Why Should I Care About Geriatric Dental Care?

The World Health Organization defines the population between 65 and 75 as “elderly”. The term “old” is used for people between 76 and 90 and “very old” for those people over the age of 90. In general, older adults severely underutilize dental services. Less than 1/3 of the elderly population sees a dentist regularly, and almost 50% haven’t visited a dentist in over 5 years. Practicing in the Palm Beach area, many of my patients maintain their active and healthy lifestyles, so consequently they are living longer today. So what does that mean when it comes to the oral health of this segment of the population? And why should you care about this topic if you’re younger than 65? Let me tell you why!


Years ago, and still today, many people believe the myth that tooth loss is caused by old age. In fact, the most common reason for tooth loss is active, untreated periodontal disease. This happens across all ages. Infection in the gums is the major reason why people experience tooth loss. Gum disease is easily treatable and preventable with regular visits to the dentist and proper oral hygiene care at home. That is why it is vital that people over the age of 65 continue to keep regular dental maintenance visits every 3 months.


With increased age there is an increased risk of staining, chipping and cracking and this age group is more at risk for fractures. This means that there is an increased need for continued maintenance and replacement. This means that if we keep on eating all foods with different textures – i.e. hard, crunchy veggies or nuts – then naturally we will see more wear and tear on our dentition – whether it is our natural dentition or a denture. This means that replacement of old, existing restorations, dentures and crowns are to be expected. Just like you take your car in for regular maintenance, it’ll be up to you to visit the dentist regularly to make sure everything is in proper working order and make any replacements necessary before the teeth become hopeless and require removal. If you do this from a young age, then you’ll be sure to have the least amount of dental treatment necessary to keep your mouth healthy for a lifetime.


Recurrent decay – (under existing crowns and fillings) – and root surface decay – (where the root is exposed due to gum recession from gum disease and/or malaligned bite) account for the most common type of cavities in the older population.

Older adults typically don’t feel pain when it comes to cavities because the pulp (nerve) shrinks as we age. When you’re young, a small cavity is much closer to your nerve, so you feel the discomfort sooner and are more apt to visit the dentist for treatment. However, the older population usually will complain about food getting caught in the cavity, and sometimes by the time they decide to seek dental care, the cavity is deep below the gum line, that the tooth is now hopeless and requires extraction. This is why it’s so important that older patients seek routine maintenance dental care to avoid preventable tooth loss.


Older patients are generally on multiple medications due to various systemic diseases. Many medications cause dry mouth as a side effect. Also, head and neck radiation treatment for patients with cancer in that region of the body, almost always have loss of function of their salivary glands, leading to dry mouth. Patients with xerostomia, or dry mouth, are at an increased risk for decay and must be specially monitored to prevent tooth loss. Possible dental treatments to help prevent decay include fluoride treatments, both daily and in-office, as well as artificial saliva products and medications.


As people age, physical and cognitive problems arise. Arthritis typically sets in and causes a significant decrease in manual dexterity. However, there are people of all ages with physical disabilities that may affect their oral hygiene. There are many options to practice good oral hygiene for someone with physical issues, including electric toothbrushes, tennis balls (YES! I said tennis balls! Don’t worry, I’ll probably write a blog on this topic alone.) and other unique tools. If cognitive issues, such as Alzheimer’s or dementia exists, then the task of oral hygiene falls to the caregiver. If there is no caregiver, there’s even a higher chance of it leading to poor oral hygiene practice at home, therefore increasing the on-set of decay and gum disease in the aging population. For this segment of the population, it is especially important to see the dentist even more often, perhaps even as often as every 1-2 months.

These are a few of the issues that afflict our brilliantly aging population. So if you know someone who has a lot of life experience, but hasn’t been to the dentist lately, then give them a call and tell them to visit the dentist TODAY!


Dr. Meli

Which Mouthwash is Right for Me?

Let’s talk mouthwash! I know it’s always so confusing when you’re standing in the oral health care aisle at a store and you look at the myriad of bottles of colorful mouthwash, wondering which one is right for you. Let me break it down so you can get a better understanding of what is available OTC.

Manufacturers divide OTC mouthwashes into three main categories:

1.) Fluoride

2.) Antiseptic

3.) Whitening

Fluoride Mouthwashes:

Fluoride mouthwashes, which are usually purple in color, are also known as “anti-cavity” because they usually contain 0.02% sodium fluoride. Yes, fluoride is good for your teeth and prevent cavities if you are cavity prone. However, in order to get this super low concentration of sodium fluoride into your teeth, the mouthwashes are super acidic, meaning they have a low pH. Over the long term, this can damage your enamel on your teeth. In fact, one of the ingredients they use is phosphoric acid, which is what we use to etch the teeth when we do bonding on teeth. So you can imagine how strong of an acid that is!

However,the fluoride treatment that you get at a dental office usually has 10 times higher concentration of fluoride, and it usually has a neutral pH. This way right after your dental hygiene maintenance, when there is no plaque or tartar present, the fluoride has it’s best chance of permeating your enamel and strengthening your teeth, and even your gums. If I had to recommend an OTC fluoride mouthwash, it’d be the ACT mouthwash. Why? Because it has a neutral pH and has 0.05% sodium fluoride in it, almost three times that of the rest of them. Also, it has a unidose measuring system at the top of the bottle, so you can never use too much and get an overdose of the mouthwash or fluoride in it. So if you like Berry Blue, Bubblegum or Fruit Punch flavor, then go for it!

Antiseptic Mouthwashes:

The next category is antiseptic mouthwashes. These are the most commonly used, and typically you’ll feel a burning sensation when rinsing with these due to the high level of alcohol. The alcohol is in fact antiseptic, but it indiscriminately kills all bacteria in our mouth, leaving it unbalanced and therefore more susceptible to a yeast or fungal infection. Also studies have definitively shown that alcohol is a huge risk factor for oral cancer. So these mouthwashes usually have 25-27% alcohol content. This is 2-3 times what we find in a glass of wine or beer. And when you drink a glass of wine or beer, you’re simply sipping it and swallowing it. Whereas with an antiseptic mouthwash, your swishing it for 30 seconds straight, twice a day, pushing it into your oral mucosa of your cheeks and gums. Over time it’s going to cause cell mutations and then lead to oral cancer. Alcohol also has a drying effect, and a dry mouth is more prone to cavities, so be aware!

Also, another popular ingredient in antiseptic mouthwashes is Cetylpyridinium Chloride, aka CPC. This has antiseptic properties, but will stain your teeth brown. And the Eucolyptol and Thymol commonly found in antiseptic mouthwash will stain your teeth yellow. Now, these stains can be removed with a professional dental cleaning, but do you really want to be walking around with severely stained teeth from a mouthwash?

Which OTC antiseptic mouthwash would I recommend? Only one that is alcohol free for sure, but overall I don’t recommend them to my patients. If they want some fresh breath and that’s about it, then I tell them to dilute it with water, this way they get the freshening effect without the harmful side effect of the alcohol contained within. In fact this is what we do in the office to give a better flavor to the water our patients rinse with while in the dental chair.

Whitening Mouthwashes:

The final category of OTC mouthwashes is whitening. These generally have hydrogen peroxide as a whitening agent. Usually you’ll see the bottles are opaque, not translucent, so that that hydrogen peroxide doesn’t disintegrate. The level of hydrogen peroxide is minimal, but it can still be damaging to your gums. Over the years, I’ve seen so many patients who’s cheeks were peeling away on the inside of their mouths due to using a whitening mouthwash. As soon as they discontinued use of the whitening mouthwash, the pain and discomfort and peeling stopped. I do not recommend anyone use a whitening mouthwash, even if it says “Pre-brushing whitening rinse” on the bottle. These only cause sensitivity and are not as effective as you might think, especially if you have plaque and/or tartar buildup on your teeth. And for patients for have any recession, the sensitivity can be especially high. If you really want whiter teeth, then be sure to floss and brush them!

So I hoped this helped open your eyes to what’s available when it comes to OTC mouthwash. I’ve also got a Mouthwash Review video on my YouTube channel, so be sure to check it out.

Next time, I’ll discuss Natural Mouthwashes and what I recommend when it comes to that category.


Dr. Meli

Is Chewing Ice Bad for my Teeth?: YAAAAAASSSSSS!!!!

This is a question I get asked quite often by my patients. “Is chewing ice bad for my teeth?”

The definitive answer is: YAAAASSSS!!!! Let me tell you about why people chew ice, and how in fact it can severely damage your choppers.

You probably started chomping on ice cubes in your drink when you were a kid and your mom had to tell you stop doing it because it was rude to make so much noise at the dinner table. Well, not only that, but you were consciously chewing on super cold and super hard stuff. Our teeth are not meant to handle so much stress when masticating (that’s the technical term for chewing). So as you can imagine, what happens over time if you continue to chew on ice, is that your teeth start to wear down and over time your bite gets all out of whack. Also, the severe cold temperature of the ice will cause the enamel on your teeth to expand and contract. Not only that, if you have any type of fillings, the material of your fillings will expand and contract at a much faster rate that the enamel of your tooth, thereby causing teeny tiny cracks in your enamel. Just like you see the cracks in the asphalt after years of winter and summer seasons passing, the same thing happens to your teeth. And eventually these micro cracks will turn into large cracks and you’ll simply break your teeth off!

Pagophagia is a form of the disorder pica and it involved the compulsive consumption of ice or iced drinks. Typically, it has been associated with iron deficiency anemia. However, once iron levels are increased, most people stop the ice chewing habit. It is purported that people with iron deficiency chew ice constantly in order to soothe the pain associated with glossitis ( an inflamed tongue) which is a symptom of iron deficiency. Usually the tongue is super red and irritated and can become painful. So the super cold ice numbs the pain, and hence leads to pagophagia .

However, if you’ve not been diagnosed with iron deficiency anemia, then why are you still chewing on ice? For some it may be generally soothing habit to calm them down in a stressful situation, much like biting your nails or gnawing on a pencil. For others they just love to visit the dentist so much that they try as hard as possible to do severe damage to their teeth so they can rack up some more dental chair time…..said no one ever! But it has been documented that due to peer pressure, children will grind and chew on hard things like ice to self-mutilate teeth because they are teased for having crooked and uneven teeth. So be sure to check up on your children and make sure they’re actually doing irreversible harm to their teeth.

Remember, our teeth are not meant to constantly chew on hard, cold chunks of ice! If you think you might be doing it because you have an underlying systemic disease like iron deficiency anemia, then call your medical doctor or your dentist to get checked out asap! And if you just can’t kick the habit then suck on the ice cubes instead – you’ll still get the pleasant cooling sensation you love without the long-term damage to your teeth.


Dr. Meli