Oral health is a significant factor in overall well-being in seniors
By Mary Otto and Liz Seegert
Good oral health is a strong indicator of good overall health in older adults. It makes sense that nutritional intake is better when a person has all or most of their teeth. Poor oral health, on the other hand, is negatively linked to obesity, sleep apnea, poorer chronic disease management, higher LDL or “bad” cholesterol levels, malnutrition, low self esteem, and other physiological problems.
A 2011 study assessed geriatric oral health of 386 seniors, and compared physical factors including body mass index, handgrip strength, and one-leg standing time with eyes open – all considered strong indicators of general health status among older adults. They found that oral health scores “are significantly associated with” muscle strength in the elderly, which in turn, affects their activities of daily living.
The good news is that more Americans are keeping their teeth into old age.
The bad news is that many still face challenges obtaining oral health care.
Medicare, the nation’s health care program for seniors does not cover routine care.
In many states, Medicaid dental benefits for poor adults are also extremely limited.
Only a minority have private dental benefits. Overall, roughly 70 percent of Americans age 65 and older have no dental coverage of any kind.
While overall oral health has improved for seniors in recent decades, the lack of access to care has serious implications for millions of elders, particularly those who are poor or living in isolated places or institutional settings.
Nearly one-fifth of Americans over age 65 have untreated decay, the Institute of Medicine observed in an exhaustive 2011 report entitled “Advancing Oral Health in America.” Untreated decay can cause pain, difficulties eating, speaking and sleeping as well as tooth loss and serious, sometimes life-threatening infections.
The finding was based upon data drawn from the National Health and Nutrition Examination Survey (NHANES) which serves as the main source of oral health information in the country. For a much-cited survey of the NHANES data, see “Trends in Oral Health Status” published by the Centers for Disease Control and Prevention. (Tables 60 to 78 provide specific details on the oral health of people 65 and older.)
Gum disease, while declining in recent years, is also prevalent, with moderate or severe forms of periodontal disease affecting 17 percent of people 65 or older, the same survey concluded. Untreated periodontal disease can result in tooth loss and can have wider systemic impact as well.
Inflammatory periodontal disease is a known complication of diabetes and some studies suggest that periodontal disease makes diabetes harder to control.
This paper from the American Dental Association provides a good summary of the current understanding of a suspected two-way relationship between periodontal disease and diabetes.
Possible links between periodontal disease and other disorders are murkier. For instance AHCJ’s medical studies topic leader Brenda Goodman did an excellent job of examining what is known and not known about a possible relationship between periodontal disease and cardiovascular disease in a WebMD article last year.
Researchers continue to delve into possible relationships between periodontal disease and other systemic diseases and illnesses. But far more work is needed to understand what is really going on. Several studies find that seniors with loss of cognitive function or those with Alzheimer’s are at increased risk for poorer oral health – particularly the 75 population. However, other studies are more ambiguous.
For an interesting and cautionary look at the flurry of recent misleading headlines touting an “Alzheimers-Gum Disease link” enjoy this piece by University of California Davis professor and blogger Jonathan Eisen.
On a more sober note, more than 7,800 people, mostly older Americans, die from oral and pharyngeal cancers each year. Each year, about 36,500 new cases of oral cancer are diagnosed, according to the Centers for Disease Control and Prevention.
It is one more reminder that even seniors – even those without teeth – need oral exams.
An estimated 22.9 percent of older Americans have lost all their teeth, according to the latest NHANES data (from 2005-08 stats). However dentures need regular cleaning and maintenance too.
Institutionalized elders remain at special risk of going without these services. A good recent piece by Catherine St. Louis of The New York Times took a look at the lack of dental care and denture care in many nursing homes. She cited a systematic review of literature that found strong evidence that improved oral hygiene and professional care reduces the progression or occurrence of respiratory diseases among frail nursing home residents, especially those in intensive care.
The Massachusetts State Department of Health and Human Services offers some helpful oral health resources for elders and those who care for them: They include:
Instructions on how to adapt a toothbrush to make it easier to use and hold:
Guidance on good nutrition and denture care for denture wearers .
A fact sheet about xerostomia, or dry mouth, which can occur in patients with diabetes, auto-immune diseases, or who are taking medications depression and anxiety, congestion and allergic reactions, high blood pressure, diarrhea, muscle spasms, urinary incontinence, or Parkinson’s disease.
The city of Boston launched a free comprehensive dental program to promote and improve the oral health and general health and well-being of Boston’s low-income seniors residing at Boston Housing Authority (BHA) public housing in 2009.
The American Dental Hygienists Association has this tip sheet on Oral Health for Seniors
And the National Center for Health and Aging offers this fact sheet on oral and physical health.
• What oral health programs are there for older adults in your state or city, especially among low-income or homebound seniors?
• How do nursing homes in your community measure up in providing routine oral care? Can you associate it with physical health status?
• Barriers to providing care, such as scope of practice limits.
• Your local or state dental and medical associations can provide information on access to oral care, dental care workforce, oral health training for medical practitioners and other stats. Hospital ED and admission data may provide some insight into serious oral-health related medical problems.