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Oral Health

Increasing numbers of people are becoming older adults. The “graying” of America has often been described in the media and is well documented by U.S. census. Baby boomers approaching retirement age are expected to make this trend even more pronounced. The age considered to be geriatric usually (and arbitrarily) begins at 65 years. This is entirely an artificial construct; many so-called geriatric processes are well evident in people years younger, and many do not manifest themselves in others until much later. That caveat aside, the transition from “elderly” to “frail elderly,” or between “young old” and “old old,” is characterized by physiological and functional change. This entry discusses these changes, their effects on oral health, and the relationship between oral health and systemic health.

Plaque Diseases

The most common of the oral diseases are the plaque diseases, namely caries and periodontal disease. Plaque is an adherent, gelatinous-like material consisting of salivary components, food residues, and bacteria. Caries is the dental term for tooth decay, and periodontal disease affects the tissues surrounding the teeth. These bacterial diseases are both chronic and progressive in nature. Progressive demineralization of the teeth by bacterial acid causes enamel breakdown (cavities), which can develop into abscess and tooth loss.

Periodontal disease causes destruction of the fibers attaching teeth to bone. Advanced periodontal disease results first in tooth mobility and then in tooth loss. During this process, recession of gum tissues exposes the root surfaces of teeth. Because these root surfaces are not protected by enamel, they are more susceptible to caries. The resulting decay is difficult to treat, and recurrence is common. More than 95% of people age 65 years and older have periodontal damage.

Other Oral Diseases

Like all conditions discussed in this entry, the following pathologies are not exclusive to an aging population, but older adults have particular susceptibility.

Fungus

Fungal infections, such as candidiasis and angular cheilitis, are common among older people. They are usually associated with other medical conditions. People with diabetes who also wear dentures are at particular increased risk, as are those who have suppressed immune systems. Oral candidiasis is especially serious for people who are HIV positive and for those taking immunosuppressive medications. It can spread to the esophagus or lungs, creating an immediate threat to life.

Angular cheilitis is a fungal condition of the lips, causing dry and cracked tissues at the corners of the mouth. If untreated, the lesions can persist indefinitely, with periodic bleeding and occasional secondary infection. It afflicts immunocompromised people, and those who wear dentures have reduced salivary flow. This seemingly minor lesion causes significant misery and decreased quality of life.

Neoplasm

Neoplasms range from epulis fissuratim, a benign growth of tissue caused by an ill-fitting denture, to life-threatening malignancies. An epulis can cause irritation, inflammation, and secondary infections. The malignancy most threatening to life is squamous cell carcinoma. It is frequently found on the side of the tongue in the back of the mouth, although it is also found on the lip, palate, cheek, and floor of the mouth. It has a poor prognosis, and successful treatment requires early diagnosis. The survival rate for people with lip cancer is high because these lesions are quite visible, and early diagnosis is typical. Lesions on the floor of the mouth or the side of the tongue have a significantly higher mortality rate. These more posterior lesions tend to be more aggressive, and diagnosis is often delayed because they are hidden from view.

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