Maintaining good oral health is an important, but easily neglected, aspect of healthy aging. In this article, we detail common oral health conditions in adults over the age of 65 years, as well as the impact of oral health on general health and nutrition. 

Common Oral Health Conditions

Caries. One of the most common oral health conditions that older adults face is dental caries, or tooth decay, with 96 percent of older adults in the United States (US) experiencing dental caries.¹ Gingival recession, periodontitis, and xerostomia (dry mouth) put older adults at a higher risk of developing root caries, compared to younger individuals.^2,3 Other risk factors for caries in older adults include poor diet,⁴ decreased salivary production,^3,5 lack of routine dental care, poor oral hygiene, lack of access to fluoridated water, low socioeconomic class, and institutionalization.³ To help prevent caries, use toothpaste and mouthwash that contain fluoride, apply fluoride varnish if available, and floss daily.^2,3,5 Silver diamine fluoride might also be beneficial in the treatment of root caries.²

Periodontal disease. Periodontal disease affects the gums and tissues that support the teeth, and it is caused by plaque accumulation.^4,6 Gingivitis is a mild periodontal disease characterized by inflammation of the gums and susceptibility to bleeding. Gingivitis can be prevented and reversed with good oral hygiene and regular dental visits.^3,6 However, when left untreated, gingivitis can progress to periodontitis, a more severe form of periodontal disease in which the periodontal ligament detaches from the tooth, creating a pocket. Plaque can then spread below the gum line, and eventually the bone and connective tissue holding the tooth in place will start to deteriorate, loosening the tooth and leading to tooth loss.^3,6 Risk factors for periodontal disease include tobacco use,^1,3,6 poor oral hygiene, and gingival recession.³ Additionally, smoking can impair the efficacy of periodontitis treatments.⁶ Periodontitis often requires professional dental intervention, including plaque removal and surgery.³

Xerostomia. Xerostomia is the subjective sensation of dry mouth, in which saliva production may or may not be reduced.⁵ Individuals with xerostomia might have difficulty chewing, swallowing, and speaking.^3,5 Other symptoms include changes in taste, cracked lips, fissured tongue, and lesions on oral soft tissues.^2,5 Xerostomia might also result in bad breath.⁵ Dentures might not fit as well as they should and rub against the gums in individuals with xerostomia, resulting in sores. Fungal infections can also occur underneath the dentures.⁶ A common cause of xerostomia in older adults is medication use,^5,6 and the intake of four or more medications per day has been associated with increased occurrence of xerostomia.² Dehydration, nerve damage, smoking, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), Sjögren’s syndrome, and head/neck radiation therapy can also cause xerostomia.^3,6 Medication-induce xerostomia can be treated by adjusting the dosage or switching to another medication when possible, and over-the-counter artificial saliva can be used to alleviate symptoms.^3,6 Individuals with xerostomia should also drink water often and avoid/limit alcoholic, sugary, and caffeinated beverages.^2,3 In addition, there are fluoridated alcohol-free toothpastes and mouthwashes specially formulated to improve salivary flow.⁵

Oral cancer. Oral cancer typically develops in adults aged 60 years or older. Seventy-five percent of cases of oral cancer are associated with excessive alcohol use, tobacco use, human papillomavirus (HPV), lack of sun protection on the lips, and family history of oral cancer.⁷ In addition, male individuals are twice as likely to develop oral cancer, compared to female individuals.⁴ Symptoms of oral cancer include white, gray, or red patches in the mouth, lip, or throat; sores in the mouth area; unexplained bleeding in the mouth; difficulty chewing, swallowing, moving the tongue, or speaking; numbness or pain in the tongue, mouth, or neck; swelling of the jaw; and ear pain.^6,7 

Association Between Oral Health and Other Health Conditions

The effects of poor oral health are not restricted to the mouth; rather, it can affect the entire body. For example, there is a bidirectional relationship between diabetes and periodontal disease.^5,8,9 Individuals with uncontrolled/poorly controlled diabetes have an increased risk of developing periodontal disease, whereas those who treat their periodontal disease and practice good oral hygiene can improve their glycemic control,^5,8 reduce associated complications, and improve quality of life.⁸ Diabetes is also associated with changes in taste, infections in the mouth (e.g., candidiasis), and impaired salivary gland function.^5,8 Additionally, rheumatoid arthritis is associated with the development of periodontal disease, xerostomia, and caries.⁸ 

Individuals with neurodegenerative disorders or severe cognitive impairment might lose the ability to brush and floss their teeth; as such, they have an increased risk of developing caries, periodontal disease, denture-induced mucositis, and infections. Alzheimer’s disease and Parkinson’s disease, as well as medications for both diseases, can cause xerostomia as well.^2,8 

Psychiatric conditions can also negatively impact oral health. Depression is associated with an increased risk of caries and tooth loss,^5,8 and research has shown that edentulism (loss of all natural teeth) and periodontal disease increase the risk of depression.⁸ Additionally, taking psychiatric medications can result in xerostomia.^5,8

Physical limitations or loss of mobility due to conditions such as arthritis can further impair oral health. Modifying an existing toothbrush to create a wider handle or use of an electronic toothbrush with a wide, easily gripped handle can help those with limited mobility maintain oral health. In lieu of floss, interdental brushes and floss handles can be used to clean between the teeth.²

Nutrition and Oral health

Nutrition and oral health go hand in hand, as poor oral health can lead to impairments in food intake, which could then result in nutrient deficiencies or malnutrition. In turn, oral health could worsen due to a lack of nutrients.^5,9 For example, older adults with tooth loss experience greater difficulty chewing and might adjust their diet to avoid foods that are harder to chew, such as fruits, vegetables, and meat. This dietary adjustment can lead to a lack of vitamins and minerals, which then contributes to oxidative stress and inflammation, thereby increasing the risk of periodontitis. Nutritional deficiencies also increase the risk of caries, oral infections, and sarcopenia.⁴ 

Various factors can contribute to decreased oral health and nutritional deficiencies/malnutrition. Studies have shown that difficulty chewing is associated with a lower intake of certain nutrients, such as calcium, vitamin B2, vitamin A, folic acid, and dietary fiber, and foods, such as vegetables and protein.^10,11 Tooth loss is linked to impaired chewing ability,^4,10 and some studies have found that tooth loss might increase the risk of malnutrition and sarcopenia.¹² Additionally, lower tongue pressure is associated with an increased risk of malnutrition.^10,11 Research has shown that impaired swallowing function puts individuals at a greater risk of malnutrition.^10,11 Some studies have identified a potential link between oral dryness (xerostomia and decrease salivary flow) and malnutrition, but other studies indicate that there is no significant association between oral dryness and nutritional status;^10,12 as such, more research is warranted.

Bottom Line

Oral health should be prioritized as we age, as many oral health conditions can be prevented with proper oral hygiene and regular visits to the dentist. Consult with your dentist to determine the best way to care for your mouth.

Sources

1. National Institutes of Health. Oral Health in America: Advances and Challenges: Executive Summary. Dec 2021. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Executive-Summary.pdf. Accessed 12 Sep 2023.
2. American Dental Association. Aging and dental health. Updated 24 Aug 2023. https://www.ada.org/en/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health. Accessed 12 Sep 2023.
3. Gonsalves WC, Wrightson AS, Henry RG. Common oral conditions in older persons. Am Fam Physician. 2008;78(7):845–852. 
4. Janto M, Iurcov R, Daina CM, et al. Oral health among elderly, impact on life quality, access of elderly patients to oral health services and methods to Improve oral health: a narrative review. J Pers Med. 2022;12(3):372.
5. The Gerontological Society of America. Oral health: an essential element of healthy aging. What’s Hot. 2017. https://www.geron.org/images/gsa/documents/oralhealth.pdf. Accessed 12 Sep 2023.
6. National Institute of Dental and Craniofacial Research. Older adults and oral health. Aug 2020. https://www.nidcr.nih.gov/sites/default/files/2018-10/older-adults-oral-health.pdf. Accessed 12 Sep 2023.
7. Cleveland Clinic. Oral cancer. Reviewed 27 Jan 2022. https://my.clevelandclinic.org/health/diseases/11184-oral-cancer#symptoms-and-causes. Accessed 12 Sep 2023.
8. Chan AKY, Tamrakar M, Jiang CM, et al. Common medical and Dental problems of older adults: a narrative review. Geriatrics (Basel). 2021;6(3):76. 
9. The Gerontological Society of America. Interrelationships between nutrition and oral health in older adults. What’s Hot. 2020. https://health.mo.gov/living/families/oralhealth/pdf/whats-hot-nutritiono-oral-health-older-adults.pdf. Accessed 12 Sep 2023.
10. Iyota, K., Mizutani, S. Deterioration of oral functions and nutrition in older individuals. Curr Oral Health Rep. 2022;9:103–110.
11. Iwasaki M, Hirano H, Ohara Y, Motokawa K. The association of oral function with dietary intake and nutritional status among older adults: latest evidence from epidemiological studies. Jpn Dent Sci Rev. 2021;57:128–137. 
12. Algra Y, Haverkort E, Kok W, et al. The association between malnutrition and oral health in older people: a systematic review. Nutrients. 2021; 13(10):3584.