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The mouth prepares food for proper digestion, protects the upper respiratory and digestive tracts, and helps us talk. These functions require healthy teeth and gums, good sensation, and working salivary glands. If disease affects any of these parts, the consequences can be serious. Problems in the mouth can have a major effect on overall health and social well-being. Proper oral health is important for everyone, but particularly for older adults who are frail or at risk of nutritional problems (see also Nutrition). Older adults tend to have more oral problems than younger people, because underlying health problems and side effects from medication are more common as we age. However, there is no evidence that oral health and function specifically decrease with age. Therefore, mouth problems such as tooth decay, missing teeth, gum disease, and low saliva levels are not a part of normal aging. In most cases, these problems can be avoided or adequately treated. With proper oral care, most people can expect to have a healthy mouth well into advanced age.
Dry Mouth Saliva is produced by three pairs of major salivary glands and hundreds of minor ones. Saliva has many important functions, including the following:
Under normal conditions, the salivary glands produce enough saliva, even in extreme old age. However, older adults commonly have a dry mouth. This is because older adults are more likely to have underlying health problems or side effects from medication that slow down salivary gland function or block production of saliva. Causes The most common cause of dry mouth is a side effect of drugs that are commonly prescribed for older adults. Many drugs used to treat pain, inflammation, high blood pressure, heart disease, depression, and overactive bladder can cause dry mouth. Dry mouth may also be caused directly by diseases in the mouth, such as tumors of the salivary glands or blocked salivary ducts. Another possible cause is alcohol intake. The single most common disease affecting the salivary glands is probably Sjögren's syndrome, which was named for the Swedish physician who first described it. This illness causes the immune system to attack the salivary glands, as well as other glands that produce moisture (eg, tear glands). Sjögren's syndrome affects about one million Americans, mostly postmenopausal women. It causes dry mouth and difficulty in swallowing dry foods, such as bread. Older women may notice that lipstick sticks to their teeth. Other diseases may also decrease the flow of saliva and cause dry mouth. Some research suggests that depression, poorly controlled diabetes, and an underactive thyroid gland (ie, hypothyroidism) may all cause decreased salivary flow. Dry mouth can also be a side effect of radiation treatments involving the head and neck. The total dose of radiation used to treat many oral cancers is often high enough to destroy the salivary glands or their blood supply. People who have undergone radiation of the head may have dry mouth, inflammation, and dental cavities. Treatment Treatment for too little saliva focuses on removing any underlying cause. For example, medications that reduce the flow of saliva should be stopped or changed, if possible, or at least taken at a lower dosage. If some salivary gland function remains, there is medication (eg, pilocarpine) that can sometimes be used to stimulate saliva production. Saliva substitutes and oral lubricants are available without a prescription. Although they can provide some relief, they do not have any of the protective properties of saliva. The risk of oral or dental disease in people with dry mouth can be greatly reduced by maintaining good oral hygiene, along with dietary restrictions such as eating less sugar. Everyone with a dry mouth should have comprehensive and frequent preventive dental care, including regular fluoride treatments. Diseases of the Teeth The most common form of dental disease is tooth decay, ie, cavities or caries. In children and young adults, cavities tend to form along the chewing surface, or the crown, of the teeth. In older adults, cavities are more common along the root surface, as gums recede and leave the root exposed. Cavities also tend to form along the margins of dental hardware such as fillings or caps, which are more common in older adults. A major risk factor for cavities is poor oral hygiene, ie, not brushing enough, not brushing properly, not flossing, etc. Older adults may have poor oral hygiene because of poor vision and loss of manual dexterity or flexibility, such as from arthritis. Other risk factors include having a dry mouth and eating sticky sweets (eg, cookies, cake, and candy). Infrequent dental visits also increase the risk of cavities and other tooth problems. Older adults sometimes do not visit the dentist because of cost, lack of transportation, or sometimes fear or ignorance. In the advanced stages, cavities often lead to infection and an abscess in the center of the tooth, or the pulp. Tooth abscesses are usually painful, but if an older adult has lost some sensitivity in the tooth, he or she may not notice the condition. Whether painful or not, abscesses should be treated promptly. If untreated, tooth abscesses can result in bacteria in the blood (ie, blood poisoning), which can lead to life-threatening infection in many organs, especially the heart (see also Infectious Illness). Preventing cavities Preventing cavities requires daily brushing with fluoride toothpaste, flossing, limiting sugar intake, and having regular dental examinations. Good oral hygiene helps to reduce the risk of tooth decay in people of all ages. Fluoride strengthens teeth and increases their resistance to decay. Fluoride treatments are usually given to prevent cavities in children and certain high-risk groups of adults, such as those with a dry mouth or those who have had radiation treatment involving the head or neck. However, the frequency of cavities in all older adults can be reduced by fluoride treatments, even when such treatments do not begin until late adulthood. Fluoride treatment should be especially considered for older adults with decreased salivary gland function. Periodontal Disease The gums support the attachment of the teeth in the mouth, and ligaments attach the teeth to the underlying bone. The gums, the ligaments, and the underlying bone itself are referred to as the periodontium. Periodontal disease develops when bacteria build up and form plaque on the teeth near the gums, or between the gums and the root surface. The most common form of periodontal disease is gingivitis, which is inflammation of the gums. In gingivitis, the gums are typically swollen and red and may bleed during brushing. These problems reverse rapidly after the plaque is removed. If the infection and inflammation extend past the gums to involve the ligaments and underlying bone, the process is termed periodontitis. Periodontitis is generally not a long, gradual process. Rather, it typically occurs as spurts of infection, inflammation, and tissue destruction in various areas. By the time we are 50 years old, most of us have signs of some periodontal disease, such as a small amount of bone loss in the jaw. Periodontal disease that is severe or has gone on for a long time eventually leads to considerable bone loss in the jaw and loss of teeth. Periodontal disease can also increase the risk that bacteria will enter the blood and infect other organs throughout the body. Again, maintaining good oral hygiene at all times is important to stop periodontitis and prevent tooth loss or complications. Risk factors for periodontal disease include age, smoking, and poor oral hygiene. Periodontitis is also generally worse in people who have poorly controlled diabetes or decreased immune function (eg, from drug treatment). Osteoporosis can make the situation worse by increasing the loss of bone that supports the teeth (see also Osteoporosis). Preventing gingivitis and periodontitis requires good oral hygiene and regular dental checkups and cleanings. Brushing and flossing at least every day removes bacterial plaque on the teeth and in the gaps between the teeth and gums. Older adults should visit the dentist at least every 6 to 12 months to have their teeth cleaned and their periodontium examined. Treatment for periodontal disease involves deep cleaning of the tooth root surfaces below the gum line. This may require local surgery and antibiotic treatment. Other Disorders of the Mouth The gums and other soft tissues that line the mouth are affected by many factors. The condition of these tissues is directly related to oral hygiene. Dentures must be cared for properly, or irritation and infection can result. Dry mouth is also an important risk factor for mouth problems, because saliva is needed to moisten and protect oral tissues. Other risk factors include smoking, drinking alcohol, and taking certain medications that may have side effects. Medical conditions can affect oral tissues, allowing yeast infections to develop in the mouth. Oral yeast infections, sometimes called thrush, can cause redness, cracking at the corners of the mouth, white patches, a change in taste, burning, itching, and pain. Older adults are particularly prone to yeast infections because of denture use, dry mouth, diabetes, and the common use of antibiotics for lung and bladder infections. Inhaled corticosteroids can also increase the risk, unless the mouth is rinsed after using the inhaler. Most yeast infections in the mouth can be easily treated with oral medication or ointments. A puzzling oral condition is known as "burning mouth syndrome." The only symptom is pain in the mouth and face, most commonly in the lips, tongue, and palate. It typically affects women over the age of 50, especially Asian American and Native American women. The cause is unknown. About 28,000 new cases of oral cancer are reported in the United States each year, with more than 95% of these in people over the age of 40. Oral cancer is more common in men than women, especially lip cancer, which affects men eight times more frequently than women. Oral cancer is strongly linked with the use of tobacco. The strongest overall risk factor is cigarette smoking, although some types of oral cancer are strongly linked to pipe smoking, cigar smoking, or snuff. Alcohol is also a risk factor, especially when people both drink and smoke. Oral cancer usually shows up as painless areas in the mouth that are red, white, or a mixture of red and white. These areas can be raised or appear as small indents or ulcers. Red or mixed areas are most likely to be malignant, and a biopsy should be taken immediately. White areas are only occasionally malignant or premalignant, but should still be watched closely. If an affected area does not disappear in 2 weeks, or increases in size, a biopsy should be taken immediately. Diagnosis and treatment Your healthcare provider or dentist should check your mouth frequently for signs of oral cancer. The examination is painless and very brief (ie, usually less than 2 minutes). If there are any suspicious areas, a biopsy should be taken by removing a small piece of tissue and then examining it under the microscope. Early diagnosis greatly improves the outcome. For example, approximately 75% of people live at least 5 more years when oral cancer is diagnosed early, compared with about a third or less of those when it is diagnosed later. The most common treatment for oral cancer is surgical removal, although some tumors can be managed with radiation. If the cancer is extensive, usually both surgery and radiation are needed. However, many types of radiation therapy have serious side effects, such as loss of salivary glands and a chronic dry mouth. Newer techniques (eg, radioactive implants) can lessen the amount of radiation damage to healthy tissues surrounding the tumor. Techniques that combine surgery with chemotherapy are under development for the treatment of extensive oral cancer. Toothlessness Advanced age was once considered synonymous with the need for false teeth. In the early 1960s, almost 75% of Americans 75 years old or older had lost all their natural teeth. Fortunately, with advances in dentistry, by the 1990s, fewer than half of older adults in this age group had lost all of their teeth. Much of this was due to improvements in dental care that these adults had as children. Nevertheless, tooth loss remains common among older adults. The leading cause is inability or unwillingness to ask for dental care for common problems such as cavities or abscesses. Cost is a problem for many older adults, because dental care is not typically covered by Medicare. A second common cause is loose teeth because of severe periodontal disease. Loose teeth make chewing difficult and painful, which can lead to poor nutrition and decreased enjoyment of food (see also Nutrition). Yet another common cause is removal of otherwise healthy teeth as a direct consequence of losing other teeth due to dental caries and periodontal disease. The remaining healthy teeth may then need to be removed so the person can wear false teeth, which have now become necessary. Nearly half of Americans 85 years old and older no longer have any natural teeth. This results in difficulty speaking or chewing, and also affects a person's appearance. Teeth support the lips and cheeks, and keep the nose and chin a certain distance apart. When a person has lost all of his or her teeth, the facial appearance changes dramatically. Dentures improve facial appearance, allow clearer speech, and help with chewing. However, dentures do not function as well as natural teeth. On average, dentures provide less than one quarter of the chewing ability of natural teeth. People who wear dentures can generally eat a wider range of foods than people without teeth, but the range is still much less than that for those with natural teeth. Denture wearers also have to chew more times before they swallow food, and they swallow their food as larger particles, which may decrease digestion. Dentures can also cause discomfort, dysfunction, and embarrassment for many older adults. This is because the bone of the jaw continues to change shape or "remodel" after the teeth are gone, which changes the fit of the dentures. This process is worsened by osteoporosis (see also Osteoporosis). Most denture wearers need to have their dentures professionally adjusted often and periodically replaced. Dentures should also be kept clean to protect overall oral health. Dentures should be removed and cleaned after meals, and soaked in a commercial disinfectant several times a week. Because dentures should be taken out of the mouth for several hours each day, most people do not wear their dentures while sleeping. Fractured or broken dentures, as well as dentures that are loose or cause soreness, should be brought to the attention of a dentist without delay. Disorders of Taste or Smell Taste perception changes with aging. Typically, older adults are not as able to taste saltiness and sweetness as well as when they were younger. The sense of smell also decreases with age, especially among men. Several drugs can decrease the sense of smell as a side effect. Causes of a reduced sense of taste include the following:
Causes of a reduced sense of smell include the following:
Changes in taste or smell can decrease overall quality of life and increase the risk of medical problems. For example, older adults may tend to over-salt food or crave sweets, which can complicate high blood pressure or diabetes. Both taste and smell are also important for having a good appetite, which can affect nutritional intake. Other problems with reduced taste or smell can lead to unknowingly eating spoiled or tainted food, or not being able to smell a gas leak. |
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Published: 10/26/2005