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Oral Health for Older Americans

Adult Oral Health

December 2006—Older Americans make up a growing percentage of the U.S. population; according to the 2000 U.S. Census, nearly 35 million are 65 years or older. By 2050, that number is expected to increase to 48 million. Oral diseases and conditions are common among these Americans who grew up without the benefit of community water fluoridation and other fluoride products.

Older Americans with the poorest oral health are those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized also increases the risk of poor oral health.

Many older Americans do not have dental insurance. Often these benefits are lost when they retire. The situation may be worse for older women, who generally have lower incomes and may never have had dental insurance.

Medicaid, the jointly-funded Federal-State health insurance program for certain low-income and needy people, funds dental care for low income and disabled elderly in some states, but reimbursements for this care are low. Medicare, which provides health insurance for people over age 65 and people with certain illnesses and disabilities, was not designed to provide routine dental care.

About 25 percent of adults 60 years old and older no longer have any natural teeth. Interestingly, toothlessness varies greatly by state. Roughly 42 percent of Americans over age 65 living in West Virginia are toothless, compared to only 13 percent of those living in California. Having missing teeth can affect nutrition, since people without teeth often prefer soft, easily chewed foods. Because dentures are not as efficient for chewing food as natural teeth, denture wearers also may choose soft foods and avoid fresh fruits and vegetables.

Periodontal (gum) disease or tooth decay (cavities) are the most frequent causes of tooth loss. Older Americans continue to experience dental decay on the crowns of teeth (coronal caries) and on tooth roots (because of gum recession). In fact, older adults may have new tooth decay at higher rates than children.

Severity of periodontal (gum) disease increases with age. About 23 percent of 65- to 74-year-olds have severe disease, which is measured by 6mm loss of attachment of the tooth to the adjacent gum tissue. At all ages men are more likely than women to have more severe disease. At all ages, people at the lowest socioeconomic level have the most severe periodontal disease.

Oral and pharyngeal cancers, which are diagnosed in some 31,000 Americans each year, result in about 7,400 deaths each year. These cancers are primarily diagnosed in the elderly. Prognosis is poor. The five-year survival rate for white patients is 56 percent and for African American patients is only 34 percent.

Most older Americans take both prescription and over-the-counter drugs. Over 400 commonly used medications can be the cause of a dry mouth. Reduction of the flow of saliva increases the risk for oral disease, since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria. Individuals in long-term care facilities—about 5 percent of the elderly—take an average of eight drugs each day.

Painful conditions that affect the facial nerves are more common among the elderly and can be severely debilitating. These conditions can affect mood, sleep, and oral-motor functions such as chewing and swallowing. Neurological diseases associated with age, such as Parkinson's disease, Alzheimer's disease, Huntington's disease, and stroke also affect oral sensory and motor functions, in addition to limiting the ability to care for oneself.

For more information on oral health on aging, see

Vargas CM, Kramarow EA, Yellowitz JA. The Oral Health of Older Americans [PDF–285K] Aging Trends, No. 3. Hyattsville, MD: National Center for Health Statistics, 2001.

What You Can Do to Maintain Your Oral Health

  • Drink fluoridated water and use fluoride toothpaste; fluoride provides protection against dental decay at all ages.
  • Practice good oral hygiene. Careful tooth brushing and flossing to reduce dental plaque can help prevent periodontal disease.
  • It is important to see your dentist on a regular basis, even if you have no natural teeth and have dentures. Professional care helps to maintain the overall health of the teeth and mouth, and provides for early detection of pre-cancerous or cancerous lesions.
  • Avoid tobacco. In addition to the general health risks posed by tobacco use, smokers have seven times the risk of developing periodontal disease compared to non-smokers. Tobacco used in any form—cigarettes, cigars, pipes, and smokeless (spit) tobacco—increases the risk for periodontal disease, oral and throat cancers, and oral fungal infection (candidiasis). Spit tobacco containing sugar also increases the risk of cavities.
  • Limit alcohol. Drinking a high amount of alcoholic beverages is a risk factor for oral and throat cancers. Alcohol and tobacco used together are the primary risk factors for these cancers.
  • Make sure that you or your loved one gets dental care prior to having cancer chemotherapy or radiation to the head or neck. These therapies can damage or destroy oral tissues and can result in severe irritation of the oral tissues and mouth ulcers, loss of salivary function, rampant tooth decay, and destruction of bone.
  • Caregivers should reinforce the daily oral hygiene routines of elders who are unable to perform these activities independently.
  • Sudden changes in taste and smell should not be considered signs of aging, but should be a sign to seek professional care.
  • If medications produce a dry mouth, ask your doctor if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco and alcohol.

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