Common Oral Conditions in Older Adults: Recognition and Management

Wanda C. Gonsalves, MD; A. Stevens Wrightson, MD; Robert G. Henry, DMD, MPH
Adapted and summarized by ChatGPT (GPT-5) from American Family Physician, 2008;78(7):845–852.

With the aging population continuously growing, oral health care for the elderly has grown to be a very important part of the medical care. 

Dental caries, periodontal disease, and others, though not all, will still affect those with and without natural teeth at least partly due to their predisposition of getting them along with the use of medications, and aging. 

Common Oral Conditions in Older Adults

This article discusses the clinical manifestations, prevention, and management of the oral conditions elderly experience most commonly, and it also points out the importance of primary care doctors in the process of promoting oral health.

Introduction

The percentage of Americans aged over 65 will be 20% of the total population which amounts to almost 71 million people—by 2030 (Jeanotte & Moore, 2007). 

Although still, the number of toothless elder people is declining due to better dental care and public health measures, physiologic changes due to aging along with chronic diseases make them more susceptible to oral and dental disorders (Gonsalves et al., 2008). 

The connections between systemic conditions and periodontal disease are well documented; diabetes, cardiovascular diseases, and even aspiration pneumonia are among the affected ones (Rose et al., 2000; Offenbacher & Beck, 2005). 

Accordingly, primary care physicians are in a prime position to spot and treat oral conditions through their patients rarely visiting dental offices for check-ups.

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Oral Health Assessment

An oral health assessment should be conducted as part of every routine geriatric evaluation. A penlight, a tongue blade, and a pair of gloves can be used by doctors to carry out a quick examination for inspection of the tongue, mucosa, gums, and teeth. 

The Oral Health Assessment Tool (OHAT), which was validated by Chalmers et al. in 2005, categorizes the different oral structures as healthy,

ROE has received a cardio-pulmonary assessment which has shown that the screening tests have determined various lesions as either normal, changed, or unhealthy and provides guidance for follow-up and referral. 

Non-dental healthcare providers can apply this screening tool with great success in community and long-term care environments. Any lesion that lasts for more than two weeks, or any change accompanied by pain, bleeding, or ulceration, deserves a referral for dental or specialist evaluation.

Age-Related Oral Changes

Senescence impacts the mouth that is quite visible and at the same time varies in texture. People may perceive that their teeth are yellow or even darker because the enamel is getting thinner and at the same time the dentin being formed underneath it is the dark one (Berg & Morgenstern, 1997). 

Losing teeth height, tooth wear, and less blood supply turns to less feeling, slower healing, and greater susceptibility to injury and decay (Baum, 1996). 

The hard tissue around the root of the tooth gets thicker as time goes by but at the same time gums may recede exposing it to decay-causing agents such as sugars and acids (Warren et al., 2000). 

The oral mucosa loses thickness and is less keratinized, while the periodontal ligament has decreasing width and losing elasticity. 

Although there is gum recession in the older population quite often, it does not necessarily mean a normal aging process and should be evaluated for periodontal disease (Levy, 1986).

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1. Dental Caries

Dental caries continue to be very common in older folks and root caries are particularly frequent because of receding gums and the exposure of root surfaces (Shay, 1997). 

Some studies show that the incidence of root caries in those over 60 years is twofold compared to younger adults (Jones, 1995). Xerostomia, poor oral hygiene, low economic status, and limited access to dental care are some of the risk factors (Douglass et al., 2004). 

The preventive measures are to keep good oral hygiene, swoop down on sugar, and make sure there is fluoride exposure through the use of toothpaste, gels, rinses, or varnishes.

Removing plaque through professional dental care is a necessity, as well as conservative management of early lesions.

2. Perio dontal Disease

Periodontal disease is a term that includes gingivitis and periodontitis. The initial stage of gum disease, gingivitis, is characterized by the presence of red, swollen, and bleeding gums that are a result of bacterial plaque forming on the gum line (Loesche, 2007). 

Periodontitis can become the next stage if gingivitis is ignored—an aggressive disease that causes deep pockets, tooth loosening, and ultimately the loss of teeth (Burt, 1994). 

Periodontitis is not just a localized infection; there are general health implications that include poorer glycemic control in diabetic patients and higher risk of heart disease (D’Aiuto et al., 2006). 

The battle against periodontitis lasts forever and it usually consists of daily brushing, flossing, and professional scaling and root planning. 

Sub antimicrobial-dose doxycycline can reduce inflammation and halting disease progression in institutions or in medically complex patients as an adjunct therapy to the above-mentioned (Mohammad et al., 2005).

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3. Dry Mouth (Xerostomia)

Xerostomia or the feeling of dry mouth affects 29–57% of the elderly population (Guggenheimer & Moore, 2003). The usual cause is medication, especially the use of antihypertensives, antidepressants, diuretics, and anticholinergics, or by the patient’s medical condition such as Sjögren’s syndrome and radiation of the head or neck (Douglass et al., 2004). 

The patient may have symptoms such as trouble swallowing, talking, or tasting, and burning on the tongue. The strategy of the oral dryness (xerostomia) management is to purge the problem of medicating or substituting medications with xerogenic ones if possible, keeping people well hydrated, and prohibiting the use of alcohol and caffeine. 

The glands producing saliva can be stimulated by means of sugarless gum and lozenges, while the application of artificial saliva products provides relief from the symptoms. 

Medicines like pilocarpine and cevimeline may be needed for very stubborn cases.

To prevent caries and fungal infections, moisture retention in the oral cavity is very important (Papas et al., 2006).

4. Oral Candidiasis

The most common fungal infection in older adults is oral candidiasis, which is associated with denture use, dry mouth, diabetes or immunodeficiency (Neville, 2002). This infection is mainly caused by the fungus Candida albicans and occurs in different clinical forms. 

Pseudomembranous candidiasis (thrush) shows up as white patches that are easy to remove; erythematous candidiasis (denture stomatitis) consists of red spots under the dentures; and angular cheilitis exhibits red cracks at the corners of the mouth. 

The diagnosis is usually made based on clinical symptoms but can be validated through potassium hydroxide preparation or culture. 

The treatment consists of using nystatin suspension or clotrimazole troches as the main topical antifungal agents, and fluconazole may be given as systemic therapy for severe or recurrent infections (Epstein et al., 2002). 

To avoid the inflammation from coming back, it is best to take out the dentures every night and then disinfect them (Webb et al., 2005).

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5. Oral Cancer

Squamous cell carcinoma, which is the most common type of oral cancer, poses a significant risk to the elderly population. Tobacco and alcohol account for about 75% of the cases (Weinberg & Estefan, 2002). 

The most probable locations of the tumor are; the lateral tongue, the lower lip and the floor of the mouth. Early changes may appear as persisting white (leukoplakia) or red (erythroplakia) patches, which will eventually lead to ulceration or swelling. 

The fact that there are no symptoms in the early period makes it necessary to carry out biopsies for all lesions that last more than two weeks. 

The way of controlling cancer depends on its size and may include a combination of surgery, radiation therapy, or chemotherapy. 

The importance of early detection for better survival is constantly being emphasized, hence the need for regular oral examinations and dissemination of information about reducing risk among patients.

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Oral Health Aids and Maintenance

The maintenance of oral hygiene is a very hard task for people suffering from arthritis, visual impairment, or neurologic disorders. 

Use of proper oral hygiene aids like electric toothbrushes, toothbrushes with bigger handles, and floss-holding tools can lead to a very good control of plaque and even independence (Saunders & Friedman, 2007). 

Primary caregivers, as well as healthcare staff, should support daily practices of brushing, flossing, and cleaning of dentures. 

Making oral hygiene a part of the daily self-care routines increases the comfort, nutrition, and quality of life in the elderly.

Conclusion

Oral health is the key factor to general health and well-being of the older adults. The aging process, along with the presence of chronic diseases and medications, makes the older population more at risk for oral pathology. 

However, proper care can turn those conditions into entirely preventable ones. Family doctors and other health personnel have the most important part in the process of assessing oral health status, early disease detection, and advocating preventive practices. 

Interdisciplinary cooperation between medicine and dentistry would have a huge impact on the older adults being able to keep their function, comfort, and dignity during the process of aging.

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