s of Medicine
The Way We Age Now
Medicine has increased the ranks of the elderly. Can it make old age any easier?
by Atul Gawande
April 30, 2007

T
he hardest substance in the human body isthe white enamel of the teeth. With age, it wears away nonetheless, allowing the softer, darker layers underneath to show through. Meanwhile, the blood supply to the pulp and the roots of the teethatrophies, and the flow of saliva diminishes; the gums tend to become inflamed and pull away from the teeth, exposing the base, making them unstable and elongating their appearance, especially the lowerones. Experts say they can gauge a person’s age to within five years from the examination of a single tooth—if the person has any teeth left to examine.

Scrupulous dental care can help avert toothloss, but growing old gets in the way. Arthritis, tremors, and small strokes, for example, make it difficult to brush and floss, and, because nerves become less sensitive with age, people may notrealize that they have cavity and gum problems until it’s too late. In the course of a normal lifetime, the muscles of the jaw lose about forty per cent of their mass and the bones of the mandible loseabout twenty per cent, becoming porous and weak. The ability to chew declines, and people shift to softer foods, which are generally higher in fermentable carbohydrates and more likely to causecavities. By the age of sixty, Americans have lost, on average, a third of their teeth. After eighty-five, almost forty per cent have no teeth at all.

Even as our bones and teeth soften, the rest of ourbody hardens. Blood vessels, joints, the muscle and valves of the heart, and even the lungs pick up substantial deposits of calcium and turn stiff. Under a microscope, the vessels and soft tissuesdisplay the same form of calcium that you find in bone. When you reach inside an elderly patient during surgery, the aorta and other major vessels often feel crunchy under your fingers. A recent study... [continua]

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