What causes problems with taste and sensitive teeth in older adults, potentially related to gum recession, tooth decay, diabetes, sinus infections, or medication side effects?

Problems with Taste and Sensitive Teeth: Causes and Clinical Approach

Direct Answer

Problems with taste and sensitive teeth in older adults are primarily caused by age-related physiological changes, medication effects, gum recession exposing dentine, systemic diseases (particularly diabetes), and poor oral hygiene—with management focused on identifying reversible causes while addressing the underlying dental and medical conditions. 1, 2

Primary Mechanisms of Taste Dysfunction

Age-Related Physiological Decline

• Normal aging causes diminished taste perception across all five basic flavors due to physiological changes in taste receptors, independent of disease states. 1
• Aging leads to alterations in olfaction and gustatory sensation that directly affect appetite and dietary selection. 3
• Lower salivary flow rates occur with advancing age, which when combined with medication effects, leads to xerostomia (dry mouth) that further impairs taste function. 3, 4

Medication-Induced Alterations

• Anticholinergic medications exacerbate taste dysfunction through multiple mechanisms affecting taste receptor function. 1
• Acetylcholinesterase inhibitors worsen taste perception by increasing saliva production and altering the oral environment. 1
• Many medications consumed by older adults contribute to decreased appetite and altered taste sensation. 3

Systemic Disease States

• Diabetes mellitus affects parasympathetic innervation and alters taste perception through autonomic dysfunction. 1
• Chronic kidney disease causes salivary disorders with altered composition (elevated urea, creatinine, sodium, potassium) that directly affects taste sensation. 3, 1
• Patients with chronic kidney disease may experience bad breath and altered taste because salivary urea converts to ammonia, occurring in one-third of hemodialysis patients. 3
• Sinus infections and GERD (affecting 8-19% of adults) can cause taste disturbances through peptic esophagitis. 1

Neurological Conditions

• Progressive neurologic diseases (Parkinson's disease, stroke, multiple sclerosis, dementia) cause taste alterations through both direct neural pathway damage and secondary effects on swallowing and oral clearance. 1
• Stroke affects taste pathways in 50% of patients with clinically significant dysphagia. 1
• Parkinson's disease causes bradykinesia affecting oral and pharyngeal function, leading to saliva pooling and altered taste perception. 1

Primary Mechanisms of Tooth Sensitivity

Gum Recession and Dentine Exposure

• Gingival recession exposes dentine to the oral environment, creating the anatomical basis for hypersensitivity through the hydrodynamic mechanism. 2, 5
• Exposed dentine allows fluid movement in dentinal tubules in response to thermal, chemical, and mechanical stimuli, which activates pulpal nerve fibers causing pain. 2
• Gum recession affects 88% of people aged 65 years and older and 50% of people aged 18-64 years at one or more sites. 6
• More than 50% of the population has one or more sites with gingival recession of 1 mm or more, with prevalence and extent increasing with age. 6

Multifactorial Etiology of Recession

• Gum recession results from inflammation, mechanical trauma (improper brushing techniques), chemical damage, smoking, tartar presence, occlusal overload, and iatrogenic factors. 5, 6
• Patients with less than adequate plaque control experience more root hypersensitivity to air stimuli than those with better oral hygiene. 7
• Recession occurs more frequently on buccal (cheek-facing) surfaces than other tooth aspects. 6

Enamel Loss and Tooth Wear

• Loss of enamel through abrasion and erosion increases dentine permeability, giving rise to sensitivity symptoms. 2
• Alterations to enamel and dentine integrity through trauma, decay, and tooth wear can increase dentine permeability. 2
• Predisposition to dentinal hypersensitivity is multifactorial, with enamel loss and gingival recession becoming more severe with advancing age. 7

Dental Pathology

• Chronic dental diseases, atrophic glossitis, and oral infections directly impair taste receptor function and are common in elderly populations. 1
• Poor dental hygiene and high intake of sugars/refined carbohydrates increase the risk of dental disease affecting both taste and tooth sensitivity. 1
• Cracked tooth syndrome can present with sensitivity symptoms that may be difficult to diagnose without considering occlusal factors. 2

Clinical Assessment Algorithm

Initial Screening Questions

• Screen for neurological symptoms including bradykinesia, tremor, cognitive changes, prior stroke, or progressive weakness. 1
• Assess medication history, particularly anticholinergics, acetylcholinesterase inhibitors, calcium channel blockers, and cyclosporine. 3, 1
• Evaluate for diabetes, chronic kidney disease, GERD, and sinus infections. 1

Oral Examination Priorities

• Identify gingival recession sites and measure extent of dentine exposure. 6
• Assess for dental caries, periodontal disease, atrophic glossitis, and oral infections. 1
• Check for dental calculus formation, which is elevated in chronic kidney disease patients due to high salivary pH and calcium-phosphorus precipitation. 3
• Evaluate occlusal factors that may contribute to cracked tooth syndrome. 2

Laboratory Assessment

• Assess for B vitamin deficiencies, particularly B12 and folate, in at-risk populations. 1
• In chronic kidney disease patients, measure BUN, creatinine, sodium, potassium, calcium, and phosphorus levels. 3

Management Strategy

Addressing Taste Dysfunction

• Ensure adequate hydration (women ≥1.6 L/day, men ≥2.0 L/day) to maintain saliva production. 1
• Provide dietary counseling to limit cariogenic foods and reduce salt intake to <6 g/day. 1
• Avoid flavor enhancers as routine intervention, as evidence does not support systematic use. 1
• Review and modify medications when possible to reduce anticholinergic burden. 1

Managing Tooth Sensitivity

• Stage management conservatively, starting with topically applied desensitizing pastes and resin bonding agents before considering irreversible interventions. 2
• Direct restorations may be necessary for significant enamel loss or exposed dentine. 2
• Root canal treatment should be reserved for cases where conservative strategies fail. 2
• Address gingival recession through gingival grafting, guided tissue regeneration, or orthodontic therapy when appropriate. 6

Preventive Measures

• Educate patients on proper oral hygiene techniques to prevent further gum recession. 5
• Recommend regular dental check-ups to monitor and prevent progression. 5
• Address occlusal overload and improper brushing techniques that contribute to recession. 5, 6

Critical Pitfalls to Avoid

• Do not assume taste changes are purely age-related without screening for reversible causes like medication effects, B vitamin deficiencies, or systemic diseases. 1
• Avoid overlooking neurological conditions that may present with both taste changes and swallowing difficulties affecting oral clearance. 1
• Do not proceed to irreversible dental interventions (root canal treatment) without first attempting conservative desensitizing strategies. 2
• Recognize that apparent hypersalivation may actually represent impaired clearance from dysphagia rather than true overproduction, particularly in neurological conditions. 4
• In chronic kidney disease patients, be aware that altered salivary composition creates a paradoxically protective effect against caries despite multiple oral health challenges. 3