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Oral health is essential to the general health and quality of life of older adults. Chronic systemic diseases increase the burden of oral diseases, predisposing older adults to oral microbial infections, pain, dysphagia, difficulty chewing, altered taste, and difficulty speaking.

  • Periodontal disease (gum disease) is the sixth leading complication of diabetes and threatens glycemic control.

  • Having <21 teeth compromises masticatory function and nutritional status and is associated with smoking, low socioeconomic status, low physical and social activity, frailty, living alone or in a nursing home, poor access to care, and higher mortality rates.

  • Xerostomia (dry mouth) seriously impairs oral function, promotes dental caries (tooth decay), and exacerbates periodontal disease. Decreased salivary flow is a side effect of >500 medications, including antidepressants, antihistamines, antihypertensives, and diuretics.

  • Bone antiresorptive agents, such as intravenous and oral bisphosphonates and denosumab, are given to treat osteoporosis. These drugs are associated with medication-related osteonecrosis of the alveolar bone. Chronic conditions contributing to increased risk are diabetes, steroid use, smoking, and use of antiangiogenic drugs.

  • Oral cancer is the eighth most common cancer in men and is seven times more likely to occur in older adults.

  • Aspiration pneumonia is a major reason for hospital admission, a leading cause of death in critically ill patients, and the second most costly of the top five hospital-acquired infections.

  • Collaboration of an interdisciplinary team, including dentists, physicians, nurses, therapists, pharmacists, and other health care professionals is critical to individualized and appropriate oral health care planning.


Although changes in oral health are not inevitable consequences of aging, profound, yet often asymptomatic, untreated oral disease is frequently present in older adults. In the United States, 19% of older adults have untreated dental caries on the crowns of their teeth, 38% have untreated dental caries on the roots of their teeth, and 37% have moderate to severe periodontal disease. Fifteen percent of older adults are fully edentulous. Thirteen percent of older adults experience orofacial pain, including jaw joint and facial pain, oral sores, burning mouth, and toothache. Chronic orofacial pain can be associated with increased frailty, social withdrawal, decreased activities of daily living, and diminished quality of life. Less than half of older adults have had a dental visit during the past year, with even lower access to care for minority, impoverished, or institutionalized elders. Medicare and many state Medicaid programs do not cover preventive or restorative dental treatment for older adults. Dental insurance is often lost after retirement. As a result, older adults pay for a significant portion of their dental expenses out of pocket, limiting their treatment choices and ability to receive care. Many forgo routine and preventive care, which can result in the need for more costly and complicated treatment, often resulting in adverse outcomes as oral health declines in the absence of prevention and treatment of oral disease at earlier stages.


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