Six things that happen to your teeth after 50 (and how to stop them)

When I started working as a dentist in the mid-1990s, one of my first patients was a woman in her early 30s with young children. We extracted all her teeth and fitted full top and bottom dentures. At the time, this wasn’t extraordinary, but it was something we were trained to do.

Thankfully, dentistry has changed enormously in the past three decades. People now expect to keep their teeth. But that creates a different challenge: teeth that erupted decades ago are being asked to keep working into our 80s and 90s.

Your mouth is a particularly unforgiving environment. Your teeth are subjected to enormous mechanical forces from chewing and are exposed to acids and sugars from food, while bacteria are constantly ready to exploit a lapse in oral hygiene. So, by 50, seemingly small problems – a little gum recession, an old filling, some tooth movement – can begin to compound.

But it’s certainly not too late to do something about your teeth.

Your gums recede

Teeth can appear longer as we get older. The tooth hasn’t grown: the gum has receded, exposing part of the root that would previously have been covered.

The exposed surface is slightly yellower than enamel and more vulnerable to staining, erosion and sensitivity.

While a certain amount of gum recession is expected with age, it can also be a sign of gum disease and bone loss, or be caused by a tooth moving outside its ideal position in the jaw.

The fix

It’s important to establish whether it is just ordinary age-related recession or is happening because of over-brushing or gum disease.

If the problem is simply over-brushing, switching to an electric toothbrush will help, as they clean effectively without requiring excessive force. A Cochrane review of 56 studies found that, compared with manual brushes, they reduced plaque by 21 per cent and gingivitis by 11 per cent after three months of use.

If the cause is gum disease (periodontitis), treating the inflammation and controlling plaque can stop or greatly slow further destruction of the bone supporting the teeth. Treatment can include professional deep cleaning, improved daily cleaning with interdental brushes and, for more advanced disease, treatment by a periodontist (a gum specialist). In certain cases, regenerative periodontal surgery using bone grafting or regenerative materials can rebuild some of the bone. Your dentist can tell you what’s needed.

Pockets form around your teeth

You won’t notice this is happening. Plaque sitting against a tooth triggers inflammation in the gum. This inflammation causes the gum to separate from the tooth, creating a tiny space or “pocket”. More plaque can then get inside and harden into tartar underneath the gum, and then we’re moving into gum disease.

These pockets often develop hidden between molars, so patients are often surprised when I probe around their gums and say there’s pocketing and bleeding.

The fix

Catch it early and it’s straightforward. You remove the plaque and inflammation, and the gum has the ability to recover. Your body is amazing once given the tools to repair itself.

Seeing a hygienist is a relatively new concept, but don’t assume it’s an expensive “add-on” just because your regular dentist used to clean teeth. Hygienists are game changers. Appointments every six months are sensible; those with gum problems should go more frequently, and those with impeccable oral hygiene, less often.

Brush twice a day and floss. There’s evidence that the extra step of adding interdental brushes to your routine removes more plaque than brushing and flossing alone, as well as improving bleeding scores and probing-pocket depth.

Old fillings develop decay

People assume that once a tooth has been filled, the problem has been permanently solved. Unfortunately, decay can develop beside an existing restoration, what we call recurrent or secondary caries.

This is an important distinction. A filling repairs the damage caused by decay; it doesn’t somehow make you immune to the disease that caused it in the first place. Research into secondary caries suggests the condition of the restoration and the patient’s underlying susceptibility to decay matter.

Filling materials can also change after decades in the mouth. Older amalgam fillings can develop ridges as the material breaks down or expands, while some older white fillings can shrink slightly. A tiny gap or rough margin gives plaque somewhere to collect.

The fix

Cleaning between your teeth becomes particularly important if you have several fillings because many of these vulnerable areas cannot be reached properly with a toothbrush.

Patients can sometimes be suspicious and question whether they need work if they’re not suffering, but decay doesn’t necessarily hurt. One of the difficulties dentists have always had is the gap between what we can see and what a patient can feel. If you wait until a tooth hurts or a filling falls out, the problem may be considerably bigger. You can always ask your dentist to show you the issue. Digital X-rays, intraoral cameras and 3D surface scans of your mouth now make it much easier for us to explain and point out problems.

Your teeth wear down and crack

Every time you clench or grind, you put pressure through your teeth. Combine decades of that with acidic foods and drinks and ordinary wear, and you may reach your 50s and suddenly realise your teeth look shorter or flatter.

A tooth containing a large filling is already structurally weaker. Put enough pressure through it, and a corner can eventually fracture.

Grinding is much more common than cracked teeth, but the two can be connected.

Signs that you may be grinding include waking with a sore jaw, repeatedly chipping teeth or breaking fillings, or noticing that the edges of your front teeth are becoming flattened, uneven or sharp against your tongue.

The fix

Your dentist will be able to tell whether your teeth are unusually worn for your age. Dentists can sometimes rebuild them to their original shape with tooth-coloured composite resin, which can restore lost height and shape without necessarily removing much healthy tooth.

For more extensive wear, veneers, crowns or onlays are available; it depends on how much tooth structure remains and why the wear occurred.

Depending on the cause, a protective night guard may help prevent further damage. Diet matters too. Patients can worry that wine is acidic, but I am far more concerned about acidic, sugary drinks and fruit juices. You don’t have to stop enjoying life. The important thing is recognising the cumulative effect and reducing it.

Your enamel wears away

When enamel – the hard outer shell that protects your teeth – wears thin, the softer layer underneath, called dentin, is exposed. Dentin is porous, so teeth become sensitive when cold and hot travel through the microscopic tubes that lead directly to the nerve inside the tooth, producing that horrible, sudden jolt we can have when eating ice cream.

One misconception I hear is that we can “rebuild” lost enamel. We can’t. Once your enamel has formed, you do not grow any more (whatever your toothpaste might claim). There is an important difference between helping remineralise and strengthen early damaged enamel and actually regrowing enamel.

The fix

We can protect what remains and prevent further deterioration. And sensitive-tooth toothpaste isn’t simply clever marketing.

A large network meta-analysis looked at 125 randomised trials involving 12,541 patients and found evidence that a number of desensitising toothpaste formulations reduced dentine sensitivity by blocking the transmission of sensation towards the nerve.

You also need to protect your remaining enamel by controlling decay, avoiding aggressive brushing and dealing with grinding. If you repeatedly develop cavities, your dentist may prescribe a high-strength fluoride toothpaste to help arrest areas of early decay and protect the tooth.

Your teeth shift and become crowded

Your teeth don’t reach adulthood and remain frozen in position – they continue moving throughout life. Everyday forces from chewing, swallowing and the resting pressure of your tongue, lips and cheeks constantly nudge your teeth.

I know this personally. Four years ago, I was approaching my own half-century milestone birthday, and I remember lying in bed one morning with a slightly painful tooth. The discomfort disappeared and I realised what had happened: I had effectively witnessed the tooth move. One tooth was beginning to cross another.

This isn’t unusual for people in their 50s. Lower canine teeth tend gradually to move closer together, crowding the lower incisors. Those lower teeth can then push against the upper teeth and contribute to movement there too. People sometimes come to me concerned that their upper teeth have suddenly become crooked, without realising that movement in their lower teeth is helping drive it. It’s not just vanity: crowded teeth are harder to clean, making plaque control harder.

The fix

Straightening teeth in your 40s, 50s and beyond can therefore have a functional and preventive purpose as well as a cosmetic one.

For my own part, I decided to act. I had invisible braces fitted behind my teeth for around 18 months. It fixed the crowding, and of course I liked the cosmetic result. I encourage my patients to do the same. I’ve even treated a patient in her early 80s with aligners because changes in her bite and tooth position were threatening her ability to keep her teeth. You’re never “too old” for orthodontics.

Dr Martin Wanendeya is a partner at Ten Dental, a practice in south London. He also teaches implant dentistry at the Royal College of Surgeons and holds academic and teaching roles at Goethe University in Frankfurt.

As told to Susanna Galton

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