I’ve Never Liked my (Fill-in-the-Blank). Am I Too Old to Consider Treatment?
I once had an 80-year-old patient ask for a plastic surgery referral. He pointed to his nose – which looked fine to me – and said the tiny bump had bothered him since he was a young man. Finally he was ready to get it fixed. I resisted the urge to give my opinion about his nose and instead redirected his attention to his missing back teeth.
Six months later the patient came in and showed off his newly perfect nose.
Which leads to the question:
Am I too old to undergo an extensive dental procedure?
Aside from any health limitations that might preclude treatment, what is the question really asking? It can mean many things including:
How long will I be around to enjoy the benefits? (You know the old joke: I’m so old I don’t even buy green bananas…)
Am I spending money frivolously? Should I instead be conserving the resources for other needs?
Should I be saving this money for my children?
Of course, these questions are unanswerable, personal, and complex. What I can address are the requirements and contraindications for certain treatments.
Dental care is expensive.
With few exceptions, dental care is not currently covered under Medicare. In 2021 there was some discussion about incorporating a dental benefit into Medicare, but unfortunately that was unsuccessful. Consequently, your dental expenses are all out of pocket.
Even if you have dental insurance, it will only cover a portion of any significant treatment.
SHOULD I GET MY TEETH STRAIGHTENED?
In a process called mesial migration, teeth move toward the center of your mouth as we age. This leads to crowding, particularly in the lower front area. Crowded teeth are more difficult to keep clean. Hygiene also becomes more challenging as manual dexterity may decrease over time.
Poor hygiene can result in gum problems, cavities, and potential tooth loss. Improving the crowding in your mouth can alleviate some of these concerns.
Plus you’ll gain a more attractive smile. And who doesn’t like that?
Most adults don’t want to wear traditional metal braces.
They are receptive to aligner orthodontics such as Invisalign where a series of semi-rigid trays move teeth gradually. The trays, however, must be worn as much as possible to be effective and ideally 24/7 with the exception of eating.
You know yourself best. Will you be disciplined enough to adhere to this regimen?
To ensure you are a good candidate for orthodontia, there are some other requirements:
Moderate to advanced gum (periodontal) issues must be addressed first.
Existing temporomandibular joint (TMJ) problems can be further exacerbated.
Dental implants are fused to the jawbone and will not move. Any orthodontic treatment must take that into account and work around it.
And how do you feel about wearing a retainer indefinitely?
Teeth are also creatures of habit and tend to move back into their original positions. A retainer worn several times a week will keep your newly straightened teeth in their place. Alternatively, sometimes a wire can be bonded onto the tongue side of the vulnerable lower front teeth to keep them restrained. This does add to the hygiene burden, though.
MY DENTIST TOLD ME I NEED SOME IMPLANTS…
My mother-in-law was a very successful denture wearer. The woman could even eat nuts where the little chunks can notoriously get underneath the denture and cause discomfort, much like a pebble in a shoe. She had a few strategic teeth left in her lower jaw on which a partial denture hung. But little by little, she began to lose those crucial teeth.
She was in her 80s when we discussed the idea of implants and I, too, asked myself the question: Will it be worthwhile for her to undergo such a procedure? We decided to proceed and placed two implants which made the difference between an unusable denture and realistic function. For her, it was a game changer – and she continued to eat her nuts until she passed away almost ten years later.
Besides helping to hold a denture, what is the single greatest benefit of an implant?
An implant feels like a natural tooth.
Multiple missing teeth can be replaced with implants, which presents a huge psychological benefit of not having to remove your false teeth at night. No one wants to see their teeth in a glass on the bathroom counter.
What are the requirements?
There must be adequate bone, both in quantity and quality, to hold the implant in place. Often bone grafting can be done to add bone in deficient areas.
You should be in relatively good health. In practical terms, this doesn’t mean an absence of all chronic underlying conditions. But you’re probably not a candidate if you had a heart attack two months ago.
Smoking will compromise the success of the implant treatment.
Despite the costs, the benefits of implant therapy are well worth it, no matter the age.
A SINGLE ROOT CANAL AND CROWN
What if you have a back tooth that has a large cavity? It can be saved but will need a root canal, a build-up, and a crown, extensive treatment that can run into thousands of dollars. Or an equally if not more extensive treatment. Your other option is to extract the tooth and live with the empty space.
Will you need that tooth to eat?
No, probably not. Chances are the gap may not even be visible.
Yet leaving an empty space can create a series of cascading events. The teeth behind the empty space may start tilting over. If enough tipping occurs, this will result in collapse of the bite and potential TMJ pathology.
You’ve all seen that person with many missing back teeth. Because there’s no tooth support for the soft tissues, the face sags. The lips are pursed together, possibly forming a straight thin line, and the mouth appears shrunken. The person looks old. Granted this is a worst case scenario, but it does happen.
This is an easy decision: fix the tooth, assuming…
The tooth is periodontally healthy, meaning it’s stable and secure in your mouth.
The root canal and crown have a highly predictable chance of long-term success.
The finances are workable. If it’s not, discuss this with your dentist to arrange either a phased treatment plan or an alternative approach.
COSMETIC DENTISTRY
Just like my 80-year-old patient who got the nose job, this is an individual and very personal decision tied to self-esteem, body image, and a host of other factors.
But whatever you do, if you’re north of, arbitrarily, age 60, don’t go white-white. Or too perfect. Remember, natural is the key.
Some questions only lead to more questions.
None of us knows the answer to the question, “Are you too old?”
But if you have the ability to proceed with treatment, are in relatively good health, have reasonable expectations, then the question of “Are you too old?” is almost irrelevant. Because none of us knows the future.