Oral health in elders has become a focus of health promotion, prevention, and intense research not only from the dental perspective, but also from the medical, nursing, nutrition, and caregiving perspectives. A report from the U.S. surgeon general on “Oral Health in America” in June 2010 indicated that this is a public health concern because it affects a large proportion of the population and is linked with overall health status.Oral health has been associated with several health outcomes, including cardiovascular disease, aspiration pneumonia, malnutrition, poor quality of life, and mortality. The Baltimore Longitudinal Study of Aging examined the association between the number of teeth and mortality risk. Five hundred subjects were studied with standardized oral examination, tooth count, tooth with caries count, and gingival and periodontal index. In addition, fasting glucose, oral glucose tolerance test, lipid profiles, and white blood cell counts were measured. Physical activity, skin-fold thickness, BMI, and chronic diseases were also evaluated. After statistical analysis, investigators found being edentulous or having less than 20 teeth as being independently associated with mortality. Consequently, it appears that number of teeth is a significant and independent risk indicator for early mortality. Improvement of oral health may have a positive impact on general health and may delay mortality.
There is some evidence of a link with lower cognitive function and greater deterioration of oral health. Over 1,900 community-dwelling adults 60 years or older with their own teeth from the National Health and Nutrition Examination Survey (NHANES, 1999-2002) were studied with cognitive measures and dental examination. Lower cognitive function was associated with increased number of missing teeth and periodontal disease. Further evidence from the Nuns Study, which was a longitudinal study of aging and Alzheimer’s disease in nuns aged 75 to 98 years, indicated that complete or nearly complete tooth loss may be a predictor of dementia late in life. Longitudinal dental data was collected from 10 annual cognitive assessments, and having between zero to nine teeth (not molars) at first cognitive exam was associated with a 2.2-fold risk of incidence of dementia.
Oral infections, particularly periodontal disease, produce a mild but persistent systemic inflammatory response that can contribute to frailty. It is associated with elevated levels of inflammatory markers such as interleukin (IL)-1 and EL-6. This is important since the consequences of frailty may be falls, impairment with activities of daily living, increased hospitalizations, and death.
Unfortunately for many elders, access to affordable dental care is a significant barrier to maintaining oral health and treating dental problems in a timely manner. Nearly half of all Medicare beneficiaries live on incomes below twice the federal poverty levels. Poverty rates are even higher among women, African American, and Latino Medicare beneficiaries. Medicare pays for slightly more than one-half (54 percent) of the health care costs of older Americans and only one percent of dental care. Moreover, Medicare is not designed to reimburse for routine dental care. Although Medicaid funds dental care for the low-income and disabled elderly in some states, reimbursements are low.
In the long-term care setting, there has been a strong emphasis and use of resources on improving daily oral care, regular dental hygiene, education of caregivers, and timely treatment when appropriate. In this population, uncooperative residents may have worse oral hygiene and more caries, and evidence shows that improving oral care reduces the occurrence of pneumonia.
At Nova Southeastern University , our Florida Coastal Geriatric Resources, Education, and Training Center (GREAT GEC) is fortunate to have an academic partnership with the College of Dental Medicine and its special needs dentistry department. We have compared medical and dental students’ education, and it is apparent they rarely train together or interact professionally. Hence, joint clinical and didactic training has been promoted. Indeed, physicians and dentists do not collaborate routinely in coordinating the care of elders with diabetes, undernutrition, or cardiovascular disease in whom oral health plays an important role.
