As the old saying goes, with age comes wisdom. We also know that as we all grow older, certain health concerns earn our full attention. One of those concerns is the importance of oral health care for our elderly population. Oral health is an important and often overlooked component of an older person’s general health and well-being. Since older Americans are living longer, this article will discuss some of the dental issues that affect our elderly population.
Periodontal disease is a chronic, bacterial plaque mediated infection that is caused by bacteria that cause giningval inflammation, bone and ultimately tooth loss if left untreated. Many older persons are prone to periodontal disease because of poor oral hygiene and gingival recession. Periodontal disease has been associated with cardiovascular disease, worsening diabetes control, poor wound healing, and aspiration pneumonia, particularly in institutionalized patients. Treatment of periodontal disease includes daily brushing and flossing and professional dental care, ranging from plaque removal to surgical debridement of infected periodontium.
We have all drank a cold glass of water only to grimace at that sharp, tingling sensation in our teeth. With aging, the appearance and structure of teeth tend to change. The teeth can darken or be yellower in appearance, which is caused by the thickness and composition of the underlying dentin and its covering, the enamel. Abrasion and attrition also contribute to changes in tooth appearance. Additionally, the gum tissues can recede causing the roots to be exposed. As a result. the cementum (i.e., the substance covering the root surface) gradually thickens. Because the cementum is highly organic, it is less resistant to environmental agents, such as sugar, acids from soft drinks.
Dental caries can occur at any age. However, because of gingival recession and periodontal disease, older persons are at higher risk of developing root caries. The incidence of root caries in patients older than 60 years is twice that of 30-year-olds; 64 percent of persons older than 80 years have root caries, and up to 96 percent have coronal caries (above the gum). Risk factors for coronal and root caries lead to increased exposure to cariogenic bacteria, such as Streptococcus mutans, Lactobacillus, and Actinomyces.
Dry Mouth: Xerostomia
Xerostomia, the subjective sensation of dry mouth caused by decreased saliva production, affects 29 to 57 percent of older persons. Saliva lubricates the oral cavity, prevents decay by promoting remineralization of teeth, and protects against fungal and bacterial infections. In addition to dry mouth, clinical manifestations of xerostomia include a burning sensation, changes in taste, and difficulty with swallowing and speech. Although salivary flow does not decrease with age alone, certain medications and illnesses increase the risk of xerostomia in older persons.
Oral and pharyngeal cancers, which are diagnosed in some 31,000 Americans each year, result in about 7,400 deaths each year. These cancers are primarily diagnosed in the elderly. Prognosis is poor. The five-year survival rate for white patients is 56 percent and for African American patients is only 34 percent. Tobacco and alcohol use are thought to be responsible for up to 75 percent of oral cancers. Oral cancer most commonly occurs, in order of frequency, on the lateral borders of the tongue, on the lips, and on the floor of the mouth. Fifteen percent of patients with oral cancer will be diagnosed with another cancer in a nearby area, such as the larynx, esophagus, or lungs.
Oral Health Tips
Below are some helpful tips that may help your parents or grandparents:
- Practice good oral hygiene. Careful tooth brushing and flossing to reduce dental plaque can help prevent periodontal disease.
- Caregivers should be educated as to the proper brushing and flossing. The caregivers should reinforce the daily oral hygiene routines of elders who are unable to perform these activities independently.
- It is important to see your dentist on a regular basis, even if you have no natural teeth and have dentures. Professional care helps to maintain the overall health of the teeth and mouth, and provides for early detection of pre-cancerous or cancerous lesions.
- Limit alcohol. Drinking a high amount of alcoholic beverages is a risk factor for oral and throat cancers. Alcohol and tobacco used together are the primary risk factors for these cancers.
- Make sure that you or your loved one gets dental care prior to having cancer chemotherapy or radiation to the head or neck. These therapies can damage or destroy oral tissues and can result in severe irritation of the oral tissues and mouth ulcers, loss of salivary function, rampant tooth decay, and destruction of bone.
- Sudden changes in taste and smell should not be considered signs of aging, but should be a sign to seek professional care.
- If medications produce a dry mouth, ask your doctor if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco and alcohol.