Getting older does not automatically mean losing your teeth.
In fact, Americans are keeping their natural teeth longer than previous generations. That is wonderful news—but it also means we are asking our teeth, gums, fillings, crowns, and implants to function for many more decades.
As we age, changes in our medical health, medications, saliva, gums, dexterity, cognition, and decades of accumulated wear can change what our mouths need.
One of the most important things I discuss with patients entering their 60s and beyond is this:
The goal shouldn't simply be to get through today's dental problem. We should be thinking about how to make the mouth as healthy, stable, functional, and easy to maintain as possible for the decades ahead.
Sixty May Mean Another Two Decades—or More
It is easy to reach 60 or 65 and begin thinking, “Do I really need to fix this? Will this tooth even matter long enough for the problem to become serious?”
But the numbers put that decision into perspective.
According to the CDC's 2024 U.S. life tables:
A person who has already reached age 60 has an average of another 23.6 years of life expectancy.
At age 65, average remaining life expectancy is 19.7 years.
At age 70, it is still 16.0 years.
Even at age 75, average remaining life expectancy is another 12.5 years.
These are population averages, not predictions for an individual. But they demonstrate an important point:
Dental decisions made at 60 may need to serve someone until their 80s or beyond.
A tooth with a serious but manageable problem at age 62 could potentially need to function for another 20 or 25 years.
“I Don't Know If I'll Live Long Enough for That Tooth to Matter”
This is a conversation I have surprisingly often.
A patient may have a significant fracture, an infected tooth, advancing decay, severe wear, periodontal problems, or another condition that is not currently causing much pain. They may consider delaying treatment because they feel they are “getting older” and may not need the tooth indefinitely.
There are certainly times when someone's medical status, prognosis, personal priorities, finances, or treatment burden appropriately change our dental recommendations.
But age alone should not automatically be the reason to postpone necessary care.
For many otherwise healthy people in their 60s and early 70s, we may realistically be planning for another 15, 20, or even 25 years of function.
And waiting can sometimes change the available choices.
A relatively manageable problem today can later become:
A painful dental emergency
An infection
A fractured tooth
A tooth that can no longer be restored
A more complicated extraction
A larger restorative problem
A problem that requires treatment when someone's overall health is less favorable
That doesn't mean every aging tooth needs aggressive treatment.
It means that when an important problem does need treatment, one question worth asking is:
“Would I rather deal with this while I am healthy and able to tolerate treatment well, or risk needing more complicated care later?”
Dental Treatment Can Become More Challenging as Overall Health Changes
Another consideration is that the physical experience of dental care can change with aging.
The American Dental Association notes that older adults may increasingly experience:
Arthritis and mobility limitations
Cardiovascular disease
Multiple medications
Hearing or vision impairment
Cognitive impairment
Difficulty following postoperative instructions
Reduced ability to perform oral hygiene independently
These factors can require changes in how dental care is delivered and can make treatment more complicated for both the patient and dental team.
Someone who is healthy, mobile, independent, and cognitively sharp at 65 may therefore reasonably consider completing important dentistry while treatment is comparatively straightforward.
That is different from treating teeth unnecessarily.
It is planning ahead.
1. Dry Mouth Becomes Much More Common
One of the biggest dental changes we see later in life is dry mouth, or xerostomia.
Importantly:
Dry mouth is common with age, but it is not considered an inevitable effect of aging itself.
It is frequently associated with medications and medical conditions.
Hundreds of medications can reduce saliva production, including some medications used for:
Blood pressure
Depression
Allergies
Bladder control
Pain
Anxiety
Other chronic conditions
The ADA estimates that dry mouth affects approximately:
30% of people over age 65
Up to 40% of people over age 80
Saliva helps:
Wash food away
Buffer acids
Protect oral tissues
Help control microorganisms
Provide minerals that participate in tooth remineralization
Make eating, speaking, and swallowing easier
When saliva decreases, cavity risk can increase substantially—particularly around exposed root surfaces.
2. Gum Recession Exposes More Vulnerable Tooth Structure
Many people notice that their teeth appear longer as they age.
Often, this is due to gum recession.
The crowns of our teeth are protected by enamel. The root surfaces underneath the gums do not have the same thick enamel covering.
When recession exposes these areas, they can become:
More sensitive
More difficult to keep clean
More vulnerable to decay
Approximately half of adults over age 75 have root decay affecting at least one tooth, according to the American Dental Association.
The combination of recession plus dry mouth can create a particularly high-risk environment for decay.
3. Gum Disease Becomes More Common
Periodontal disease is another major concern later in life.
Approximately 60% of adults age 65 and older have periodontitis.
Periodontitis causes destruction of the tissues and bone supporting the teeth and can eventually contribute to:
Recession
Bone loss
Tooth mobility
Changes in the bite
Tooth loss
Periodontal disease can often be managed, particularly when identified and treated appropriately.
The important distinction is that something being common with aging does not make it inevitable.
4. Old Dental Work Ages Too
Many people in their 60s, 70s, and 80s have something younger adults simply have not accumulated yet:
decades of dentistry.
A single tooth may have had:
A filling placed decades ago
Another filling later
A crown
A root canal
Significant wear
Years of clenching or grinding
Dental restorations survive millions of chewing cycles and years of exposure to bacteria, temperature changes, and mechanical forces.
Older restorations do not automatically need replacement.
But as patients keep their natural teeth longer, deterioration of existing restorations becomes an increasingly important issue to monitor.
5. Tooth Wear and Cracks Accumulate Over Time
Teeth are remarkably durable, but they are not indestructible.
Over decades, we may see:
Flattened biting surfaces
Chipping
Crack lines
Larger fractures
Wear from clenching or grinding
Acid erosion
Structural weakening around large restorations
Not every crack requires treatment.
One of our jobs as dentists is to determine which areas can safely be monitored and which present a meaningful risk for future fracture.
6. Twenty Teeth Is an Important Functional Threshold
There is another number worth knowing as we think about dental aging:
20 natural teeth.
A systematic review of the dental literature found that approximately 20 teeth with nine to ten pairs of contacting teeth is associated with adequate chewing efficiency and perceived chewing ability.
Below that level, chewing efficiency generally declines.
Research into the “shortened dental arch” concept has shown that some people can function acceptably with the front teeth and premolars even when the back molars are absent.
Once someone approaches the minimum number and distribution of teeth required for good function, every additional tooth that is lost becomes increasingly important.
That is why preserving strategic teeth can become more—not less—important later in life.
Fewer Teeth Can Affect More Than the Mouth
The ability to chew affects what foods people can comfortably eat.
Studies of older adults have found that reduced numbers of functional teeth are associated with:
Difficulty chewing
Avoidance of foods such as meats, vegetables, breads, and other harder-to-chew foods
Differences in dietary quality and nutrient intake
Reduced oral-health-related quality of life
A large review of 140 studies found that older adults retaining at least 20 teeth generally had better health and quality-of-life outcomes, while having fewer than 20 teeth was associated with greater functional dependence and disability.
More recent systematic reviews have also found associations between having fewer than 20 teeth and physical frailty. One 2025 meta-analysis found that older adults with fewer than 20 teeth had higher observed odds of physical frailty. Importantly, these studies show association—not proof that tooth loss itself causes frailty.
What About Tooth Loss and Cognitive Decline?
This is an area of growing research, but it requires careful wording.
A systematic review and meta-analysis of prospective studies found that people with fewer than 20 teeth had approximately:
26% higher observed risk of developing cognitive decline
22% higher observed risk of developing dementia
compared with people who retained at least 20 teeth.
Several factors could contribute to the relationship, including:
Shared chronic disease and inflammatory risk factors
Nutrition
Socioeconomic factors
Access to healthcare
Reduced chewing function
Cognitive decline itself making oral hygiene and dental care more difficult
In other words, the relationship may work in several directions.
What the research does reinforce is that oral function and tooth retention are meaningful components of healthy aging, not merely cosmetic concerns.
7. Brushing and Flossing Can Become Physically Harder
Arthritis, reduced grip strength, tremor, neurologic disease, visual changes, stroke, and cognitive decline can make home care increasingly difficult.
Sometimes the solution is not telling someone to “brush better.”
It is choosing better tools.
That might include:
An electric toothbrush
A larger toothbrush handle
Interdental brushes
Floss holders
Water flossers
Caregiver assistance when needed
8. Cognitive Changes Can Make Dental Disease Much Harder to Manage
There is another reason preventive dentistry becomes especially important before advanced age.
When significant cognitive impairment or dementia develops, the ADA notes that patients are at increased risk for:
Cavities
Periodontal disease
Oral infection
Difficulty maintaining home care
Dental appointments themselves can also become more challenging because patients may have difficulty processing instructions, tolerating unfamiliar environments, or following postoperative directions.
This creates an important long-term goal:
Enter later life with the mouth as healthy, stable, cleanable, and low-maintenance as reasonably possible.
9. Tooth Loss Is More Common With Age—but It Isn't Inevitable
Losing all of our teeth was once almost accepted as part of growing older.
That shouldn't be our expectation today.
The goal is not necessarily to save every tooth at any cost.
Instead, we want to preserve a healthy and functional dentition for as long as reasonably possible.
Sometimes that means repairing a tooth.
Sometimes it means replacing one.
Sometimes it means deciding that a particular tooth has a poor prognosis and creating a thoughtful plan around its loss.
The important thing is that the decision is intentional rather than made because “I'm getting older anyway.”
10. Oral Cancer Risk Also Deserves Attention
Dental examinations involve much more than looking for cavities.
We also evaluate the:
Tongue
Lips
Gums
Cheeks
Floor of the mouth
Palate
Other oral tissues
Oral cavity and throat cancers occur primarily in older adults.
Persistent sores, unexplained red or white patches, lumps, numbness, swallowing changes, or other lesions that do not resolve should be professionally evaluated.
Think About Dentistry as Planning for Your Future Self
One of the most important conversations I have with patients approaching retirement age is not simply:
“What needs to be fixed today?”
It is:
“What do we want your mouth to look like when you're 80?”
For some people, that may mean:
Stabilizing periodontal disease
Addressing significant decay
Protecting structurally vulnerable teeth
Replacing strategically important missing teeth
Simplifying complicated dental work
Managing dry mouth aggressively
Improving home-care tools
Planning around anticipated retirement or insurance changes
There is no universal answer.
A healthy 65-year-old may reasonably choose treatment designed to serve them for decades.
Someone with severe medical problems or limited life expectancy may appropriately make completely different choices.
Comprehensive dentistry means recognizing that distinction.
The goal isn't to perform more dentistry simply because someone is aging.
The goal is to make thoughtful decisions today that give your future self the best chance of having a comfortable, functional, maintainable mouth tomorrow.
At LAT Dentistry in Roanoke, Virginia, we work with patients to understand their medical health, dental risk, goals, preferences, and long-term outlook so we can develop a plan that makes sense for the person—not simply the tooth.
What Can You Do to Keep Your Teeth Healthy as You Age?
Fortunately, many of the dental problems associated with aging are preventable or manageable.
At home:
Brush thoroughly twice daily.
Clean between the teeth every day.
Drink plenty of water.
Limit frequent sugar and carbohydrate exposure.
Avoid tobacco.
Tell your dentist if your mouth feels unusually dry.
Use preventive products appropriate for your individual cavity risk.
At your dental visits:
Your dental team can monitor:
Gum and bone health
Gum recession
Root cavities
Dry mouth
Changes around crowns and fillings
Tooth wear and fractures
Oral soft tissues
Dentures or implants
Changes in your bite
Areas that may benefit from additional preventive care
The Goal Has Changed: We're Trying to Keep Your Teeth for Life
One of the biggest shifts in modern dentistry is our expectation for aging.
We don't assume that teeth will simply “wear out” and eventually need to be removed.
More adults are keeping their teeth later into life than ever before.
But keeping those teeth healthy may require the prevention strategy to change as the person changes.
A 70-year-old taking six medications with dry mouth and gum recession may need very different preventive care than that same person needed at age 30.
That's why comprehensive dental care isn't just about finding cavities.
It's about continually asking:
What has changed, what is this patient's risk now, and what can we do today to help them keep their teeth healthy for the decades ahead?
At LAT Dentistry in Roanoke, Virginia, our goal is to understand those changing risk factors and build an individualized plan around each person's health, priorities, and long-term goals.