Oral and dental issues in older people

Medical practitioners have an important role to play in promoting oral health in older people, who may rarely see a dentist. Encourage older people to have regular dental reviews.

Poor oral hygiene is common in older people, particularly in residential aged-care facilities. Maintaining oral hygiene is often hampered by cognitive or physical impairment (eg dementia, poor manual dexterity, blindness). Promote oral hygiene—the use of a powered toothbrush and alcohol-free mouthwash are effective strategies to prevent dental caries and periodontal disease.

Undiagnosed or poorly managed dental conditions that cause pain can contribute to behavioural issues in patients with dementia. Older people, particularly those in residential aged-care facilities, often have complex oral health issues. Dry mouth and falls are common in older people, particularly in people taking multiple medications. Falls have the potential to cause oral trauma (eg a broken tooth, tooth avulsion, maxillofacial trauma).

Denture use is associated with traumatic ulcers, denture-associated erythematous stomatitis, oral candidiasis and angular cheilitis (see Diagnosis of oral and oropharyngeal infection caused by Candida and related species). Ask about denture fitting and check denture hygiene is correct and effective. However, denture use is declining with older people increasingly retaining their teeth; this is contributing to a significant increase in the incidence of dental caries and periodontal disease.

Dental caries in older people is exacerbated by dry mouth, poor oral hygiene and changes in diet. The stages of dental caries are depicted in Stages of dental caries and Early carious lesions and cavities. While awaiting dental review, consider the use of toothpaste containing 5000 ppm of fluoride. Reassure patients that, in some cases, dental caries can be managed with professionally applied topical treatments (eg fluoride varnish, silver fluoride formulations) that do not require tooth extraction or fillings.

Periodontal disease (eg gingivitis, periodontitis) is common in older people. There is growing evidence that poor periodontal health is associated with many systemic diseases, including aspiration pneumonia, cerebrovascular events, atherosclerosis, diabetes, autoimmune diseases (eg rheumatoid arthritis) and other chronic diseases.

For patients presenting with lesions in the mouth, have a high index of suspicion for oral cancer—oral cancer is more common in older people and can mimic many oral mucosal diseases (see Assessment of oral mucosal disease).