The Disproportionate Impact of Oral Disease on the Elderly

In an article he wrote as a guest editor for the American Journal of Public Health, Ira B. Lamster, DDS, MMSc, succinctly delineates the issues that account for the disproportionate impact oral and dental diseases have on the elderly.

For both obvious and less obvious reasons, oral and dental diseases have a disproportionate effect on the elderly. In addition to years of exposure of the teeth and related structures to microbial assault, their oral cavities will show evidence of wear and tear as a result of normal use (chewing and talking) and destructive oral habits such as bruxism (habitual grinding of the teeth). The elderly also suffer from chronic disorders that can directly or indirectly affect oral health, including autoimmune disorders such as pemphigus and pemphigoid. The elderly often require multiple medications, and a common side effect of more than 500 medications is reduced salivary flow. A reduction in saliva can adversely affect quality of life, reduce the efficiency of chewing, and lead to significant problems of the teeth and their supporting structures.

The elderly may also have difficulty performing routine oral hygiene procedures because of physical limitations. In addition, oral infection is now recognized as a risk factor for a number of systemic diseases, including cardiovascular and cerebrovascular diseases, diabetes mellitus, and respiratory disorders. Finally, it is important to emphasize that once people have become edentulous (toothless) and are using complete dentures, their oral health needs do not cease. Jaws are not static and may continue to resorb over time. Ill-fitting prostheses can adversely affect chewing and lead to poor nutrition. People without teeth remain susceptible to oral cancer, mucosal diseases, and alterations in salivary gland function.”

Lamster IB. Oral health care services for older adults: A looming crisis. Am J Public Health. 2004; 94(5):699-702.