Tooth Care In The Elderly Dental Disease Is A Serious Problem In This Growing Population

Older Americans make up a growing percentage of the U.S. population. According to the 2000 U.S. Census, nearly 35 million are 65 years or older. And by 2050, that number is expected to increase to 48 million.
Meanwhile, oral diseases and conditions are common among these Americans who grew up without the benefit of community water fluoridation and other fluoride products.

Older Americans with the poorest oral health are those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized also increases the risk of poor oral health.

To make matters worse, many older Americans do not have dental insurance. Often, these benefits are lost when they retire. The situation may be worse for older women, who generally have lower incomes and may never have had dental insurance.

Medicaid, the jointly-funded federal-state health insurance program for certain low-income and needy people, funds dental care for low-income and disabled elderly in some states, but reimbursements for this care are low. Medicare, which provides health insurance for people over age 65 and certain people with disabilities, was not designed to provide routine dental care.

And routine dental care is precisely what many elderly Americans lack.

Age-old Problem

About 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of adults 65 years old and older no longer have any natural teeth. Interestingly, toothlessness varies greatly by state. Roughly 42{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of older Americans living in Kentucky and West Virginia are toothless, compared to only 13{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those living in Hawaii.

Having missing teeth can affect nutrition, since people without teeth often prefer soft, easily chewed foods. Because dentures are not as efficient in chewing performance as natural teeth, denture wearers also may choose soft diets and avoid fresh fruits and vegetables.

Periodontal (gum) disease or dental decay (cavities) most often cause tooth loss. Older Americans continue to experience dental decay on the crowns of teeth and on tooth roots, the latter because of gum recession.

Severity of periodontal disease increases with age. About 23{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of 65- to 74-year-olds have severe disease, which is measured by 6-mm loss of attachment of the tooth to the adjacent gum tissue. At all ages, men are more likely than women to have more severe disease. And at all ages, people at the lowest socioeconomic level have the most severe periodontal disease.

Oral and pharyngeal cancers, which are diagnosed in some 30,000 Americans each year, result in 8,000 deaths each year. These cancers are primarily diagnosed in the elderly. Prognosis is poor. The five-year survival rate for white patients is 56{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, and for African-American patients it is only 34{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}.

Most older Americans take both prescription and over-the-counter drugs. Over 400 commonly used medications can be the cause of a dry mouth. Reduction of salivary flow increases the risk for oral disease since saliva contains anti-microbial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria. Individuals in long-term-care facilities — about 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the elderly — take an average of eight drugs each day.

Painful conditions that affect facial nerves are more common among the elderly and can be severely debilitating. These conditions can affect mood, sleep, and oral-motor functions such as chewing and swallowing. Neurological diseases associated with age, such as Parkinson’s disease, Alzheimer’s disease, Huntington’s disease, and stroke, also affect oral sensory and motor functions, in addition to limiting the ability to care for oneself.

What Can They Do?

Dentists recommend several steps elderly people can take to promote their tooth health and limit the extent of dental disease.

• Drink fluoridated water and use fluoride toothpaste; fluoride provides protection against dental decay at all ages.
• Practice good oral hygiene. Careful tooth brushing and flossing to reduce dental plaque can help prevent periodontal disease.
• Get professional oral health care, even if one has no natural teeth. Professional care helps to maintain the overall health of the teeth and mouth, and provides for early detection of pre-cancerous or cancerous lesions.
• Avoid tobacco. In addition to the general health risks posed by tobacco use, smokers have seven times the risk of developing periodontal disease compared to non-smokers. Tobacco used in any form — cigarettes, cigars, pipes, and smokeless (spit) tobacco — increases the risk for periodontal disease, oral and throat cancers, and oral fungal infection (candidiasis). Spit tobacco containing sugar also increases the risk of dental decay.
• Limit alcohol. Excessive alcohol consumption is a risk factor for oral and throat cancers. Alcohol and tobacco used together are the primary risk factors for these cancers.
• Make sure dental care is provided prior to undergoing cancer chemotherapy or radiation to the head or neck. These therapies can damage or destroy oral tissues and can result in severe mucosal inflammation and ulcers, loss of salivary function, rampant decay, and destruction of bone.
• Caregivers should attend to the daily oral hygiene procedures of elders who are unable to perform these activities independently.
• Sudden changes in taste and smell should not be considered signs of aging, but should be an alert to seek professional care.

Information for this article was provided by the U.S. Centers for Disease Control and Prevention.