The aging mouth: differentiating normal aging from disease.

Aging is the physiologic change that occurs over time. In humans, this change occurs at different rates and are related to lifestyle, environment and genetics. It can be challenging to differentiate normal aging from disease. In the oral cavity, with increasing age the teeth demonstrate wearing of the enamel, chipping and fracture lines, and a darker color. The pulp chamber and canals are reduced in size as a result of the deposition of secondary dentin. Coronal or root caries, however, represent disease. A limited amount of periodontal attachment loss occurs in association with aging, usually manifesting as recession on the buccal surface of teeth. Severe periodontitis occurs in 10.5-12% of the population, with the peak incidence being observed at 35-40 years of age. Changes to the mucosal tissue that occur with age include reduced wound-healing capacity. However, environmental factors, such as smoking, dramatically increase the risk of mucosal pathology. Reduced salivary gland function is often seen in association with medication usage, as well as with disorders such as diabetes mellitus. Both medication use and chronic disorders are more common in older adults. Masticatory function is of particular importance for older adults. Maintenance of a nutritionally complete diet is important for avoiding sarcopenia and the frailty syndrome. Successful oral aging is associated with adequate function and comfort. A reduced, but functional, dentition of 20 teeth in occlusion has been proposed as a measure of successful oral aging. Healthy oral aging is important to healthy aging from both biological and social perspectives.

Tooth loss as a predictor of shortened longevity: exploring the hypothesis.

Many factors contribute to human tooth loss, including oral hygiene practices, trauma, smoking, health status, socio-economic status and individual preferences. Loss of teeth impairs quality-of-life measures, including the eating of most foods that require full masticatory function. A recent study of centenarians found that at age 65-74 years, those who lived to be 100 had a lower rate of edentulism than did younger members of their birth cohort at ages 65-74 years. Oral health was consistent with compression of morbidity toward the end of life. This article explores the hypothesis that factors associated with oral disease and noncommunicable diseases may increase the risk of tooth loss and lead to diminished longevity as a result of multifactorial interactions. It specifically addresses two critical questions. The first is: 'Can we conclude that the number of teeth in aging humans can affect longevity and life expectancy?' The answer is yes. The second is: 'Is tooth loss a predictor of shortened longevity?' Again, the answer is yes. Edentulism and partial edentulism are discussed as a disability, and how the philosophy/belief systems of dental providers and patients toward retaining teeth influences the outcome of tooth loss is also examined. Osteoporosis and cognitive impairment provide examples of modifying risk factors.

Oral health disparity in older adults: dental decay and tooth loss.

Progress has been made in reducing dental caries and edentulism in older adults, but disparities continue to exist related to race, ethnicity, socioeconomic level, and sex. Lack of training in treating medically complex patients, economic factors including absence of coverage for oral health services in Medicare and as a required service for adults in Medicaid, and attitudinal issues on the part of patients, caregivers, and providers contribute to barriers to care for older adults. In addition to the impact of oral health on overall health, oral health impacts quality of life and social and employment opportunities.

An oral health study of centenarians and children of centenarians.

OBJECTIVES: To determine whether oral health is better in centenarians than in a published birth cohort-matched sample and to compare oral health in centenarian offspring with a case-controlled reference sample. DESIGN: Observational cross-sectional study. SETTING: New England Centenarian Study (NECS). PARTICIPANTS: Seventy-three centenarians, 467 offspring, and 251 offspring generation-reference cohort subjects from the NECS. MEASUREMENTS: A self-report questionnaire was administered to measure oral health in all three groups, with edentulous rate as the primary outcome measure. The NECS made information on sociodemographic characteristics and medical history available. Centenarian results were compared with published birth cohort-matched results. Data from offspring and reference cohorts were analyzed to determine differences in oral health and associations between oral health measures and specific medical conditions. RESULTS: The edentulous rate of centenarians (36.5%) was lower than that of their birth cohort (46%) when they were aged 65 to 74 in 1971 to 1974 (according to National Center of Health Statistics). Adjusting for confounding factors, the reference cohort was more likely to be edentulous (adjusted odds ratio (AOR) = 2.78, 95% confidence interval CI = 1.17-6.56), less likely to have all or more than half of their own teeth (AOR = 0.48, 95% CI = 0.3-0.76), and less likely to report excellent or very good oral health (AOR = 0.65, 95% CI = 0.45-0.94) than the centenarian offspring. CONCLUSION: Centenarians and their offspring have better oral health than their respective birth cohorts. Oral health may prove to be a helpful marker for systemic health and healthy aging.

Xerostomia: the "invisible" oral health condition.

Xerostomia, or dry mouth, is perhaps one of the most underappreciated, underdiagnosed, and undermanaged oral health conditions. Recognition of a xerostomic condition is important because it can significantly affect the overall quality of life and contribute to diminishing oral health in a number of ways. This article will provide an overview of the etiology of xerostomia, the sequelae of the condition, and suggestions for pharmacological and non-pharmacological management of the condition to improve a patient's quality of life.

Xerostomia: the "invisible" oral health condition.

Xerostomia, or dry mouth, is perhaps one of the most underappreciated, underdiagnosed, and undermanaged oral health conditions. Recognition of a xerostomic condition is important because it can significantly affect the overall quality of life and contribute to diminishing oral health in a number of ways. This article will provide an overview of the etiology of xerostomia, the sequelae of the condition, and suggestions for pharmacological and nonpharmacological management of the condition to improve a patient's quality of life.

Taking dentistry to the geriatric patient: a home visit model.

Frail, medically complex elders comprise an increasing dentally underserved population. The "demographic imperative" clearly shows that the number of elders is growing-from a current estimate of 40 million to a projection of 87 million in 2050. Oral health is a critical component of overall health and is increasingly recognized as critical to quality of life. This article describes a program to deliver oral health care services to homebound elders in the Greater Boston area through the collaboration of the geriatric dentistry and geriatric medicine fellowship programs at Boston University. The article reports on data collected between 2005 and 2007 on the demographics, needs, and services provided to a sample of 195 patients visited in their homes. Also identified are the types of third-party coverage reported for the patients and the implications for source of payment for dental services for the elderly in the future.

Mentoring: leadership, learning, legacy.

As the dental profession develops over the next few decades, there will be identifiable changes in the demography of the profession. Enrollment trends reflect a growing number of women in dental schools and in the dental profession. There is an increasing number of dentists--men and women--from countries and cultures outside of the United States. The profession must be prepared to address the question of how to engage women--as well as minorities--in more active and visible roles in organized dentistry. The challenge is clear, and the outcome will provide an indicator to the strength of our professional associations in the future. Mentoring of women dentists is one effective way of creating a pathway to participation.