As the years go by, the mouth undergoes both anatomical and physiological changes. These changes, together with poor oral hygiene and certain lifestyles and ailments can impact oral health. 

The main oral disorders and pathologies, for their prevalence and relevance, that may affect adults over fifty include xerostomia, periodontal diseases and tooth loss. Additionally, with the widespread use today of dental implants to replace lost teeth, we must pay special attention to their care and long-term maintenance. 

XEROSTOMIA 

Xerostomia is the subjective sensation of dry mouth, and is usually associated with a reduction in the amount of saliva or a change in its composition (for example, saliva that is more viscous may cause the feeling of dry mouth). The prevalence of xerostomia in those over 55 is 40%. 

At this age, it is common for people to take several medications daily to treat one or more conditions, such as cardiovascular or respiratory diseases, etc. Medicines that affect the Autonomic Nervous System, which regulates salivary gland secretion, are likely to cause alterations in salivary flow. Over 500 drugs are estimated to produce xerostomia (80% of those most prescribed), such as antihypertensives, antidepressants, anticholinergics, etc. 

Furthermore, we must consider the increasing incidence of tumours in the head and neck region. Their treatment often involves the administration of radiation therapy and/or chemotherapy, which have side effects on the oral cavity, etc. In the case of radiation therapy, if the salivary glands are within the radiation field, irreversible damage to the salivary glands may occur, leading to permanent decreased saliva production. In contrast, chemotherapy-induced xerostomia can be reversed, so that normal salivation values are restored after the treatment ends. 

Finally, there are certain systemic diseases which may cause xerostomia, due both to their treatment and to the pathology itself, as in the case of diabetes. 

The main repercussion of lack of saliva or changes in its composition is the loss of saliva’s protective properties, favouring the onset of caries and other opportunistic infections, such as candidiasis, bad breath and difficulties in chewing and swallowing. 

Valuable advice can be provided at the pharmacy to improve the quality of life of those suffering from xerostomia - i.e. drinking water frequently to keep the mouth moist, avoiding irritants (tobacco, alcohol, coffee and spicy, acidic or salty foods), and above all, stepping up oral hygiene with two main objectives: to keep the oral cavity hydrated and to prevent oral infection from decreased salivary flow. 

PERIODONTAL DISEASES 

Periodontal, or gum, diseases are infectious and inflammatory diseases of the tissues surrounding the teeth: gum, periodontal ligament and alveolar bone. 

Essentially, they are divided into gingivitis and periodontitis. The main difference between the two is that in gingivitis, an infection and inflammation of the periodontal tissue occurs without there being loss of supporting tissue or bone, while in periodontitis there is destruction of the alveolar bone. The importance of gingivitis is that it precedes periodontitis, although not all cases of gingivitis result in periodontitis, as a certain genetic predisposition is necessary. 

Periodontitis is the main cause of tooth loss in adults. 

According to one study—Carasol et al., 2016—carried out in Spain on over 5,000 working adults, just 5.4% of the population had healthy gums, a figure that is even lower in those over 45. In fact, according to the same study, 6 out of 10 people over 45 had periodontitis. 

The main cause of both gingivitis and periodontitis is the accumulation of bacterial plaque, or biofilm, at the gingival margin (the junction between gum and tooth) and between the teeth, because it is difficult to clean these areas with a toothbrush. Biofilm develops dysbiosis, which is what causes a non-specific immune response, producing inflammation of the gum - aka gingivitis. 

Over time, if bacterial plaque, or biofilm, is not removed through proper hygiene, it can mature and internalise into the gum, which gives rise to the growth of bacterial species that are capable of destroying the periodontal tissues—mainly the periodontal ligament and the alveolar bone—which is what we call periodontitis. 

It is very important to bear in mind that in the case of smokers, the signs may be “camouflaged”: smoking disguises gum disease. 

Pharmacists may suspect gum disease if a customer claims to have inflamed, reddened and/or bleeding gums. In these cases, the first thing to do is to recommend they visit the dentist to get proper diagnosis and treatment. 

In addition, the importance of having proper dental hygiene should be emphasised, recommending the use of interdental tools, such as floss and tape, interproximal brushes or oral irrigators to remove bacterial plaque from between the teeth and the gingival margin. Daily use of toothpastes and mouthwashes containing antiseptics, such as cetylpyridinium chloride, should also be recommended to prevent and help control gingivitis, or containing chlorhexidine to aid in the treatment of periodontitis. 

Furthermore, many population studies have shown that there is a relationship between periodontitis (especially in its most severe forms) and systemic diseases such as type 2 diabetes, ischaemic heart disease and certain adverse pregnancy outcomes, including pre-term birth or low birth weight. 

Therefore, smokers, pregnant women, diabetics and those with cardiovascular diseases should make prophylactic use of specific oral hygiene products to prevent and control gum disease. 

DENTAL IMPLANTS 

One of the most common ways to replace lost teeth is with dental implants. 

Like teeth, dental implants can also suffer infectious and inflammatory disease of supporting tissues, which in the case of implants, is known as peri-implant disease. 

Peri-implant disease is mainly due to the accumulation of bacterial plaque, or biofilm, from poor oral hygiene around implant-supported prostheses. This infection causes inflammation of the mucosa, called peri-implant mucositis, which is equivalent to gingivitis around teeth. If bacterial plaque continues to build up, internalising and maturing, it may lead to peri-implantitis, equivalent to periodontitis in teeth, in which destruction of the bone supporting the implant occurs. 

The destruction of the bone supporting the implant causes loss of attachment, with the consequent risk of loss in the future. It is therefore important to take care of implants as if they were natural teeth. 

There are several specific brushes for implants. To be able to effectively clean implants and prostheses, these may somewhat differ from regular toothbrushes. 

Hygiene is especially important in the interdental spaces or between the implants, using dental floss or tape, interdental brushes or oral irrigators, depending on the size of each space. 

Finally, it is necessary to get check-ups as recommended by the dentist to check the state of the implants and of the tissues that surround them, to thereby prevent any complications and to ensure the long-term success of the implants.