Oral health and aging Addressing Issues and Providing Solutions

Good oral health is about much more than a bright white smile. It is about better overall health, and a better quality of life. It may seem simplistic to say that brushing your teeth can help prevent heart attacks, but it is also correct.

There is increasing and disturbing evidence of a connection between poor oral health and several major chronic diseases.

Research has made it clear that through quality oral care, some diseases can be detected earlier or, in some cases, avoided altogether. This may reduce the likelihood of premature death.

Growing Older and Oral Health

The aging process can be as hard on our mouths, teeth, and gums as it is on other parts of our bodies. As we get older, we are more susceptible to the buildup of plaque and the weakening and cracking of older fillings. In addition, there is a tendency for our teeth to become brittle, and many seniors suffer from diminished muscular control, which can make chewing or wearing dentures more difficult. Finally, the older we get, the more vigilant we need to be against developing gum disease.

It is extremely important to remember that for generally healthy, functionally independent seniors, these potential changes need not present a serious risk. The habits that kept our mouths healthy when we were younger will help to keep them healthy as we age. By practicing vigilant oral hygiene at home, including thorough brushing (using fluoridated toothpaste) and flossing twice a day, and by visiting a dentist regularly for a comprehensive oral examination and diagnosis, professional cleanings and to keep fillings in good repair, seniors can prevent, and in some cases reverse, potentially serious oral disease. It’s important to know that dentists are well trained to help detect signs of nutritional deficiencies, as well as symptoms of a number of systemic diseases including: early diabetes, adverse drug reactions, oral cancers, infections and immune disorders.2 However, not all seniors are healthy and functionally independent. The story is unfortunately very different for frail or functionally dependent seniors. These are people who need assistance to maintain even the most basic levels of personal care, whether at home or in a long term care (LTC) facility. They are most vulnerable to oral disease because, in many cases, they simply cannot perform their own oral care.

Dementia, particularly Alzheimer’s Disease, increases in prevalence with age. Unless regular, effective assistance is provided, the progressive loss of intellectual function and memory inevitably leads to neglect of oral hygiene.3 Elderly people suffering from dementia often forget to brush and may vehemently resist efforts to assist them, making care very challenging. Over time, dental treatment also becomes increasingly difficult as many patients cannot tolerate lengthy procedures and are unable to understand the reason for treatment.

Assistance with daily oral hygiene is also often needed for older adults with loss of strength, mobility, dexterity or any other functional loss. Conditions that make self-care extremely difficult include tremors, inability to grip a toothbrush (possibly as the result of arthritis, Parkinson’s disease or stroke), visual impairments and difficulty swallowing.

Good oral hygiene is as important in our later years as it was when we were children. Adults who are able to take care of their oral health must do so, and adults who cannot must be helped. The consequences otherwise can be severe.

Consequences of Poor Oral Health

Most of us have been told since childhood about the importance of good oral hygiene. Dentists and parents tell their children that regular brushing and flossing can help us avoid tooth decay and cavities.

We know that good oral hygiene leads to good oral health.

What is not as well-known is that there is a critical association between good oral health and good overall health in general, and that relationship only becomes more important as we age.

Without question, people are living longer than ever before. The older we get, however, the more likely we are to develop one or more chronic diseases (for example, diabetes). A great many of these diseases (more than 100) can affect our oral health.4 In fact, most changes in the oral health of seniors are the consequences of chronic disease and medications, accompanied by physical disability and/or cognitive impairment.

Of even greater concern than the link between chronic disease and poor oral health is the reverse connection – the one that suggests that poor oral health can put one at higher risk for other diseases. There is a growing body of scientific research suggesting a relationship between periodontal (gum) disease and various systemic or chronic diseases.

Respiratory Infections (Pneumonia)

Bacterial pneumonia is the leading cause of death of LTC residents5 and there is a disturbing link between gum disease and pneumonia. The microorganisms that cause pneumonia are commonly found in significantly high concentrations in the dental plaque of elderly people with gum disease. Many studies have demonstrated that poor oral hygiene in older adults is a major risk factor for pneumonia, in particular a strain called “aspiration pneumonia,” which is caused by bacteria-laden saliva accidentally entering the windpipe and travelling to the lungs.

Current scientific literature now strongly supports effective oral health-care interventions for reducing the risk of pneumonia among the frail elderly, especially those living in nursing homes.

Cardiovascular Disease (Heart and Stroke)

Several studies have shown that having gum disease increases one’s risk of developing cardiovascular disease (CVD). Inflammation is a major risk factor for heart disease, and the bacterial accumulations associated with periodontal disease can increase inflammation levels throughout the entire body. When bacteria in infected gums break free, they can enter the bloodstream, attach to blood vessels and cause clots, which aggravate high blood pressure and increase the chances of a heart attack or a stroke.

Diabetes

Research overwhelmingly indicates a two-way association between gum disease and diabetes. Because diabetics are particularly susceptible to contracting infections, they are at greater risk than most people of developing gum disease. At the same time, oral infections can increase the severity of diabetes by increasing blood sugar levels, leading to such complications as premature degeneration of the eyes, kidneys, nerves and blood vessels.

Malnutrition

There is a clear relationship between poor oral health and malnutrition in the elderly. Older individuals with good oral health benefit from being able to eat a much broader variety of nutritious foods than those with pain, discomfort or tooth loss. One large UK study, which recorded details of the oral health and past dental care of more than 1,000 LTC residents, found very high levels of cavities, plaque retention and poor denture care. Subjects reported inflammation and soreness of the mouth, difficulty eating, problems with taste and difficulty caring for their own mouths. The researchers concluded that poor dental health, combined with diminished ability to communicate, can cause weight loss, dehydration and infirmity.

Other Benefits of Good Oral Health

In addition to helping prevent the conditions listed above, good oral health and hygiene have been associated in less direct ways with the prevention of other diseases.

Osteoporosis

Osteoporosis, one of the most common human bone diseases, affects approximately two million Canadians, including over onethird of women over the age of 65. The disease is characterized by decreased bone density and weakened bones. As it progresses, osteoporosis can compromise bones to the point that they break under otherwise normal stresses. It is often considered a “silent disease” that has few symptoms in its early stages.

There is a strong relationship between bone metabolism and oral health, and dentists are in a unique position to help identify people with low bone density. Early signs of osteoporosis can often be seen in the mouth and detected through oral examination and dental X-rays.

Rheumatoid Arthritis

There is also evidence that treating severe gum disease may alleviate some of the symptoms of rheumatoid arthritis (RA) in people suffering from both conditions. RA and periodontitis are both common chronic inflammatory conditions. Researchers have concluded that non-surgical periodontal therapy had a beneficial effect on the signs and symptoms of RA, regardless of the medications being used to treat the condition.

The connection between oral health and good overall health is clear.

We know, as we have since childhood, that the key to good oral health is almost always good, basic oral hygiene – brushing, flossing, and regular trips to the dentist. For many seniors and Ontarians this is a straightforward, simple piece of overall good health.

But we also know that there are some seniors who need more help than that and those seniors deserve our attention. They deserve good oral health care. The ODA thinks it is time to act on behalf of those seniors.