By Mike Magee, MD

When most of us think of fluoride in the water and tooth decay, we think of kids. But the American Dental Association is raising the alarm that there is an equal risk of tooth decay on the other end of the age spectrum. Why is this the case? Because with age, erosion gradually exposes root surfaces and bacteria work their way into cracks and imperfections around old fillings. Plus, older citizens make less saliva, a condition accentuated by many of the medications administered for chronic diseases. This means more acid contact for longer periods of time with the tooth surface. Finally, the natural tendency with age is to select softer and sweeter foods, which increase the risk for cavities.
  
In the past, if you were lucky enough to survive beyond 65, you ran a very good chance of losing your teeth. But today more than three quarters of Americans over 65 have their original teeth, and the vast majority are intent on keeping them. The ADA would like to help. They've launched a multi-faceted three-year program titled “Oral Longevity” to create educational resources and innovative programs for consumers and oral health professionals targeting the special oral needs of an aging population. Part of the program involves a reemphasis on the basics, including regular brushing with fluoride and check-ups. Part of the reason ADA is so interested is that we now know that keeping teeth healthy is not simply a cosmetic issue. Tooth decay is an infectious and transmissible bacterial disease that increases one’s chances of heart disease and stroke.

Fluoride helps prevent tooth decay, mostly by protecting the surface of the tooth from the breakdown of acids in the mouth and an oral process called "demineralization. It also promotes re-mineralization and repair of the tooth when a cavity starts to form.

You can get flouride in either topical or systemic form. Topical fluorides include toothpaste, mouthwash and professionally applied therapies. Systemic fluorides are ingested into the body and incorporated into the tooth-formation process. This fluoride is obtained through water fluoridation or with dietary supplements like tablets, drops or lozenges. Exposure to an appropriate mix of these types of fluoride leads to stronger and more attractive teeth.

In addition to fluoride, the ADA recommends the following for all older Americans:

1. Brushing and flossing your teeth twice a day using soft bristles.
2. Replace your toothbrush every three or four months, or sooner if the bristles becomes frayed.
3. If you wear dentures, remember to clean them on a daily basis. Take your dentures out of your mouth for at least four hours every day.
4. Consume optimally fluoridated water to prevent tooth decay no matter how old you are. If you choose bottled water, check the label for fluoride content.
5. Quit Smoking. Smoking increases problems with gum disease, tooth decay and tooth loss. It also affects healing after dental procedures and the retention of dental implants.
6. Visit your dentist regularly for a complete dental check up.

As always, I'm interested in your opinion on flouride, as well as dental health in general. Do you think extra flouride is a good idea? To learn more, watch this week's video, embedded with this blog, and then leave a comment.

With Baby Boomers aging and all Americans living longer lives, the question of long-term care is on a lot of people’s minds. You may be surprised to know that the average cost of one year in a nursing home now exceeds $70,000. Even more daunting, though, is the fact that the average net worth of 65 year olds today is only $110,000.

This means the cost of living in a nursing home could take everything you have, including your home, in 18 months or less. And for younger people, the news will only get worse: The estimated average cost for one year in a nursing home in 2030 is $190,000.

Currently, only 7% of American seniors have enough saved to cover even one year of nursing home care.  Thus, 70% of single people and 50% of married couples who require long-term care become destitute.

The reality is that 60% of current 65 year olds will require some kind of long-term care in their lifetime – either at home, in an assisted living facility, or in a nursing home. That’s why so many people are looking with renewed interest at long-term care insurance, a safety-net concept for seniors that has been around for quite some time, but is now suddenly more relevant than ever.

Long-term care can range from basic help with tasks around the house to more essential assistance with activities of daily living – like bathing, eating or getting dressed.

Many think they will be able to fall back on family members or friends, but looking ahead, this safety net is likely to weaken. With the size of the American family getting smaller, there are fewer adult children to do the care giving. Also, children live farther away from their parents than they did a generation ago.

Medicaid used to be more of an option for nursing home care. Some families “spent down” their assets, basically causing themselves to go broke on paper and then qualifying for government payments to a nursing home. But the Deficit Reduction Act of 2005 has modified the rules, making it somewhat more difficult, though not impossible, to qualify for Medicaid coverage.

That leaves long-term care insurance as an option. The policies are increasingly common and flexible, but, of course, they’re not free. It can cost a 55 year old $5,000 per year for a plan that provides $200 per day for a lifetime with an annual 5% inflation adjustment and an initial 60-day waiting period. That probably puts this type of insurance out of reach for a good number of people. But there are a few things you can do to bring down the cost, ranging from limiting the benefit period to sharing a policy with your spouse. To learn more about long-term care insurance, watch this week’s video, embedded with this blog post, or read the full transcript. Then let me know your feelings: Should we be doing more to provide long-term care options for our citizens?