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Learning Objectives

  • Describe normal healthy tissue, abnormal tissue (hard and soft) and 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 patient limitations that decrease their ability to perform daily oral hygiene care.

  • Recognize why being part of an interprofessional health care team along with oral health care providers (dentists, hygienists, dental assistants, caregivers) ensures good oral health in long-term care facilities.

  • Identify the oral health challenges that frail homebound patients will face.

  • Recognize when to refer and what criteria are most important when referring an older adult patient to an oral health professional.

Key Clinical Points

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

  2. A preventive model of oral health care for all older adult patients includes fluoride-containing gels, varnishes, rinses and pastes, antibacterial rinses, electric toothbrushes, floss threaders, and other adaptive methods.

  3. Many common medications have adverse 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 vice versa, and may affect dental treatment.


The centrality of the mouth to human health, function, and behavior is clear. The abilities to eat, smile, speak, and interact with others are essential functions. This chapter presents the contributions of the mouth to health and function in an older person’s life. The components of the oral cavity are described along with age-related 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. Finally, goals of long-term oral health care are described, along with options for long-term oral health care.


Specialized tissues have evolved in the orofacial region that allow us to speak, process food, and protect us from pathogens and trauma (Table 32-1). 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 keeping them intact and pliable, and moistens the food bolus into a swallow-acceptable form. These activities are finely coordinated; a disturbance in any one function can compromise speech, alimentation, and the quality of a patient’s life (Table 32-2).


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