Could Your Smile Be Aging You?

Yellowing teeth, sore gums and a crowded mouth can make you look older than your years. Here's how to turn back the clock

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Karen Curtis, a registered nurse who makes her home in New Orleans, has never thought of herself as vain. Yet the 48-year-old sometimes finds herself in front of the mirror practicing how to smile—with her mouth closed. The reason: As she’s grown older, her teeth have gotten a bit more brittle, and a few have cracked. Her once pristine whites are now dingy from years of drinking coffee; the bonding, crowns and implant she received years ago no longer match her natural teeth. In addition, her gums are receding slightly. “I feel young, but I think my smile is aging me,” Curtis says.

She’s far from alone. By the time many women reach their midforties, hormonal changes and decades of wear and tear have left them with smiles that are a bit dingier and with tooth loss from dry mouth, periodontal disease and other dental issues. “For some women, the changes can be very dramatic,” says Debra Glassman, DDS, a dentist in private practice in New York City. However, most of these age-related changes can be prevented or easily treated, says Irwin Smigel, DDS, founder and president of the American Society of Dental Aesthetics, thanks to a huge improvement in dental technology over the past 15 years.

Floss daily and brush at least twice a day: Those are the basics, but there’s a lot more you need to know. Start here.
Emiliano Ponzi

Problem: Gum Disease

About 38 percent of adult women suffer from periodontitis, a chronic inflammatory condition characterized by pocket formation (loss of gum surrounding the teeth) as well as bone loss around the teeth. “One of the risk factors for periodontal disease is aging,” says Stuart Froum, DDS, director of the clinical research department of periodontology and implant dentistry at New York University College of Dentistry.

Another risk factor is smoking. A recent University of Buffalo study found that postmenopausal women who are heavy smokers—defined as those who have smoked the equivalent of a pack a day for 26 years or longer—are nearly twice as likely to experience tooth loss, a possible side effect of untreated gum disease, as those who have never smoked. “Smoking may accelerate the progression of periodontal disease through nicotine’s toxic effects on bone,” says Xiaodan Mai, the Buffalo study’s lead author. Smokers also tend to have lower levels of bone-promoting estrogen than nonsmokers, she adds.

Whatever the cause, gum disease is typically managed—it’s generally not cured—through periodic deep cleanings at your dentist’s or periodontist’s office. Your dentist may also insert antibiotics at the infected site to assist healing. On the horizon: an entirely different approach to thwarting the disease. “Probiotics is the new buzzword,” says Beechwood, Ohio, periodontist Marcus Castro. Several small studies have suggested that “good” bacteria—the kind found in yogurt and supplements—can improve gum health and reduce the “bad” bacteria in the mouth. “It makes some sense, since probiotics repopulate the body with good bacteria,” Castro says. “I have one patient who needed an extra boost to control his gum disease, and he started taking probiotics. He’s responding well. This is only one patient, and obviously there need to be more studies, but if your doctor is OK with your taking probiotics, why not give it a try as an adjunct to accepted methods of treating gum disease?”


Problem: Dry Mouth

A decrease in saliva is one of the lesser-known effects of the decline in estrogen levels that menopause brings. You may also experience altered taste—sweets may taste metallic or bitter—and a new sensitivity to hot or cold foods, says Sally Cram, DDS, a Washington, D.C., periodontist and spokesperson for the American Dental Association. While many women simply get used to the feeling of dryness, they shouldn’t: Saliva maintains the right acid/alkalinity (aka pH balance) in your mouth and is necessary for neutralizing the acid produced by harmful oral bacteria. That’s why a dry mouth predisposes you to cavities and gum disease.


Many over-the-counter products effectively combat dry mouth, as can chewing sugarless gum. But what you eat also affects the amount of saliva—hence, the acid level—in your mouth. A study published this spring in the journal General Dentistry found that consuming Cheddar cheese (but not milk or sugar-free yogurt) increased saliva production and reduced the acidity of the mouth. In addition, certain compounds found in any cheese may adhere to tooth enamel, protecting teeth from acid.

Since cheese has a lot of calories, no one is suggesting you make it a centerpiece of your diet. But a small cube as a snack, after meals or in between, could improve your oral health, says Jeffrey Cole, DDS, president of the Academy of General Dentistry. Cram suggests another option if you suffer from dry mouth: Reduce your intake of foods that make it worse, such as alcohol (especially red wine), coffee, tea, soda and mouth rinses that contain alcohol.

Paul Fell/

Problem: Bone Loss

Many studies from the past several years have shown that the fate of your mouth and teeth is intricately bound up with the state of your bones, which often get more fragile as you grow older. “When estrogen is waning in the lead-up to menopause and afterward, the bone in the jaw can thin and become unable to support the teeth,” Froum notes. For every 1-percent-a-year decrease in your body’s bone-mineral density, your risk of tooth loss increases more than four times, according to a report from the Cleveland Clinic Journal of Medicine. “The jaw, which supports your teeth, is an extension of your skeleton. So if you want to save your smile, you have to keep your bones healthy,” says study coauthor Holly Thacker, MD, director of the Center for Specialized Women’s Health at the Cleveland Clinic. The Rx for strong bones: Consume 1,000 milligrams of calcium daily (from food or supplements) if you’re 50 or under, or 1,200 to 2,000 milligrams if you’re older. In addition, those 50 and younger should aim for 1,000 international units (IU) of vitamin D3a day, generally from supplements, while people 51 and up need 2,000 IU of D3.

Dental researchers are working hard on ways to regenerate bone that has eroded, says Pamela McClain, DDS, past president of the American Academy of Periodontology. One advance, an adjunct to traditional bone grafting, is the application of a growth factor (sometimes taken from the embryonic stem cells of pigs) into the damaged bone to stimulate the development of new tissue in the jaw, Froum explains. Building up the bones is important if you want an implant to replace lost teeth: The implants need a structure to hang on to.

Robert Kneschke/

Problem: Dental Erosion

Dental erosion, which usually affects all the teeth in your mouth at once, “is a chemical stripping of minerals from teeth—the enamel is eaten away by acids,” says Mohamed Bassiouny, DMD, PhD, a restorative dentist and a professor at the Kornberg School of Dentistry at Temple University. Without that protective enamel, teeth become sensitive, develop cavities and crack more easily than normal.

Bassiouny was the lead author in a case study published in the journal General Dentistry that compared the damage in the mouths of three individuals—a methamphetamine user, a cocaine user and an excessive diet-soda drinker—and concluded that each showed the same type and severity of dental erosion. In other words, excess diet-soda consumption is as bad for your mouth as meth and cocaine. What constitutes an excessive amount of soda? The subject in the case study consumed two liters of diet soda every day for three to five years. “That sounds like a lot of soda, but I do think that women may underestimate their own consumption,” says Bassiouny. And several earlier studies found a relationship between drinking smaller amounts of soda—diet or -otherwise—and dental erosion.

Since most sodas (especially colas) are corrosive because of their citric acid and phosphoric acid content, Bassiouny recommends limiting yourself to about six 12-ounce cans a week. After you indulge, rinse your mouth with water, which will dilute the acid in your mouth; salivary flow will help return acidity levels to normal. Wait about an hour to brush your teeth after a soda snack, since the abrasive scrubbing could further damage already weakened enamel. Also, drink your soda in one sitting, rather than sip it over time, so the acids have less opportunity to do damage. Another tactic: Drink through a straw placed toward the back of your mouth. You’ll avoid bathing your teeth in acid.


Problem: Yellowing Teeth

As you age, your tooth enamel thins, leaving you more vulnerable to staining, says Cole. So your daily coffee fix may be darkening your teeth more and more as you grow older. In addition, because the enamel is thinner, a yellowish component of teeth called the dentin starts to show, giving them an off-color cast.

While over-the-counter products do lighten your teeth, you’ll get optimal whitening with an in-office treatment performed by a dentist. There are now several options for people with sensitive teeth and gums, which are prone to irritation during lightening procedures. “Most often, sensitivity happens because a part of the tooth is exposed where gums have eroded somewhat,” says Smigel. If you are sensitive, a dentist may use a customized dam during an office treatment to cover the exposed area of the teeth nearest the gums, Glassman says. And a relatively new whitening product promises to cut down on pain in those with sensitive teeth: Philips Zoom WhiteSpeed Light-Activated Whitening System allows dentists to adjust intensity settings on patients. Of the 500-plus patients who participated in a test of WhiteSpeed, more than three quarters said they felt little to no discomfort during the treatment.


Problem: Short, Long or Overlapping Teeth

Your teeth may shift inward as you age, giving your mouth a slightly sunken appearance. The upper two front teeth also tend to shorten, usually by about two millimeters. So when you are at rest with your lips slightly parted or when you flash a big smile, your upper lip covers the front teeth. And that’s not a good look. “Some women appear as if they’ve lost their front teeth,” Glassman says.

For slightly shortened front teeth, bonding or veneers may be your best option.

You may also be a candidate for what’s known as crown lengthening, in which the dentist gets rid of excess gum tissue so that “short stubby teeth” look longer when you smile, says Castro. Conversely, if you are “long in the tooth”—your gums have receded, which makes you look older—tissue grafts can be done to cover exposed tooth roots. A possible benefit of that surgery is that your teeth can become less sensitive. Gums can also be resculpted to correct gummy smiles and uneven gum lines.

If your teeth have gotten slightly crooked and you want to whiten them as well as reverse any sunkenness in your face, veneers can be a good choice, since they add bulk and support the facial tissue, Smigel says. Alternatively, crooked teeth can be straightened with braces. Many adults who do not have severe orthodontic problems opt for Invisalign, which, as the name implies, are barely noticeable. The clear braces, which can be removed when you eat, cover your teeth. Every two weeks you switch to a new prescription until your teeth are optimally aligned.

Konstantin Chagin/

Surprising Canker Cause

If you’re prone to the small lesions known as canker sores, check your toothpaste for sodium lauryl sulfate (SLS), the ingredient that makes the product sudsy. “The research is a little squishy, but if a patient experiences recurrent canker sores, I’ll tell her to test an SLS-free brand of toothpaste,” says Cleveland dentist Thomas Snyder. Recent research has not corroborated earlier findings of a relationship between SLS and canker sores; however, a 2012 study in the journal Oral Diseases showed that using SLS-free toothpaste reduced the pain of existing canker sores and spurred their healing. Canker sores usually heal on their own in a few weeks, but since they can be related to medical conditions—deficiencies in vitamin B12 and folate as well as infection with the peptic ulcer bacterial culprit Helicobacter pylori—tell your MD if you tend to have outbreaks.


The Health Benefits of Mouthwash

Does mouthwash improve anything besides your breath? According to a recent study, the answer is a resounding yes. Research published in the journal General Dentistry shows that using a germ-killing mouth rinse can substantially reduce plaque and gingivitis (bleeding gums). The six-month study involved nearly 140 adults who brushed their teeth and rinsed—for 30 seconds, morning and night—with either an antimicrobial or a placebo mouthwash. Both groups flossed. Slightly more than half of the teeth cleaned with the antiseptic mouthwash had less plaque by the end of the study, compared with only 12 percent of the teeth treated with the placebo. In addition, nearly 100 percent of those using the antimicrobial mouthwash showed a reduction in bleeding gums, versus 30 percent in the control group.


Why the boost? “An antibacterial mouthwash gets into areas that you just can’t reach with brushing and flossing and kills off the remaining bacteria,” explains Jeffrey Cole, DDS, president of the Academy of General Dentistry. The product used in the study was Listerine, but many brands of mouthwash provide germ-fighting benefits.


Should you rinse with mouthwash before or after brushing? Despite the lack of studies on the subject, many dentists have strong opinions. Rinsing before brushing could loosen the plaque on your teeth, making brushing more effective, says Debra Glassman, DDS, a dentist in New York City. But rinsing after scrubbing your teeth should annihilate any plaque you missed, Cole says. The bottom line: Ask your dentist which practice would work best for you.

Next: Why You'll Be Healthier in the Next 15 Years

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First published in the September 2013 issue

Share Your Thoughts!


Lynette 11.14.2013

This is a serious area of aging that other publications fail to address. Not only do our teeth and gums affect the way we look, but our overall health as well. Many dentists are the first to diagnose serious diseases elsewhere in the body by looking at our teeth and gums.
At the same time, dental care is very expensive (I know; I've had to spend tens of thousands on my teeth, although I brush and floss "religiously"). But women need to be prepared to forego frivolous expenditures to have the money to preserve their oral health.
Great work!

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