Eyes, ears, teeth, and skin

Why the senses matter#

Eyes, ears, teeth, and skin rarely kill anyone, which is why they get neglected. But they decide whether you can drive, follow a conversation at dinner, chew a steak, or spend a day outside. Several also connect to the big diseases. Untreated hearing loss and vision loss together account for an estimated 9% of dementia (see Brain health), gum disease tracks with heart disease, and skin cancer is the most common cancer in the US.

Eyes#

Bottom line: Get a comprehensive eye exam every two years from 18, a dilated baseline by 40, and an exam every year from 65 or if you have risk factors. Diabetes means a dilated exam every year. AREDS2 vitamins help only people who already have intermediate or advanced macular degeneration, and blue light from screens does not damage your eyes.

Eye exam schedule#

The optimal schedule follows the American Optometric Association's evidence-based guideline, which is more frequent than the American Academy of Ophthalmology's (AAO) minimum. The exam is cheap, painless, and the only way to catch glaucoma before it takes sight.

Risk factors that call for yearly exams include a personal or family history of eye disease, diabetes or high blood pressure, and medications with eye side effects. A comprehensive exam, by an ophthalmologist (a medical doctor) or optometrist, includes dilating the pupils to look at the retina and optic nerve. A vision check at the DMV or a glasses fitting is not the same thing.

Both specialty schedules go beyond the US Preventive Services Task Force, which found the evidence insufficient to recommend for or against glaucoma screening in adults 40 and older (2022) Weak. This guide follows the more frequent schedule because glaucoma damage is permanent and the exam is low-risk.

Glaucoma#

Glaucoma damages the optic nerve, usually without pain or early symptoms; side vision fades first, and lost vision cannot be restored. Risk is higher after 40, with a family history, in people of African, Hispanic, or Asian heritage, and with high eye pressure, diabetes, high blood pressure, or long-term steroid use. A pressure check alone isn't enough; diagnosis needs a full exam of the optic nerve and visual field. Treatment with eye drops, laser, or surgery lowers pressure and slows further loss Strong.

Macular degeneration and AREDS2#

Age-related macular degeneration (AMD) damages the macula, the center of the retina used for reading and faces. The AREDS trials tested high-dose antioxidant vitamins and found that the original formula reduced the risk of advanced AMD by about 25% over five years in people with intermediate or late AMD Strong. The current AREDS2 formula contains vitamin C 500 mg, vitamin E 400 IU, zinc 80 mg, copper 2 mg, lutein 10 mg, and zeaxanthin 2 mg.

Cataracts#

A cataract is clouding of the eye's lens. It causes blurry or dim vision, needing more light to read, and glare from oncoming headlights at night. Surgery replaces the cloudy lens with an artificial one, and the AAO advises considering it when cataracts keep you from doing what you want or need to do Strong. In a cohort of 3,038 older adults, cataract surgery was associated with 29% lower dementia risk, while glaucoma surgery (which does not restore vision) showed no link. That is observational, but it adds a reason not to put off surgery once vision limits you. See Brain health.

Nearsightedness#

People with nearsightedness (myopia) have a higher risk of retinal detachment, and severe myopia also raises the risk of glaucoma and cataracts. If you are very nearsighted, keep up with dilated exams. For children, more time outdoors in daylight lowers the risk of developing myopia.

Screens and blue light#

Screen discomfort is usually digital eye strain from blinking less and focusing close for hours. It causes no lasting damage. The AAO's fix is the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds, and use artificial tears if your eyes feel dry.

Sunglasses and driving#

Ultraviolet light contributes to cataracts and other eye damage. Choose sunglasses labeled 100% UV protection or "UV400"; lens darkness, color, mirror coatings, and polarization say nothing about UV blocking, and wraparound frames block more light from the sides Moderate. Polarized lenses are still useful for glare off water and roads.

If night driving is getting harder, get an eye exam rather than just avoiding it; cataract glare and an out-of-date prescription are both fixable.

Ears#

Bottom line: Hearing loss is common, gradual, and linked to dementia. Get a baseline hearing test by 40, repeat it every 3 years and yearly from 60, treat loss with hearing aids (over-the-counter options now cost far less), and protect your ears from sounds above 85 decibels.

How common hearing loss is#

Disabling hearing loss affects 22% of Americans aged 65 to 74 and 55% of those 75 and older. Yet among adults 70 and older who could benefit from hearing aids, fewer than 1 in 3 have ever used them, and among those 20 to 69, about 16%. Most age-related loss starts with high-pitched sounds, so the first sign is often trouble understanding speech in noisy rooms rather than not hearing at all.

Hearing and dementia#

The 2024 Lancet Commission attributes 7% of dementia to hearing loss, tied with LDL cholesterol as the largest single factor. In a 2023 meta-analysis of observational studies, hearing aid users had 19% lower risk of long-term cognitive decline than people with untreated loss. In the randomized ACHIEVE trial of 977 adults aged 70 to 84, hearing aids with audiology support did not slow cognitive decline over three years overall, though they slowed it by about 48% in an exploratory higher-risk subgroup Moderate. A brain benefit is likely but not proven; better communication and quality of life are certain. More in Brain health.

Getting tested#

The optimal plan Weak is a baseline hearing test (audiogram) by 40, earlier if you have years of noise exposure; a repeat every 3 years; and a test every year from 60 or once any loss appears. Go sooner if you notice any of these: asking people to repeat themselves, turning the TV up, struggling in restaurants, or ringing in the ears. The reasoning: loss creeps in over decades, is among the largest modifiable dementia risks, and is easy to treat, while the test is cheap and harmless. No professional body sets an interval; the American Speech-Language-Hearing Association says there is no agreed-upon schedule. Guideline minimum: the USPSTF found insufficient evidence to recommend routine hearing screening in adults 50 and older without symptoms (2021).

Options for testing:

• An audiologist. The most complete test. Medicare Part B covers diagnostic hearing exams ordered by a clinician, and you can see an audiologist once every 12 months without an order for gradual hearing loss. Original Medicare does not cover hearing aids.
• A smartphone or earbud test. Apple's Hearing Test runs on AirPods Pro 2 and later with an iPhone. It is a convenient check between audiograms; treat an abnormal result as a reason to see an audiologist.

Hearing aids#

Since October 17, 2022, adults 18 and older with perceived mild to moderate hearing loss can buy FDA-regulated hearing aids over the counter, without an exam, prescription, or fitting. In September 2024 the FDA authorized the first over-the-counter hearing aid software, Apple's Hearing Aid feature, after a study of 118 people found self-fitting worked about as well as professional fitting. As of October 2026 it runs on AirPods Pro 2 and AirPods Pro 3 (about $249 for the Pro 3).

The FDA advises seeing a doctor, preferably an ear, nose, and throat specialist, before using OTC aids if you have ear pain, drainage, or a deformity, heavy wax, severe dizziness, sudden or fluctuating hearing changes, or hearing loss or ringing in only one ear. Expect a few weeks of adjustment while your brain gets used to sounds it has not heard clearly in years.

Protecting your hearing#

Noise damage is permanent and cumulative. NIOSH recommends a workplace limit of 85 A-weighted decibels (dBA) averaged over 8 hours, and every 3 dBA increase halves the safe time. That works out to about 4 hours at 88 dBA and about 15 minutes at 100 dBA.

Foam earplugs are cheap and effective when rolled and inserted properly; musician's earplugs lower volume more evenly so music still sounds natural. Phones and smartwatches can measure ambient noise and headphone volume. A simple rule from NIOSH: if you have to raise your voice to be heard by someone 3 feet away, the noise is around 85 dBA, loud enough to protect against Strong. Workplace and environmental noise rules are covered in Avoiding harm.

Tinnitus#

About 10% of US adults had ringing or buzzing lasting at least five minutes in the past year. The otolaryngology guideline recommends a hearing test for tinnitus that is in one ear, lasts six months or more, or comes with hearing trouble; hearing aids when there is hearing loss; and cognitive behavioral therapy (CBT) for persistent, bothersome tinnitus Moderate. It recommends against ginkgo, melatonin, zinc, and other supplements, and against routine use of antidepressants or anticonvulsants for tinnitus Negative. Tinnitus that pulses with your heartbeat, or that comes with one-sided hearing loss, needs a doctor's evaluation.

Teeth and gums#

Bottom line: Brush twice a day for two minutes with fluoride toothpaste, clean between your teeth once a day, and get a checkup and cleaning every 6 months, or every 3 to 4 months if you have gum disease. Gum disease is linked to heart disease and dementia, but the link is not proven to be causal; keep your mouth healthy for its own sake.

Gum disease and the rest of the body#

Periodontitis is chronic infection and inflammation of the tissues that hold teeth in place; untreated, it loosens and loses teeth. It affects 42% of US adults 30 and older, with severe disease in 7.8%, most often in people over 65 and in smokers.

The links beyond the mouth are real but uncertain Mixed:

• Heart disease. The American Heart Association concluded in 2012 that gum disease is associated with atherosclerosis independent of shared risk factors, but that evidence does not show that it causes heart disease or that treating it prevents heart attacks.
• Dementia. A 2026 meta-analysis of cohort studies found severe periodontitis linked to 16% higher risk of cognitive impairment or dementia and losing all teeth to 26% higher risk, with the authors noting that bias and confounding limit causal conclusions. The gum bacterium Porphyromonas gingivalis and its toxic enzymes have been found in Alzheimer's brains, but a drug designed to block those enzymes, atuzaginstat, failed in the GAIN trial.

Daily care#

Water flossers and wooden picks have limited and inconsistent evidence. Widely available electric brushes such as Philips Sonicare and Oral-B are fine choices; the Cochrane review could not show that one powered design consistently beats another.

Mouthwash and blood pressure#

Bacteria on the tongue convert nitrate from vegetables into nitrite, which the body turns into nitric oxide, a molecule that relaxes blood vessels. Strong antiseptic mouthwash disrupts this. In a study of 19 healthy volunteers, a week of chlorhexidine mouthwash cut oral nitrite production by 90% and raised blood pressure by 2 to 3.5 mm Hg. In a cohort of 540 overweight adults, using over-the-counter mouthwash twice a day or more was linked to about twice the rate of new hypertension. But a 2024 trial of 45 adults found chlorhexidine impaired nitrite production without raising blood pressure Mixed.

On the other side, the ADA notes that essential-oil mouthrinses reduce gingivitis. A sensible position: with good brushing and cleaning habits you don't need a daily antiseptic rinse, but if a dentist prescribes chlorhexidine for a short course, use it.

Dental visits#

The optimal plan is a checkup and professional cleaning every 6 months, and every 3 to 4 months if you have periodontitis Weak. Cleanings remove hardened tartar that brushing cannot, and the visits are cheap and low-risk. For gum disease, the European Federation of Periodontology's guideline calls for maintenance visits every 3 to 12 months, tailored to risk (an expert-consensus recommendation); start at the short end until your gums are stable.

The evidence for 6 months is thin. A 2020 Cochrane review found high-certainty evidence that, for adults, risk-based recall intervals and 6-month intervals produce little or no difference in cavities, gum bleeding, or quality of life over four years, and little difference even with 24-month intervals. So 6 months is a cheap margin, not a proven necessity; if your dentist judges you low risk, 12 months is reasonable. Guideline minimum: the ADA says intervals should be tailored to each patient.

Optimal is not maximal for dental X-rays. For adults with no cavities and no increased risk, the ADA and FDA advise bitewing X-rays only every 24 to 36 months, and every 6 to 18 months if you are prone to cavities, not at every cleaning.

Dry mouth from medications#

Saliva protects teeth. Hundreds of medicines reduce it, including some blood pressure, depression, and bladder drugs. Dry mouth raises the risk of cavities and fungal infections. Sip water, limit alcohol and caffeine, use a humidifier at night, chew sugarless gum, and tell your dentist, who may recommend prescription fluoride.

Xylitol#

Xylitol is a sugar alcohol used in sugar-free gum, mints, and toothpaste; the NIDCR notes that products containing it may help prevent cavities. In 2024, a Cleveland Clinic study found that people with the highest blood xylitol levels had 57% higher risk of heart attack, stroke, or death over three years than those with the lowest, and that a xylitol-sweetened drink increased blood clotting activity in volunteers Weak. That evidence is observational plus short-term lab work, and the doses in gum and toothpaste are much smaller than in a sweetened drink. Gum and mints are reasonable; using xylitol as a bulk sweetener in food and drinks is harder to justify. See Nutrition for other sweeteners.

The water fluoridation debate#

Community water fluoridation became a political fight in 2024 to 2026. The facts, presented neutrally:

• The benefit. The CDC's fluoridation page, last updated in May 2024, says fluoridated water at the recommended level of 0.7 mg per liter reduces cavities by about 25% in children and adults. A 2024 Cochrane review found that modern studies show smaller benefits than pre-1975 studies, mainly in children, and found no eligible studies measuring cavities in adults.
• The safety question. In August 2024 the National Toxicology Program concluded with moderate confidence that fluoride above 1.5 mg per liter is associated with lower IQ in children, roughly twice the US level, and found insufficient data to say whether 0.7 mg per liter has any effect.
• The policy changes. Utah and Florida banned fluoridation statewide in 2025; bills were introduced in many other states, and no further statewide bans had passed as of September 2026. HHS Secretary Robert F. Kennedy Jr. said he would tell the CDC to stop recommending fluoridation, the EPA began an expedited review of fluoride's safety, and the FDA moved to restrict some fluoride supplements for children. The American Dental Association unreservedly endorses community water fluoridation as safe and effective.

For adults the practical point is simple: fluoride toothpaste does most of the protective work. If your community stops fluoridating and you are prone to cavities, ask your dentist about prescription toothpaste or fluoride varnish.

Sleep apnea and the dentist#

Dentists make one of the treatments for sleep apnea. For adults with obstructive sleep apnea who cannot tolerate CPAP or prefer an alternative, the sleep and dental sleep medicine societies recommend a custom oral appliance that holds the lower jaw forward Moderate. Diagnosis comes first, through a sleep test; see Sleep.

Skin#

Bottom line: Use broad-spectrum SPF 30 or higher whenever the UV index is 3 or more, wear hats and shade, and never use tanning beds. Check your skin monthly, see a dermatologist for a full-skin exam every 2 years from 40 if you have light skin (yearly if you are at high risk), and go sooner for any spot that is new, changing, itching, or bleeding. If you have already had skin cancers, ask about nicotinamide.

Skin cancer types and risk#

Lifetime melanoma risk is about 3% (1 in 33) for White Americans, 0.5% for Hispanic Americans, and 0.1% for Black Americans. Risk rises with frequent sunburns, older age, and male sex, according to the USPSTF, and with fair skin, many or unusual moles, a family history of melanoma, and a weakened immune system (organ transplant recipients are at especially high risk). In people with darker skin, melanoma is often diagnosed later and appears on palms, soles, or under the nails.

Screening and self-checks#

The optimal plan Weak has three tiers. The Skin Cancer Foundation advises a head-to-toe self-exam once a month for everyone and a yearly professional exam; this guide adjusts the professional exam to your risk, because skin checks have a real downside. US melanoma diagnoses have risen far faster than melanoma deaths, a sign that many small melanomas found by screening would never have caused harm, and Germany's national screening program, started in 2008, has not clearly lowered melanoma deaths.

Guideline minimum: the USPSTF concluded in 2023 that the evidence is insufficient to recommend for or against routine skin exams by clinicians for adults without symptoms. That statement does not cover people with a personal or family history of skin cancer, and it found self-examination counseling also unproven (2018).

Use the ABCDEs from the American Academy of Dermatology to judge moles:

• A, asymmetry. One half is unlike the other.
• B, border. Irregular, scalloped, or poorly defined edge.
• C, color. Varies from one area to another.
• D, diameter. Usually larger than 6 mm (a pencil eraser), though melanomas can be smaller.
• E, evolving. Looks different from your other moles or is changing in size, shape, or color.

Photographing your skin every few months makes changes easier to see. Other cancer screening is covered in Cancer.

Sun protection#

The strongest evidence comes from a randomized trial in Nambour, Australia, where 1,621 adults were assigned to apply sunscreen every day or use it as they pleased from 1992 to 1996. Daily users later had fewer invasive melanomas (3 vs 11 over the next decade; hazard ratio 0.27) and fewer squamous cell carcinoma tumors, though not fewer basal cell cancers. Daily use also slowed visible skin aging by 24% (see below) Strong.

How to use it, per the AAD:

• Choose a broad-spectrum (UVA and UVB), water-resistant sunscreen with SPF 30 or higher.
• Apply enough: about 1 ounce (a shot glass) to cover exposed skin on an adult body.
• Reapply about every two hours outdoors, and after swimming or sweating. "Water resistant" means 40 or 80 minutes, not all day.
• Check the UV index. The EPA says protection is needed at a UV index of 3 or higher and extra protection at 8 or more; UV peaks from late morning to mid-afternoon. If your shadow is shorter than you are, seek shade.

Protective clothing, wide-brimmed hats, and shade, which the EPA lists alongside sunscreen, don't wear off or need reapplying. Get vitamin D from food or a supplement rather than from sunburn; the AAD and the supplements chapter agree on that. Morning light for your body clock is covered in Sleep.

Sunscreen safety and regulation#

As of October 2026, the FDA's 2021 proposal classifies zinc oxide and titanium dioxide as safe and effective and says 12 other filters, including oxybenzone and avobenzone, need more data; the FDA stresses that this does not mean they are unsafe. That proposal is still not final. In June 2026 the FDA added a new filter, bemotrizinol, to the list of permitted sunscreen ingredients, and in September 2026 it finalized the removal of PABA and trolamine salicylate, which no US products contained.

In an FDA-run trial of 48 adults, blood levels of all six chemical filters tested exceeded the level above which the FDA asks for more safety studies after a single day of use. Absorption is not the same as harm: the AAD says no available sunscreen ingredient has been shown to harm human health, while sunburn and skin cancer are proven harms. In 2021, testing found benzene, a carcinogen and manufacturing contaminant, in some spray sunscreens, and Johnson & Johnson recalled five Neutrogena and Aveeno aerosol lines. The recalled products were aerosols; lotions also avoid inhaling spray.

A reasonable choice: mineral sunscreen for the face or sensitive skin, and any broad-spectrum SPF 30+ product you will actually reapply for the body.

Tanning beds#

The International Agency for Research on Cancer classifies UV tanning devices as Group 1, carcinogenic to humans (2009), the same category as tobacco. In a meta-analysis of 27 studies, ever using sunbeds raised melanoma risk by 20%, and starting before 35 raised it by 87%, with risk climbing about 1.8% for each additional session per year Strong. There is no safe tanning bed. Self-tanners are the alternative.

Nicotinamide for people at high risk#

Nicotinamide is a form of vitamin B3 (not the same as niacin, which causes flushing). In the ONTRAC trial, 386 Australians who had had at least two non-melanoma skin cancers in five years took 500 mg twice daily or placebo for a year. Nicotinamide users had 23% fewer new non-melanoma skin cancers and fewer precancerous actinic keratoses, with no benefit once they stopped. A later trial in 158 organ transplant recipients found no benefit, though it was stopped early for poor recruitment. In a 2025 study of 33,822 US veterans, nicotinamide use was linked to 14% lower skin cancer risk overall and 54% lower when started after a first skin cancer; that study is observational.

Nicotinamide 500 mg twice daily, the dose used in trials Moderate, is worth discussing with your dermatologist if you have had more than one basal or squamous cell cancer. There is no evidence it helps people who have never had skin cancer, and it does not replace sun protection or skin exams. More in Supplements.

Skin aging#

Much of the visible aging on sun-exposed skin (wrinkles, spots, leathery texture) is photoaging from UV. In the Nambour trial, 903 adults under 55 who used sunscreen daily showed no detectable increase in skin aging after 4.5 years, and aged 24% less than the discretionary group.

Irritation is the main reason people quit retinoids, so starting slowly (a low strength, a small amount, a few nights a week) helps. Retinoids make skin more sun-sensitive, which is one more reason for daily sunscreen. A dermatologist or telehealth service can prescribe tretinoin.

Action plan#