The Second Fifty Years Promoting Health and Preventing Disability (1992) / Chapter Skim
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Oral Health Problems in the 'Second Fifty'
Oral Health Problems in the 'Second Fifty'
Pages 119-135
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From page 119... ...
tooth loss resulting from oral diseases and conditions;~4) oral expressions of systemic cliseases and side effects from medications; and ;5)
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Individuals beyond age 50 exhibit rising levels of dysfunction through increases! tooth Toss, root caries, periodontal diseases, pain, and oral complications of general systemic conditions.
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Tissue Pathologies an c' Oral Cancer 121 Numerous oral mucosal conditions are prevalent among older adults. Sometimes they are secondary to systemic disease; at other times they occur as a result of side effects of medication, ill-fitting dentures, and substance abuse (e.g., tobacco and alcohol)
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From page 122... ...
of these root surfaces were filled.43 The caries process reflects the interaction of four basic risk factors: a susceptible tooth surface, the presence of a sufficient number of cariogenic microorganisms, inadequate fluoride exposure, and ingestion of a caries-conducive diet. Other factors conducive to dental caries include a history of high caries prevalence, reduced salivary flow, altered salivary composition, gingival recession, and poor oral hygiene.
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From page 123... ...
The prevalence and severity of periodontal diseases increase with age, yet most individuals have signs of destructive disease in only a few sites at periodic intervals.74344 The higher prevalence and severity of periodontal diseases among older persons may not be the result of enhanced susceptibility but rather may reflect the accumulation of disease over time.44 These diseases are prevalent in otherwise healthy individuals, although certain systemic conditions (e.g., diabetes) appear to be associated with more severe types of periodontal diseases.
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Other agerelated changes in taste, olfaction, and oral sensation, such as touch, temperature, and pressure sensibility, have been observed but have not been well described or documented.34 Tooth Loss Because tooth Toss is the sequels of caries, perioclontitis, and trauma, it is a general indicator of the amount of severe oral diseases experienced by an individual or a population.49 The relationship between tooth Toss and oral diseases, however, is complicated. Tooth Toss also reflects aspects of the dental delivery system that are not disease related for example, the cost, access to, and utilization of dental services, limitations of existing technology, and variations among treatment options offered and chosen in the dentist/patient interaction.
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Tooth loss increases after the age of 35 ant! increases considerably in the over-50 age groups.37 Replacement of missing teeth is necessary to retain an adequately functioning clentition.
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From page 126... ...
impaired healing, which may lead to chronic destructive periodontal disease and other oral problems.29 Psychoses, affective disorders, and steep disturbances, on the other hand, may affect the patient's willingness or ability to perform appropriate oral hygiene or seek dental services, thus affecting oral health, speech, or swallowing.29 Neurological problems, including stroke, Alzheimer's disease, and Parkinson's disease, can adversely affect oral functions. Slower movements, reduced agility, arthritis, Alzheimer's disease, impaired vision and hearing, urinary dysfunction, and vascular insufficiency may all undermine the ability to follow recommenciations for self-care.
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From page 127... ...
will be needed by upcoming cohorts to maintain a functional dentition; as a result, the total absence of insurance or prepayment mechanisms, and the failure of many reimbursement systems to acknowledge and support preventive services, may create significant barriers to regular use of dental services in the over-50 population.~5 i9 Many direct risk factors for common oral diseases of older adults are known. The reduction of those factors, or their actual elimination, is possible through appropriate preventive self-care, elimination of high-risk behaviors, professionally provided preventive, diagnostic, and therapeutic care, and a supportive environment.
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From page 128... ...
Altering this risk requires interaction between dentists and physicians regarding medications and systemic diseases. Prevention of Gingivitis and Periodontitis Dental plaque retention is a major problem in oIcler adults and is often exacerbated by existing restorations, rough root surface topology, and an inability to brush sufficiently.
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From page 129... ...
Of all the direct and indirect risk factors for oral dysfunction among older aclults, the use of professionally provided services is the most affected by social, economic, environmental, and individual resources.~4 Social and economic factors, including Tower levels of education, rural residence, and inability to pay, have been linked to the underutilization of services. Moreover, increased risk for candidiasis, denture ulcers, root caries, coronal caries, gingivitis, and periodontal disease has been linked to inadequate dental care in institutional settings.8 Besides factors such as the ability to pay and accessibility to care, the barriers to improved oral health often include a number of indirect factors that are correlated with oral functional impairments.
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Research 1. Studies should be conducted to examine the prevalence, incidence, cohort differences, and risk factors of oral dysfunction in oilier adults E.g., tooth Toss, oral cancer, oral mucosal conditions, oral sequelae of systemic diseases, chronic orofacial pain, trauma, salivary glance dysfunction, and aspects of caries and periodontal diseases)
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From page 131... ...
The use of preventive and early oral health diagnostic services should be encouraged through public- and private-sector incentives to expand and extend dental benefits to the retired population and through incentives for dental professionals to provide care to compromised older adults outside traditional dental care settings (e.g., Tongterm care facilities, mobile vans, portable equipment, institutions)
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5. Institutional education programs for health professionals should be enhanced to improve knowledge, attitudes, and behaviors regarding primary prevention, diagnosis, and treatment for oral functional disabilities of older adults.
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G Perceived barriers to the use of dental services by the elderly.
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B Patterns of tooth loss and accumulated prosthetic treatment potential in U.S.
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A Oral health status in the US: Tooth loss and edentulism.
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