While 4 out of 10 adults over the age of 65 still lose their teeth, many more are now retaining at least some of their natural teeth into their final years. Before the full impact of fluoridation, fluoride toothpastes, and improved oral hygiene and dental care, three-fourths of the population eventually ended up toothless. That solved the problem of dental decay and periodontal disease, but the elderly were hardly more comfortable with dentures.

With aging comes a decrease in dexterity and, less concern with oral hygiene. Diets tend to become softer and food debris and plaque accumulate around the natural teeth, contributing to root decay and advancing periodontal disease. Teeth become more brittle and fracture.

Drugs, radiation therapy, and aging also decrease salivary flow. "Dry mouth" accelerates tooth decay and reduces denture stability and comfort. It is then only a matter of time before dental decay, periodontal diseases and loss of teeth occur.

At a time when more frequent professional care is necessary the elderly don't have the funds for periodontal therapy, fillings, crowns, root canal treatment, bridges and dentures. Still, the problem is not so much that the elderly require substantially different dental care than the younger adult population but that they lack the means and access to obtain it.

Maintaining oral hygiene can be aided through the use of electric toothbrushes and oral irrigation devices. Fluoride rinses, gels, varnishes and antimicrobial agents can be administered by nursing home personnel to inhibit root carriers.

If we could rid ourselves of archaic licensing board restrictions, we could train nurses and nurse's aids to apply fluoride varnishes, which is easier to apply than traditional topical fluoride application and is as effective in inhibiting root decay.

Studies have also shown that better dental care among the elderly in nursing homes could reduce cases of a certain type of pneumonia especially aspiration pneumonia which is an infection that occurs after stomach contents or bits of food are inhaled into the lungs.

Elderly people are at higher risk if they have dental plaque or certain types of mouth bacteria. This is an area that tends to be overlooked in most nursing homes as it is often left to the elderly residents to clean their mouths while in many cases, due to physical limitations they cannot.

Institutions for the aged should arrange for visiting dentists and hygienists to perform periodic examinations, prophylaxis, and fillings using portable equipment. Nursing homes should assign and educate specific staff members, doubling as nurse's aids, to do some actual tooth brushing for those elderly who cannot do it themselves.

However, these types of dental care programs are not organized and funded. This simply reflects the low priority society places on dental health care for the elderly.

If you have family members in nursing homes or your own home, one of the best things you can do for them is to ensure they receive proper dental care. A gift that keeps on giving are dental products that help the elderly maintain proper dental hygiene.