Update in clinical procedures

Life expectancy has increased dramatically in the past few decades. In our modern societies, people age with higher levels of physical functionality, active lifestyles and social inclusion. Along with this, their oral health becomes even more important.

Modern ‘active’ ageing has no place for edentulousness

Elderly patients have more persisting teeth, but few are intact. With increasing age, the risk of disease and disability rises. This means it is more difficult for many to maintain good oral hygiene and regularly attend dental appointments. These factors lead to impaired oral health to the point that the more persisting teeth the patient has, the bigger the risk of oral disease. This is called the ‘dental paradox’.

The more persisting teeth, the greater the risk of oral disease

A number of health programmes have been put in place for elderly patients to preserve more of their teeth into old age. The World Health Organisation (WHO) has set the objective of at least 20 teeth per person in the elderly. Of course, the way we replace lost teeth is also changing. The differences in oral health are more pronounced in elderly people, and are more related to their general health status, general limitations, gender and socioeconomic factors. The prevalence of caries in elderly dependents who cannot visit the dentist is much higher[1].

Inflamm-ageing?

Inflamm-ageing describes the increase in the bod’s pro-inflammatory status with advancing age. As age increases, so does inflammation. For elderly people, chronic low-grade inflammation develops (probably due to up-regulation of the inflammatory response), accelerating the biological ageing. Inability to maintain proper oral hygiene, together with progression of chronic periodontitis and greater fragility in the mucosa, in an impaired immune system scenario, all leads to a vicious pathologic feedback cycle between oral inflammation and many age-related diseases, like Alzheimer, atherosclerosis, type-2 diabetes and chronic heart diseases.

Poor dental status and chewing deficiencies associated with cognitive decline

Not all persisting teeth in elderly patients have the same value. Anterior teeth rank highly in the OHRQoL index (oral health related quality of life), whereas posterior teeth are more useful for chewing. According to a recent Swedish study, about 50% of conventional prostheses are in poor condition and have not been adjusted in a long time (Lantto et al., 2018). Chewing function requires a sufficient number of teeth free of disease and in occlusal contact, or a well-fitting prosthesis. Nutrition is usually a challenge for the elderly, and it should be noted that cognitive function has also been shown to correlate with a well-preserved chewing function (Lexomboon et al., 2012, Kossioni et al., 2018).

Dry mouth: adverse drug event and major cause of discomfort

Despite recent measures to control drug prescription, there has been a notable increase in the intake of drugs in older people. Hyposalivation has been shown to increase with the number of medications being taken. Another side-effect of numerous medications is oral dryness or xerostomia, a condition that severely impacts patient well-being. The speaker explained that oral dryness paves the way for dental caries, dysgeusia, oral mucosal soreness and oral candidiasis. Dry mouth is primarily caused by drugs used to combat incontinence, followed by antidepressants and psycholeptics (Tan 2018).

Dysphagia, aspiration pneumonia, oral hygiene and risk

Dysphagia is a common problem among elderly patients who are in care or who have been institutionalised. It can lead to aspiration pneumonia. This is because large amounts of plaque and a considerable bacterial load can usually be found in older patients’ mouths due to their inability to adequately maintain their oral hygiene. Nurse assistance to help with this, and no nocturnal use of dentures can reduce mortality from aspiration pneumonia (Müller 2015).

The speaker stated that improving oral care can positively affect general health in the elderly, and vice versa.

Following a diagnosis of dementia, oral health sharply decreases (Ástvaldsdóttir 2018). Proper oral hygiene can not only improve patients’ oral health, but can also have a positive effect on their health in general. Therefore, oral hygiene programmes for elderly patients who are dependent on care should be implemented, and caregivers should be properly educated and motivated.

[1] Data from Sweden. National register SkaPa www.skapareg.se and Oral care AB www.oralcare.se