Oral health is a critical component to overall health for all ages, but according to dental and medical experts from UConn Health, vigilance is especially critical for the elderly.
In a review article recently published in the Journal of the American Geriatrics Society, the authors outline the potential complications that can arise from poor oral hygiene in older adults and cite the role of all health care professionals in working to promote good oral hygiene in this population.
"All health care professionals should work to promote good oral hygiene for their older patients," said Dr. Patrick Coll, professor of family medicine and medicine at the UConn School of Medicine and lead author of the review article. They "should consider an oral examination during an annual wellness visit, especially for those patients who are not receiving regular dental care."
The need is evident, say the authors. Data from the National Center for Health Statistics indicates that the prevalence of cavities is more than twice as high in older adults than younger adults. The prevalence of periodontitis -- a serious gum infection that damages the soft tissue and destroys the bone that supports your teeth -- also increases with age. As many as 64% of older adults in the U.S. have periodontitis.
Periodontitis is associated with a variety of medical conditions including cardiovascular disease and diabetes. Patients with replacement heart valves and prosthetic joints should be particularly careful regarding their oral hygiene, according to the authors.
It is well recognized that manipulation of teeth and their support structures can result in bacteria present in the oral cavity being released into the bloodstream, which may lead to infections in parts of the body far removed from the oral cavity, they write.
Even tooth brushing for those who have poor oral hygiene can cause bacteria to be released into the blood stream and these bacteria can potentially cause joint infections and heart valve infections."
Dr. Patrick Coll, professor of family medicine and medicine, UConn School of Medicine
Without good oral hygiene, the use of fluoride, and regular dental care, older adults are more prone to damage to the oral cavity and the extension of infection into surrounding tissues.
Tooth loss, for instance, can affect a person's ability to chew, which can lead to malnutrition. Chronic oral infection is a recognized risk factor for heart disease, and can also lead to the spread of infection to artificial joints and endocardial implants.
Researchers noted several populations of older adults who are at increased risk for oral health problems, including patients with diabetes, patients with dementia, and those in long-term care settings.
Patients with dementia--particularly those with advanced dementia--may neglect their oral health and may be reluctant to see a dental hygienist.
And, many residents in nursing homes also do not receive adequate dental care, despite federal requirements for nursing homes to provide both routine and emergency dental care. Nursing home facilities, the experts say, should adopt risk assessment tools to identify patients at high risk for poor oral hygiene and educate staff on the importance of good oral hygiene and how to provide it.
The experts recommend that all older adults should have biannual dental cleaning performed by a hygientist and a biannual oral health assessment by their dentist.
"Your mouth is a mirror to your body," says Dr. Sree Raghavendra, co-author of the article and assistant professor in the Department of Craniofacial Sciences at the UConn School of Dental Medicine.
"This article is a prime example of true interprofessional collaboration that emphasizes the importance of the entire health care team coming together to take care of all of our patients and especially our geriatric population."
Coll, P.P. et al. (2019) The Prevention of Infections in Older Adults: Oral Health. Journal of the American Geriatrics Society. doi.org/10.1111/jgs.16154.