Academic journal article Generations

Chronic Oral Disease and Disability in Later Life

Academic journal article Generations

Chronic Oral Disease and Disability in Later Life

Article excerpt

The mix of dominant chronic oral conditions in late life has dramatically shifted in the past fifty years. The first national survey of adult oral health, published by the National Institutes of Health in 1957, revealed that over two-thirds of Americans over age 75 had no natural teeth. The dominant oral condition was toothlessness. Findings from the latest such survey, published in 1986, made clear that the dental status of elderly Americans had significantly improved: Nearly two-thirds of Americans over age 75 now retained some or all of their natural teeth. Subsequent regional studies have confirmed that Americans in their eighth decade and beyond are a compelling success story for oral health. The current cohort of elders has maintained their teeth beyond all expectations of their forebears, thanks to exposure to fluoride in drinking water and toothpaste, the explosion in numbers and sophistication of dental personnel following World War II, and pervasive public health campaigns (Shay and Ship, 1995).

But maintaining teeth and their supporting structures into advanced age is not without its literal and figurative price. The most common dental diseases, decay and gum disorders, now threaten oral health across the lifespan and remain the major reasons for tooth loss, regardless of age. This article will discuss the three most common chronic oral diseases-dental decay (caries), gum disease (periodontitis), and tooth loss-and the particular challenges they represent in and to older people and those who are concerned about their health and well-being.


Caries and periodontitis-and their most extreme consequence, the loss of a tooth-come about when balance shifts between trillions of bacteria in the mouth, on the one hand, and defenses against the microbes on the other. Although over 300 different species of oral organisms have been identified (and an equal number is believed to be present but has eluded characterization), only a fraction are commonly implicated in oral disease. Growth of destructive bacteria is customarily kept in check by a wide range of salivary molecules, the immune system, and personal hygiene habits. But disease can and does readily result if growth of disease-causing microorganisms is assisted by reduction in any defenses, an abundance of nutrients for the undesirable species, or expanded environments where they can thrive (Shay, 2002).

Daily dental hygiene requires a level of manual dexterity, visual acuity, and tactile sense that may be impaired in advanced age because of arthritis, peripheral neuropathy, or diminished cognitive status or sight. Older people may also lack adequate saliva. A dry mouth is the most commonly reported potential side effect of the most frequently prescribed drugs. Reduction of saliva resulting from the complex drug regimens of older patients, whose life quality is enhanced by these treatments, is therefore a serious matter. Saliva should be a potent and omnipresent line of defense against oral disease. But when saliva is altered or diminished, as a side effect of a drug prescribed for another chronic condition, dental disease can and frequently does flourish (Sreebny and Valdini, 1987).


The teeth are covered by enamel, a translucent composite of crystals of calcium phosphate. Enamel is soluble in the mix of acids certain oral bacteria excrete when they ingest dietary sugar. Usually the microscopic loss of enamel that occurs in this manner following a meal is reversed by calcium in saliva. But irreversible loss in tooth structure occurs when acid exposures are frequent, saliva is insufficient, or colonies of bacteria (plaque) on the teeth are not regularly removed. When dissolution occurs and then repeatedly recurs on the same spot over a matter of weeks, months, or years, a small cavity forms. Beneath enamel is dentin, a mineralized tissue similar to bone. When caries reaches dentin, tooth destruction rate accelerates because dentin is more porous and less mineralized than enamel (Pashley, 1991). …

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