Chapter 032. Oral Manifestations of Disease (Part 10)

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Aging and Oral Health While tooth loss and dental disease are not normal consequences of aging, a complex array of structural and functional changes occurs with age that can affect oral health. Subtle changes in tooth structure (e.g., diminished pulp space and volume, sclerosis of dentinal tubules, altered proportions of nerve and vascular pulp content) result in diminished or altered pain sensitivity, reduced reparative capacity, and increased tooth brittleness. In addition, age-associated fatty replacement of salivary acini may reduce physiologic reserve, thus increasing the risk of xerostomia. Poor oral hygiene often results when vision fails or when patients lose manual dexterity...

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Chapter 032. Oral Manifestations of Disease (Part 10) Aging and Oral Health While tooth loss and dental disease are not normal consequences of aging, a complex array of structural and functional changes occurs with age that can affect oral health. Subtle changes in tooth structure (e.g., diminished pulp space and volume, sclerosis of dentinal tubules, altered proportions of nerve and vascular pulp content) result in diminished or altered pain sensitivity, reduced reparative capacity, and increased tooth brittleness. In addition, age-associated fatty replacement of salivary acini may reduce physiologic reserve, thus increasing the risk of xerostomia.
Poor oral hygiene often results when vision fails or when patients lose manual dexterity and upper extremity flexibility. This is particularly common for nursing home residents and must be emphasized since regular oral cleaning and dental care has been shown to reduce the incidence of pneumonia. Other risks for dental decay include limited lifetime fluoride exposure and preference by some older adults for intensely sweet foods when taste and olfaction wane. These factors occur in an increasing proportion of persons over age 75 who retain teeth that have extensive restorations and exposed roots. Without assiduous care, decay can become quite advanced yet remain asymptomatic. Consequently, much or all of the tooth can be destroyed before the process is detected. Periodontal disease, a leading cause of tooth loss, is indicated by loss of alveolar bone height. Over 90% of Americans have some degree of periodontal disease by age 50. Healthy adults who have not experienced significant alveolar bone loss by the sixth decade do not typically develop significant worsening with advancing age. Complete edentulousness with advanced age, though less common than in previous decades, is still present in approximately 50% of Americans age ≥85.
Speech, mastication, and facial contours are dramatically affected. Edentulousness may also worsen obstructive sleep apnea, particularly in those without symptoms while wearing dentures. Dentures can improve speech articulation and restore diminished facial contours. Mastication is restored less predictably, and those expecting dentures to improve oral intake are often disappointed. Dentures require periodic adjustment to accommodate inevitable remodeling that leads to a diminished volume of the alveolar ridge. Pain can result from friction or traumatic lesions produced by loose dentures. Poor fit and poor oral hygiene may permit candidiasis to develop. This may be asymptomatic or painful and is indicated by erythematous smooth or granular tissue conforming to an area covered by the appliance. Further Readings Durso SC: Interaction with other health team members in caring for elderly patients. Dent Clin N Am 49:377, 2005 [PMID: 15755411]
Little JW et al (eds): Dental Management of the Medically Compromised Patient, 6th ed. St. Louis, Mosby, 2002 Regezi JA, Sciubba JJ: Oral Pathology: Clinical Pathologic Correlations, 4th ed. Philadelphia, Saunders, 2002 Spahr A et al: Periodontal infection and coronary heart disease. Role of periodontal bacteria and importance of total pathogen burden in the coronary event and periodontal disease (CORODONT) study. Arch Intern Med 166:554, 2006 [PMID: 16534043] Woo SB et al: Systematic Review: Bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753, 2006 [PMID: 16702591]