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Essentials of Diagnosis

  • The physical examination for oral health and diseases includes lymph nodes, lips, tongue, mucosa lining cheeks, floor and roof of the mouth, gingiva (gums), saliva, natural teeth, artificial teeth, and observation of oral cleanliness.

  • Xerostomia (dry mouth) resulting from decreased salivary flow, hypofunction of salivary glands, or changed salivary composition affects 10% to 40% of older adults, seriously impairs oral function (lubrication, cleansing, chewing, swallowing), promotes dental caries (tooth decay), exacerbates periodontal disease (gum disease), and compromises nutritional intake.

  • Periodontal disease is marked by the loss of alveolar bone and supporting tissues around teeth; advanced periodontitis (severe bone loss) leads to increasing tooth mobility and loss of teeth, and has been found to be associated with many systemic diseases.

General Principles in Older Adults

Oral health is essential to general health and quality of life for older adults. Chronic disease increases the burden of oral disease, predisposing older adults to oral microbial infections, pain, altered taste, difficulty chewing and speaking, and dysphagia. Clinical research demonstrates the benefits of maintaining oral health and the deleterious consequences of oral neglect.

  • Weight loss and failure to thrive are common in patients with poor oral health. Concomitant psychosocial consequences undermine self-esteem, compromise social interaction, and contribute to chronic stress and depression.

  • Periodontal disease (gum disease) is the sixth leading complication of diabetes and threatens glycemic control. Poor glycemic control is associated with a 3-fold increase in the risk of periodontal disease. Treatment of periodontal disease results in a 10% to 20% improvement in glycemic control.

  • 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 tricyclic antidepressants, antihistamines, antihypertensives, and diuretics.

  • Oral cancer is the eighth most common cancer in men and is 7 times more likely to occur in older adults.

  • Aspiration pneumonia is the major reason for hospital admission from nursing homes and has a mortality rate of 20% to 50%. Effective daily oral hygiene lowers the incidence of aspiration pneumonia among patients in nursing facilities and hospitals.

By addressing oral health needs, health care professionals play a critical role in improving the health and quality of life of older adults. Clinicians should be familiar with normal and pathologic oral morphology. Clinicians have a positive impact by counseling patients on effective preventive measures, including regular dental visits.

Oral Disease & Access to Care

Although changes in oral health are not inevitable consequences of aging, profound, yet often asymptomatic, untreated oral disease is frequently present in older adults. Twenty-three percent of older adults have untreated dental caries, and 70% have periodontal disease. Almost a third of older adults are fully edentulous (missing all natural teeth). Seniors older than age 65 years average 19 remaining teeth. The World Health Organization recognizes that of the original 32 teeth, ...

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