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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #25, #48, #49


Learning Objectives

  • Describe the differences between normal healthy hard and soft tissue and nonhealthy tissue or lesions in the oral cavity.

  • List the primary barriers to professional oral health care: finances, perceived need, access to care, and the clinician’s inability to care for the challenges that face this population.

  • Identify limitations that patients have that decrease their ability to perform oral hygiene and home care.

  • Understand the importance of being part of an interdisciplinary team along with an oral health care group (dentist, dental specialist, dental hygienist, dental assistant, home health and nurse aides) to ensure good oral health in long-term care.

  • Understand the oral health challenges that a frail medically compromised homebound patient will face.

  • Understand when to refer and what criteria are most important when referring a geriatric dental patient to a dental health care professional.

Key Clinical Points

  1. Comprehensive oral health screening should be part of the patient’s initial history and physical.

  2. Tools used in a preventive model of oral health care for geriatric dental patients include fluoride-containing gels, varnishes, rinses and paste, antibacterial rinses, electric tooth brushes, floss threaders, and other adaptive methods.

  3. Many common medications can have negative effects on the oral cavity and oral health.

  4. Disease in the oral cavity can diminish a patient’s overall health and quality of life.

  5. Common systemic medical conditions may affect oral health and affect the treatment options in the oral cavity.


The centrality of the mouth to human health, function, and behavior is clear. The ability to eat, smile, speak, and interact with other people depends on an intact oral cavity. The initiation of alimentation and protection of the host are essential functions. The purpose of this chapter is to present the contributions of the mouth to health and function in an older person’s life. The components of the oral cavity will be described along with age- and disease-related changes, how to evaluate geriatric patients’ oral conditions, and when to refer. The impacts of oral conditions on quality of life are described, as are disparities in access to and outcomes of oral health care and the importance of prevention in health status. Goals of long-term oral health care are described, along with options for providing long-term oral health care.


Many specialized tissues have evolved in the orofacial region that allow us to speak, process food, and protect us from pathogens and trauma (Table 37-1). The teeth, the periodontium, and the muscles of mastication prepare food for swallowing. The tongue plays a central role in communication and is a key participant in food bolus preparation and translocation. Salivary glands provide secretions with multiple functions; saliva lubricates oral mucosal tissues to keep them intact and ...

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