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Chapter 032. Oral Manifestations of Disease (Part 10)

Aging and Oral Health While tooth loss and dental disease are not normal consequences of aging, a complex array of structural and functional changes occurs with age that can affect oral health. Subtle changes in tooth structure (e.g., diminished pulp space and volume, sclerosis of dentinal tubules, altered proportions of nerve and vascular pulp content) result in diminished or altered pain sensitivity, reduced reparative capacity, and increased tooth brittleness. In addition, age-associated fatty replacement of salivary acini may reduce physiologic reserve, thus increasing the risk of xerostomia. Poor oral hygiene often results when vision fails or when patients lose manual dexterity. | Chapter 032. Oral Manifestations of Disease Part 10 Aging and Oral Health While tooth loss and dental disease are not normal consequences of aging a complex array of structural and functional changes occurs with age that can affect oral health. Subtle changes in tooth structure e.g. diminished pulp space and volume sclerosis of dentinal tubules altered proportions of nerve and vascular pulp content result in diminished or altered pain sensitivity reduced reparative capacity and increased tooth brittleness. In addition age-associated fatty replacement of salivary acini may reduce physiologic reserve thus increasing the risk of xerostomia. Poor oral hygiene often results when vision fails or when patients lose manual dexterity and upper extremity flexibility. This is particularly common for nursing home residents and must be emphasized since regular oral cleaning and dental care has been shown to reduce the incidence of pneumonia. Other risks for dental decay include limited lifetime fluoride exposure and preference by some older adults for intensely sweet foods when taste and olfaction wane. These factors occur in an increasing proportion of persons over age 75 who retain teeth that have extensive restorations and exposed roots. Without assiduou s care decay can become quite advanced yet remain asymptomatic. Consequently much or all of the tooth can be destroyed before the process is detected. Periodontal disease a leading cause of tooth loss is indicated by loss of alveolar bone height. Over 90 of Americans have some degree of periodontal disease by age 50. Healthy adults who have not experienced significant alveolar bone loss by the sixth decade do not typically develop significant worsening with advancing age. Complete edentulousness with advanced age though less common than in previous decades is still present in approximately 50 of Americans age 85. Speech mastication and facial contours are dramatically affected. Edentulousness may also worsen obstructive .