CDC Gets to Root Causes of Oral Disease in Elders

Article excerpt

The first of two articles.

The eyes may be the window to the soul; but the mouth mirrors a person's health and well-being throughout life and into old age. That is because oral dis eases and conditions can affect many aspects of an individual's general health status, as well as emotional and psychological well-being, by affecting speech, laughter and social expression. Several health conditions can, in turn, have an impact on oral health.

Many people erroneously believe that losing one's teeth is an inevitable part of aging and that there is nothing they can do about it. Although in the 19505 fewer than 50% of older adults retained their teeth, now more than 70% of the 36 million adults 65 or older in the United States keep their teeth into old age. As a result, strategies for maintaining healthy teeth and gums-such as good oral hygiene, fluoride in drinking water and toothpaste, and regular professional care-are as important for older adults as for children. Yet, even though the growing number of older adults retaining their teeth is good news, they also face the challenge of preserving those teeth at a time when physical, cognitive or financial limitations may hinder their ability to maintain their oral health.


There is more at stake for oral health than having an attractive smile and cavity-free teeth. Oral problems can lead to needless pain and suffering; difficulty speaking, chewing and swallowing; loss of self-esteem; and higher healthcare costs. Each year, about 28,000 Americans are diagnosed with mouth and throat cancers, which can result in disfigurement and death. In addition, periodontal (gum) diseases are associated with diabetes, and emerging evidence suggests a relationship between severe periodontal disease and cardiovascular disease and stroke.

"Older adults, along with caregivers, healthcare providers and policymakers, should be aware of effective ways to prevent and control oral diseases," stated Barbara Gooch, a dental officer in the Division of Oral Health of the Centers for Disease Control and Prevention's (CDC) National Center for Chronic Dis ease Prevention and Health Promotion in Atlanta. She explained that teeth are lost due to tooth decay and gum disease, not aging alone. The risk for these oral difficulties may increase with age for many reasons. For example, certain medications can impair the production of saliva, which is needed to lubricate the mouth and gums, reduce bacterial growth and provide important minerals. The combination of dry mouth, receding gums, poor oral hygiene and a lack of fluoride can lead to tooth decay and result in the need for extensive and costly treatment.

Maintaining good oral health is even more challenging for adults with chronic illnesses and disabilities. Physical and cognitive limitations often can make it difficult for them to brush their teeth. Older adults who are homebound or in nursing homes are likely to face even greater challenges. For many of these elders, daily assistance with oral hygiene is critical, Gooch said. The use of fluoride products also is important, particularly brushing with fluoride toothpaste and drinking fluoridated water, but mouth rinses, varnishes or supplements may also be recommended. Homebound elders or those in nursing homes-even those who no longer have their teeth or wear dentures-should receive regular oral examinations and dental care.

For many older adults, their need for preventive and treatment services will continue and may increase at a time when their annual incomes are likely to diminish, according to research by Richard J. Manski of the University of Maryland and Baltimore College of Dental Surgery (American Journal of Public Health, May 2004). Most older adults pay for dental services out of pocket because employer-provided dental insurance coverage usually ends with retirement. Furthermore, Medicare does not cover routine dental services, and Medicaid coverage is limited and is available in less than half the states. …