Ever hear the expression “getting long in the tooth?” The meaning lies in horses’ teeth, which unlike humans', continue to grow with age so that it is possible to estimate a horse's age by examining them. In humans, teeth do not continue to grow after adulthood but we might still be able to tell the age because of the conditions of oral health among older adults.
Severity of periodontal (gum) disease increases with age and about 23 percent of 65- to 74-year-olds have severe disease. At all ages men are more likely than women to have more severe disease. Overall, people at the lowest socioeconomic level have the most severe periodontal disease. The result is that close to 25 percent of adults 60 years old and older no longer have their natural teeth. In California-- -a richer state--this rate declines to 13 percent. Having missing teeth, or dentures, can affect nutrition, since people without teeth often prefer soft, easily chewed, heavily processed foods and avoid more nutritional fresh fruits and vegetables.
Oral diseases affect our most basic human needs beyond just eating. Social communication can be greatly impacted by the ability to smile, and speech may also become difficult to produce and to be understand. Oral health might also influence the overall health of the body. Bacteria has been shown to go from the mouth to the heart through the bloodstream. In fact, a recent consensus paper calls for cooperation between cardiologists and periodontists in helping patients reduce their risk of these associated diseases.
The mouth provides a good indicator of the condition of the body as a whole. People with diabetes are at special risk for periodontal disease. Dry mouth, often a symptom of undetected diabetes--but is also often caused by a host over 400 commonly used medications--can cause soreness, ulcers, infections, swallowing difficulty and tooth decay. Smoking makes these problems worse.
Geriatric dentistry is a growing approach of providing treatment to the unique needs of an aging population. As the population of older adults in San Diego continues to increase, the dental profession is becoming better equipped to meet the older adult population’s special needs. Certainly mobility is one of those special needs, and in San Diego County, dentistry is beginning to mobilize to take dental care to where the patient needs it most-- homes, care facilities and private care residences.
Functional limitations such as difficulty in holding a toothbrush due to stroke or arthritis can make daily dental care difficult. And certainly lacking the cognitive capacity to care for oral health can place an individual at risk for aspiration pneumonia due to bacterial plaque buildup on oral surfaces. Aspiration pneumonia is a significant risk for those suffering from dementia.
Many older Californians do not have dental insurance. Often these benefits are lost when they retire. And although MediCal, which covers low income and disabled elderly, can cover some costs, it is difficult to find dentist that take MediCal. Medicare, which provides health insurance for older adults, was not designed to provide routine dental care. Good evidence exists that oral health improves quality of life. It is not just about the smile, it is about having something to smile about.
Mario Garrett is a professor of Gerontology at San Diego State University can be reached at mariusgarrett@yahoo.com
Julie Sugita, is a dentist, gerontologist, and private licensed fiduciary for older adults, and can be reached at j.sugita5@gmail.com.
© Mario Garrett 2010
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