medical conditions can cause changes to the inside of one’s mouth, leading to conditions such as dry mouth and gum overgrowth (i.e. enlargement of gums due to inflammatory responses).

In addition, older adults tend to experience natural wear-and-tear of teeth over time due to normal aging.

This often results in loss of enamel (the outer protective layer of the teeth), and recession of gums which increases root exposure.

As a result, older adults are more susceptible to common dental conditions ranging from:

• Tooth decay (caries)

• Ulcerations, 

• Infections, to 

• Gum disease

With the number of people worldwide aged 60 or older expected to nearly double to 2.1 billion by 2025 based on World Health Organisation’s projection, in part due to the use of long-term medications to prolong life, it is important to understand how certain medical conditions and medications and can affect your oral health, and what can be done to ensure the best outcomes for your oral health.

In this ‘Ask the Specialist’ Q&A forum, Dr Kong Rui Ling answers your questions on common dental issues that older adults face. Learn about the:

• Effects of long-term medications on oral health

• Common dental issues faced by older adults, how to manage them and more!

About Dr Kong Rui Ling

Dr Kong Rui Ling graduated with a Bachelor of Dental Surgery from King’s College London in 2010 and obtained her Master in Dental Surgery (Prosthodontics) in 2021 from the National University of Singapore. 

She is currently pursuing a Graduate Diploma in Geriatric Dentistry, and is an accredited Prosthodontist with the Singapore Dental Council. Her clinical interests include management of medically compromised geriatric patients, digital and implant assisted dentures.

Questions and answers on oral health for seniors

1. Question by Khoom Tay

Dear Dr Kong,

What are the impacts of bisphosphonate on the gum bones and teeth?

Answer by Dr Kong Rui Ling

Dear Khoom Tay,

Bisphosphonates are a class of drugs primarily used to treat bone-related conditions, such as osteoporosis, and to prevent bone fractures in people with cancer that has spread to the bones. While they are effective in strengthening bones and reducing fractures, bisphosphonates can have specific impacts on the gum bones and teeth, particularly in some individuals.

Some of the potential impacts of bisphosphonates on oral health include:

1. Osteonecrosis of the jaw (ONJ)

• Most serious impact:  A condition where the bone in the jaw starts to die due to reduced blood flow. This is more common in patients who are treated with intravenous bisphosphonates (used for cancer-related bone problems), but it can also occur in those on oral bisphosphonates (used for osteoporosis).

• Symptoms can include jaw pain, swelling, infection, and exposed bone. ONJ can occur after dental procedures like extractions, or even spontaneously.

2. Delayed healing after dental procedures

• Bisphosphonates can result in a slowdown in the healing process after dental procedures, such as tooth extractions, implants, or oral surgeries. This can lead to complications, including infection or delayed recovery.

3. Increased risk of dental infections

• The inhibition of bone remodeling by bisphosphonates can potentially reduce the ability of the gums and bone to repair themselves after injury or infection. This can make it harder for the body to fight off infections in the gums or teeth.

It is important that you discuss the need for bisphosphonates medication with your medical doctor, and not let the above impacts of the medication deter you from taking it as the risks are relatively low, and benefits are likely to outweigh the risks.

2. Question by Caroline

Dear Dr Kong,

I am prediabetic. Oral health is paramount but I am afraid of my condition and oral health. How do I help myself be pro-active in dental care so I don't lose my teeth prematurely?

I suffer from teeth sensitivity. Some days I feel as if my front row of teeth are weak or shifting during my stressful moments. Should I see a dentist to ascertain if they are at risk of cracking or falling out if I bite down accidentally on them?

Thank you for your advice.

Answer by Dr Kong Rui Ling

Dear Caroline,

Taking proactive steps in your dental care can significantly reduce the risk of premature tooth loss. Here is a comprehensive guide to help you stay on top of your oral health:

1. Practice consistent oral hygiene

• Brush twice a day with a soft-bristled toothbrush and fluoride toothpaste for at least two minutes, making sure to clean all surfaces of your teeth and along the gumline.

• Floss daily to help remove plaque and food particles between teeth, areas that your toothbrush may miss. This is especially important for preventing gum disease, which can lead to tooth loss.

• Use a mouthwash with antimicrobial or fluoride components daily to help kill bacteria and strengthen your teeth.

2. Regular dental checkups and cleanings

• Visit your dentist at least once every six months or as recommended by your dentist.

• Early Detection through routine visits allow the dentist to catch any problems early, like cavities, gum disease, or signs of oral cancer, and address them before they become more serious.

3. Dietary considerations

• Eat a balanced diet, limit sugary and acidic foods and stay hydrated with water.

4. Quit smoking or using tobacco

• Smoking and tobacco use significantly increase the risk of gum disease, tooth decay, and oral cancer. If you smoke or use tobacco, consider quitting to improve your oral health and overall well-being.

5. Protect your teeth

• Use a mouthguard if you grind your teeth at night (a condition known as bruxism). Grinding can wear down teeth and lead to fractures or premature tooth loss.

I would encourage you to seek a dental consultation early to get the problem diagnosed and treated early. You may consider booking an appointment with NDCS using the HealthBuddy app, or seeing a general dentist in a private clinic for a consult in case it is a problem where time is of the essence.

3. Question by Doris

Dear Dr,

I am 68 years old. I have denture up and below. And the one below my gum is giving me a problem till today I have not seen my dentist at all.

I need someone who is specialise for gum problems and tooth decay.

I would love to register upcoming talk but I will be away till 3rd week of April.

Need your help, thanks.

Answer by Dr Kong Rui Ling

Dear Doris,

It sounds like you do need attention from a dentist to assess your current set of dentures and determine the cause of discomfort. I would highly encourage you to get in touch with your dentist, or NDCS through an appointment request on the Health Buddy app, so that the above option can be discussed sooner rather than later.

4. Question by Richard

Dear Dr Kong,

I am a 77-year-old Singaporean retiree.

My teeth are generally in good condition as I clean them well using dental floss, dental rubberised picks a proxa brush.

Whenever I visit my dentist for regular cleaning and polishing, the electric drill always hits sensitive spots and that makes me jump! 

My question is: Can I be rid of sensitive nerve spots? I also find that as I grow older my teeth become brittle and break more frequently than some years ago.

Please let me know if there is anything that can be done to minimise gum sensitivity and slow down brittle teeth. Thank you.

Answer by Dr Kong Rui Ling

Dear Richard,

Sensitive teeth occur when the underlying dentin (the layer beneath the tooth enamel) becomes exposed, typically because the enamel has worn down or the gums have receded, exposing more of the roots of the teeth. For the same reasons, older adults are at a higher risk of developing tooth decay at the roots of teeth. It could eventually lead to teeth fracturing if the decay is severe.

There are several steps you can take to help minimize gum sensitivity and slow down the process of brittle teeth. Both gum sensitivity and brittle teeth can be linked to various factors, such as oral hygiene habits, diet, and health conditions. Here are some strategies to address both issues:

Minimizing gum sensitivity

1. Use a soft-bristled toothbrush 
   - Switching to a soft-bristled toothbrush helps reduce irritation to the gums and enamel.

2. Brush gently
   - Avoid brushing too aggressively, as this can wear away your gum tissue and enamel, making your teeth more sensitive.

3. Desensitising toothpaste
   - Consider using a toothpaste designed for sensitive teeth. These contain compounds that block the pathways to the nerves inside your teeth, reducing sensitivity.

4. Fluoride treatments
   - Fluoride strengthens enamel and can help reduce sensitivity.

5. Avoid acidic foods and drinks
   - Acidic foods (like citrus fruits, vinegar, and soda) can irritate sensitive gums and contribute to enamel erosion. If you consume acidic foods or drinks, rinse your mouth with water afterward to help neutralize the acid.

5. Question by June

Hello Doctor,

I would like to know, for an elderly with no teeth at all, is it advisable to have a mix of implants and denture done?

I was thinking that if they have implants, the denture can then sit better in their mouth without using the dental glue.

Appreciate your advice, thank you.

Answer by Dr Kong Rui Ling

Dear June,

For many older adults, implant-supported dentures can be an excellent solution for improving quality of life, especially if they have had problems with traditional dentures.

However, as with any procedure, it is important to consult with a dentist to determine whether you are a good candidate for dental implants. The decision will depend on your oral health, bone structure, medical history, and personal preferences. 

Do book a consultation with your dentist to discuss in greater detail the risks and benefits of such dental treatment.

6. Question by Choo Pin

Dear Dr,

I noticed a tiny red dot on my lower left gum. The tiny red dot is very tiny, can’t even measure , it has been there for 9 months, never grow bigger till Now. It doesn’t affect my eating. It’s normal I don’t feel it at all.

I went to see a dentist, had an x ray and examined the whole mouth, nothing abnormal,  found nothing and asked me to do a biopsy.

I was not keen so asked to come back March to check again. Do you have advice on what this red dot could be? Thank you.

Answer by Dr Kong Rui Ling

Dear Choo Pin,

Without a detailed physical examination of your mouth, I am unable to advise what the red dot could be. A review appointment with the dentist would be the best option for closer monitoring of the area.

7. Question by Arnold

Hi Dr. Kong,

I am aged 75, male, a Singapore citizen. I have a heart stent installed and 4 years ago was diagnosed with prostate cancer with metasis to my bone (pelvic, leg...etc).

Am now undergoing treatments and taking daily medicines as prescribed and monthly injectable medicines: DENOSUMAB & LUCRIN DEPOT.

Now, I intend to make dentures because all my moral teeth were extracted on the advice of NDCS a few years ago, because I need to go for the 3-monthly injectable medicines.

Currently, I am using the front teeth, upper and lower row, to chew the foods during my lunch and dinner. This will lead to indigestion. I am afraid that all my front teeth would one day in future will get loose one by one.

Should I keep the front teeth and make dentures for those missing teeth? Or I need to extract all the front teeth and then make dentures?

I look forward to your early professional advice, thanking you.

Answer by Dr Kong Rui Ling

Dear Arnold,

Whether you should keep your front teeth or extract them and go for dentures depends on several factors, including the condition of your current teeth, your overall oral health, your medical history, and the recommendation of your dentist. 

If your front teeth are still healthy and stable (with no severe decay, damage, or infection), it is generally best to keep them. Healthy teeth provide better support for facial structure, help with speech, and contribute to chewing function. They also maintain natural aesthetics.

However, if there is significant damage to multiple teeth, sometimes it is best to extract and replace them. I would highly encourage you to get in touch with your dentist to discuss a suitable treatment plan after a detailed assessment is performed.

8. Question by Mdm Tan

Good day, Dr Kong

I'm a Heart patient. My question to you is, do we still need to take antibiotics before every visit to a dentist (to be taken 1 hour before appointment time)? 

Private dental clinic charged me $8-10 for 8-10pcs/250mg of Amoxicillin. Which I find the price is too high compared to polyclinic (for normal consultation where antibiotics is required)

How often do we need to go for normal cleaning?

Should I make appointment with NDCS and what are their charges for normal cleaning n antibiotics if I still need to continue taking?

Thank you for taking the time to answer my questions.

Answer by Dr Kong Rui Ling

Dear Mdm Tan, 

The use of antibiotics before dental procedure may act as a preventive measure to reduce the risk of bacteraemia (the presence of bacteria in the bloodstream), which could lead to more serious infections such as infective endocarditis (an infection of the heart valves) or infections in artificial joints or prosthetic devices. 

The need for antibiotics prior to dental procedure is best determined by your cardiologist. If you are unsure if there is still a need for it, you may contact your cardiologist to check.

I would recommend visiting your dentist at least once every six months, though this duration may differ depending on your existing oral health and maintenance regime. 

Early detection through routine visits allow the dentist to catch any problems early, like cavities, gum disease, or signs of oral cancer, and address them before they become more serious.

9. Question by Cheong Lee

Dear Dr,

What can the elderly do to prevent losing their teeth?

Answer by Dr Kong Rui Ling

Dear Cheong Lee,

Taking proactive steps in your dental care can significantly reduce the risk of premature tooth loss. Here is a comprehensive guide to help you stay on top of your oral health:

1. Practice consistent oral hygiene

• Brush twice a day with a soft-bristled toothbrush and fluoride toothpaste for at least two minutes, making sure to clean all surfaces of your teeth and along the gumline.

• Floss daily to help remove plaque and food particles between teeth, areas that your toothbrush may miss. This is especially important for preventing gum disease, which can lead to tooth loss.

• Use a mouthwash with antimicrobial or fluoride components daily to help kill bacteria and strengthen your teeth.

2. Regular dental checkups and cleanings

• Visit your dentist at least once every six months or as recommended by your dentist.

• Early Detection through routine visits allow the dentist to catch any problems early, like cavities, gum disease, or signs of oral cancer, and address them before they become more serious.

3. Dietary considerations

• Eat a balanced diet, limit sugary and acidic foods and stay hydrated with water.

4. Quit smoking or using tobacco

• Smoking and tobacco use significantly increase the risk of gum disease, tooth decay, and oral cancer. If you smoke or use tobacco, consider quitting to improve your oral health and overall well-being.

5. Protect your teeth

• Use a mouthguard if you grind your teeth at night (a condition known as bruxism). Grinding can wear down teeth and lead to fractures or premature tooth loss.

10. Question by Zakaria

Hi Dr Kong Rui Ling,

I have a serious gum disease and over the years have been losing few of my teeth. I did brush my teeth daily and yet the gum disease never subsided.

Now my upper front teeth are loose and I’m afraid the teeth might come out. I intended to go for upper and lower set of teeth implants compared to using a denture for more easier chewing of food.

I have a few questions to ask you which I hope you able to answer my inquiries regarding gum disease and teeth implants.

a) Is serious gum disease still able to be treated?

b) With gum disease, is it possible for me to go for an upper and lower full set of teeth implants?

c) Is the cost of treatment for gum disease costly?

d) Does gum disease lead to other health issues such as heart problem, etc?

e) Which it a better option for those who has a gum disease? Dentures or teeth implants? 

Thank you for answering my questions.

Answer by Dr Kong Rui Ling

Dear Zakaria,

It sounds like you might be diagnosed with periodontitis. This condition causes the gums to recede, and the bone that supports the teeth may begin to break down. As the disease progresses, it can lead to tooth mobility and even tooth loss if not treated.

Periodontitis is treatable, but the treatment success largely depends on the severity of the condition and how early it is detected. 

Periodontitis is a chronic disease that can be managed and controlled with the right treatment, but it cannot be completely cured, especially in advanced stages. However, with proper care, it is possible to halt its progression, reduce symptoms, and restore gum health.

If you are free from gum disease, dental implants are typically the preferred choice due to their longevity, natural feel, and ability to preserve bone and gum health. 

Dental implants are only viable if the gum disease is under control and you have enough healthy bone to support them. If your gum disease is more advanced or if you are unable to undergo surgery, dentures might be the better immediate option.

It is essential to consult with a dentist or periodontist to evaluate the severity of your gum disease, the condition of your bone, and your overall oral health before deciding on the best treatment plan.

11. Question by Charles

Dear Dr Kong

I saw your Q&A on dental health. I am a retiree. I do suffer from a number of dental issues:

• Wearing off of enamel
• Previous root canal treated teeth breaking off
• Molar crown breaking off
• Tooth decay

I believe my issue is extensive and I hesitate to see a private orthodontist as I expect the cost will be significant.

Does SingHealth as part of the Polyclinic system provide for dental care of such nature?

Should I first visit the Polyclinic and from there they can advise me if I need to seek consultations with more senior specialists?

I am currently with the Punggol Polyclinic FPC service at Oasis Terrace.

Answer by Dr Kong Rui Ling

Dear Charles,

You may make an appointment at any dental polyclinic to have a detailed assessment performed first. There are polyclinics under the Singhealth cluster, and one of them is the Punggol Polyclinic. 

If the dentist determines that you need more specialised treatment, an appropriate referral will be made for you to receive the appropriate care at National Dental Centre Singapore at subsidised rates.

12. Question by Lily

Hi Dr,

My husband has no teeth and eats with his gums. He is only around 65years old and underweight as he depends on soft food.

As he has no money to make dentures, what can be done to help him? Thank you.

Answer by Dr Kong Rui Ling

Dear Lily,

You may proceed to fix an appointment in a dental polyclinic to obtain a referral letter for your husband to be seen at National Dental Centre Singapore. An appointment can subsequently be fixed with a medical social worker to assist in financial matters pertaining to dental treatment.

13. Question by Mee Eng

Dear Dr Kong, 

May I know how to protect teeth from falling out after filling.

For elderly patient, how long have to arrange for dentist appointment?

Being 60 years old and above, will they able to adjust teeth?

Answer by Dr Kong Rui Ling

Dear Mee Eng,

You may protect your teeth by practicing excellent oral hygiene such as brushing with a soft-bristled toothbrush and fluoride toothpaste for two minutes twice a day. Make sure to brush along the gumline to remove plaque and food particles.

Floss between your teeth at least once a day to remove plaque and debris from areas that your toothbrush cannot reach. This helps to prevent gum disease and cavities between the teeth.

Schedule regular dental visits (typically every 6 months) for exams and professional cleanings. Your dentist can catch early signs of tooth decay, gum disease, and other issues before they progress into more serious problems.

14. Question by Les

Dear Dr Kong, I have the following questions:

I was told by the dentist that all my teeth are cracked inside as the x-ray has shown. The reason could be due to grinding during sleep and/or the acidity of citrus juice. 

The dentist also said that in a few years, more of my teeth will crack away as I age (I am 62 years old) like what has happened with one of my bunny teeth cracked a few months ago.  I am still awaiting for the implant process to complete.

a) Besides wearing the teeth guard to sleep nightly, what else can be done to protect my teeth without them cracking away? What other treatment can be done to strengthen the teeth, e.g. enamel coating, without converting to denture totally when not all teeth will crack at the same time and implants are too expensive and take too long.

b) I also have receding gums.  How to stop gum from receding further and what treatment can be done to restore gum and be able to take cold drinks without pain or discomfort?

Thank you for your advice.

Answer by Dr Kong Rui Ling

Dear Les,

It sounds like you are dealing with multiple concerns related to teeth protection, strengthening your enamel, and gum recession.

For tooth protection and strengthening, you can continue using your night guard, use fluoride treatments, enamel-strengthening toothpaste, and avoid acidic foods.

For gum recession, practicing proper brushing techniques and considering professional treatments like scaling, gum grafting, can help slow the progression and alleviate discomfort. Desensitising treatments for cold sensitivity can also make a significant difference.

Since implants are relatively expensive and takes time, focusing on prevention and early intervention is the best approach. Be sure to consult your dentist or periodontist to tailor a plan that suits your specific oral health needs.

15. Question by Joseph

Hi Dr,

I am an elderly and was treated for tooth decay to prevent potential risk of developing into root canal issue a year ago and was told by the dentist the sensitivity of the area will go away after few weeks of treatment, avoiding drinking cold water and chew too hard food at the back of the teeth.

However, till now I still find that gum area very sensitive. Pls advise.

Answer by Dr Kong Rui Ling

Dear Joseph,

While some level of sensitivity after a treatment for tooth decay is normal and should improve with time, persistent or severe sensitivity should be addressed by your dentist. 

They can take X-rays and conduct a clinical examination to identify any underlying causes such as infection, root canal complications, issues with fillings or crowns and the need for further treatment.

16. Question by Mohd Ishak

Hi Doc,

My dentist recommends root planting & debridement for my a/m condition. Its a term used for receding gums in men over 50s.

There are also many gaps between my teeth where food gets stuck, and I have to constantly use a toothpick to dislodge the food particles.

My dentist said that the procedure does not fill up the gaps but it will help to slower the effect of the condition.

Should I follow his advice? Just need a second opinion. Thank you.

Answer by Dr Kong Rui Ling

Dear Mohd Ishak,

Dental floss and interdental brushes are better alternatives to toothpicks for cleaning gaps between your teeth. They are gentler and more effective at removing plaque and food particles.

Scaling and root planing can be highly effective procedures to slow down gum recession and improve the overall health of your gums. 

While it cannot reverse severe recession or regrow lost gum tissue, it can stop the progression of gum disease, reduce inflammation, and promote healing. 

Regular follow-ups with your dentist are important to track your progress and ensure your gums stay healthy. If you have significant recession, your dentist might discuss additional treatments like gum grafting to restore the gum tissue.

17. Question by Anonymous

Hi Dr Kong,

I’ve been experiencing toothache since last Friday, weekends got more severe with redness on the gums.. it’s a molar tooth with past fillings on it. I have been using salt gargle, orasyl gargle and oral ibuprofen to manage the pain.

I have seen a dentist on Monday but he did nothing except concluded that I need a crown due to constant grinding of tooth, it has further cracklines.. I asked for further fillings but was refused. only solution he gave was crown!

I’m going for surgery on 13 March, (bilateral removal of expanders to insert breasts implants) I had breast cancer n I’ve been thru 4 surgeries last year due to infection after bilateral mastectomy..

Though the redness is more or less gone since Monday but I’m still having the pain.. what should I do?

I need temporary solution to ease the pain till after surgery at least 4-6 weeks later then can do crown if that’s the only solution! Kindly advise what other remedy? Thank you.

Answer by Dr Kong Rui Ling

Dear Anonymous,

It does sound like you might be experiencing some discomfort. Without a thorough dental assessment, I am unable to provide a diagnosis for your condition.

I would highly encourage you to return to your dentist as soon as possible, or seek an urgent appointment with a general dentist in a private clinic to alleviate the pain prior to your upcoming surgery.

18. Question by Peng Boon

Hi Dr Kong Rui Ling,

How to stop bone loss at the base of teeth?

I have this problem for more than 10 years although I visit my dentist twice a year.  My gums are not inflamed because I brush my teeth thoroughly twice a day and started to inject mouth wash, such as Listerine, into the gaps between the gum and teeth some 5 years ago.

Now the bone loss has reach the point where I feel pain when I am chewing something hard like meat or nuts. I have managed to keep my loose teeth for about 10 years already. Three years ago, a dental specialist advised to pull out the loose teeth.  I did not and my loose teeth are still useable.

Question: is there anything better than Listerine, such as antibiotics, to inject into the gaps between teeth and gum? Thank you for your advice.

Answer by Dr Kong Rui Ling

Dear Peng Boon,

While Listerine and other over-the-counter mouthwashes can help with general oral hygiene by reducing bacteria and freshening breath, they are not a replacement for more specialized treatments if you are dealing with more serious oral health issues, such as gum disease (periodontitis). 

Injecting antibiotics into the gaps between your teeth and gums is not a typical or recommended practice for maintaining oral health due to the risks of infection. It should be done administered orally or topically under a dentist's supervision.

19. Question by Monica

Dear Dr,

All my upper molars are gone. How can I get an implant? I am coming to age 67.

Any risk involved and the implanted teeth how long will it last? Also, can share with me the cost of one tooth? Thank you.

Answer by Dr Kong Rui Ling

Dear Monica,

Dental implants are a popular and effective solution for replacing missing teeth, but like any medical procedure, they come with certain risks. Some of the common risks are infection, implant failure, damage to surrounding structures, implant loosening and pain/discomfort.

That said, dental implants are generally very safe when performed by an experienced dentist or oral surgeon.

Dental implants are designed to be a long-term solution and, with proper care, can last 20 years or longer. However, the longevity is dependent on the patient’s oral hygiene, medical condition and lifestyle factors.

The cost of an implant at National Dental Centre Singapore starts from $5,000, depending on the complexity of the case such as the need for additional procedures such as bone grafting. Some fees are Medisave claimable.

20. Question by Caroline

Good day Dr,

I'm a senior and grind my teeth. Will a night guard help and how much does it cost to make it at NDCS? Thank you.

Answer by Dr Kong Rui Ling

Dear Caroline,

Yes, a night guard can help significantly if you grind your teeth, a condition known as bruxism. Many seniors experience bruxism, which can lead to several issues like tooth wear, jaw pain, headaches, and even damage to dental work like fillings and crowns. 

Some of the benefits of a nightguard are protection from wearing down further, reduce pressure on the jaw and the muscles that control it, and prevent damage to dental restorations.

The cost of a nightguard in NDCS may start from $300-500, excluding other fees such as consultation etc. 

You may consider booking an appointment with NDCS using the HealthBuddy app, or see a general dentist in a private clinic for the fabrication of the nightguard.

Ref: G25

Related articles:

Mild Gum Disease: How to Prevent and Manage

Dentures vs Implants: How to Choose Which Is Right for You

Common Questions about Dental Health and Treatment - Answered!