1

DENTAL PROBLEMS IN

OLD AGE

JYOTI PACHISIA

M.SC 1ST YEAR FOOD AND

NUTRITION

ROLL NO. 07

J D BIRLA INSTITUTE

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ABOUT THIS TOPIC

As the first segment of the gastrointestinal system, the oral cavity

provides the point of entry for nutrients. The condition of the oral

cavity, therefore, can facilitate or undermine nutritional status. If

dietary habits are unfavourably influenced by poor oral health,

nutritional status can be compromised. However, nutritional status

can also contribute to or exacerbate oral disease. General well‑being

is related to health and disease states of the oral cavity as well as the

rest of the body. An awareness of this interrelationship is essential

when the clinician is working with the older patient because the

incidence of major dental problems and the frequency of chronic

illness and pharmacotherapy increase dramatically in older people.

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SERIAL NO. CONTENTS COVERED PAGE NO.

1 HEALTH STATUS OF INDIAN

GERIATRIC POPULATION

4-5

2 ORAL HEALTH STATUS OF

INDIAN GERIATRIC PEOPLE

6

3 COMMON DENTAL PROBLEMS

SEEN IN OLD AGE

7-22

4 BASIC ORAL HYGIENE RULES TO

BE FOLLOWED

23

5 NUTRITION AND ORAL HEALTH 24-25

6 ORAL HEALTH PROGRAMMES 26-27

7 CONCLUSION 28

8 REFERENCES 29

CONTENTS

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India is an aging society with the rate of growth of aging population exceeding the growth of

general population. In India, it is estimated that the elderly in the age group 60 and above is

expected to increase from 71 million in 2001 to 179 million in 2031 and in the case of those

70 year and older, the projected

increase is from 27 million in

2001 to 132 million in 2051.

Data available from India suggest

that almost 50 per cent of the

elderly suffer from chronic

diseases with the prevalence of

diseases increasing with age from

39% in 60-64 year to 55% in

those older than 70 year.

Cardiovascular diseases followed

by respiratory diseases are two of

the common causes of death

among the elderly in India.

Hearing and Visual impairments

are two of the common causes of morbidity in the aged population. A National Survey noted

that 5 per cent of the elderly have difficulty in physical morbidity with women (7%)

experiencing more difficulty than men. Varying degrees of neuropsychiatric disorders being

one out of three elders, with depression being the commonest disorder in the elderly.

Among the elderly, the focus is not only on reducing disease related morbidity and mortality,

but on promoting optimal health and ensuring disability-free years. In a population based

study in a rural district from South India, authors using the International Classification of

Impairments, Disabilities and Handicaps, noted that visual disability was the single most

important cause of preventable disability (56%) among the elderly aged above 60 yr with

only one third of them using assistive devices. In another study from northern India, a

HEALTH STATUS OF INDIAN

GERIATRIC POPULATION

5

significant proportion of the elderly

surveyed had multiple health-related

morbidities (42.5%) and a higher number

of morbidities were associated with

greater disability and psychological

distress. In a clinic based study from a

tertiary health care centre in Delhi, of the

1586 subjects aged 60 yr and above, 6.9

per cent had impairment in daily

activities. A study from Assam showed

that utilization of health services was very low among the rural elderly compared to the urban

elderly.

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Indian geriatric population has poor oral health and prosthetic status with high unmet needs.

Indiscriminate studies and paucity of data on residents depicts the proportionate degree of

negligence towards the oral health conditions in residents. By and large, there is a hike in the

incidence of root caries, edentulousness (tooth loss), periodontal problems and oral mucosal

disorders.

Dental Council conducted National Oral health Surveys in 65 to 74 year old elderly in urban

and rural households in each state in 2002-2003 as per the WHO recommendations. The data

collected shown a prevalence of 85% and 80% among 65-74 years old for dental caries and

periodontal diseases respectively. According to cross-sectional study, Dental caries (43.2%)

and periodontal diseases (34.8%) were the most common dental disorders in urban residents

of Nagpur, Maharashtra. Only 4.2% had complete dentures and 22% are completely

edentulous in geriatric homes of Mangalore. Moreover, in Delhi, 44.9% of the elderly had

decayed teeth, 39.2% were edentulous. 57.9% had deep periodontal pockets.

ORAL HEALTH STATUS OF

INDIAN GERIATRIC

POPULATION

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COMMON DENTAL

PROBLEMS

TOOTH LOSS/ EDENTULISM

DENTURE STOMATITIS

DENTAL CARIES

PERIODONTAL DISEASE

XEROSTOMIA/ DRY

MOUTH

ORAL CANCER

ORAL ULCER GINGIVITIS

SENSITIVITY CANDIDIASIS ANGULAR CHELITIS

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1. TOOTH LOSS/ EDENTULISM:

Edentulism is the state of having lost all of one’s natural teeth. Monitoring the occurrence of

an oral “end state” such as edentulism is important because it is an indicator of both

population health and the functioning and

adequacy of a country’s oral health care

system. It is a debilitating and irreversible

condition and is described as the “final

marker of disease burden for oral health.”

Edentulism remains a major disease

worldwide, especially among older adults.

Factors associated with edentulism include

socioeconomic factors such as increasing

age, gender, lower education, lower

economic status, lower social class, health

security and rural residence; chronic conditions such as asthma, diabetes, arthritis, angina

pectoris, stroke, hypertension and obesity; health risk behaviour including smoking,

inadequate consumption of fruit and vegetables, infrequent dental visits; and other health-risk

factors including functional disability, lower scores on cognitive testing, poorer self- rated

level of general health, social cohesion and self- esteem and quality of life.

Edentulism leads to reduced food intake specially fruits and vegetables thereby increasing the

risk of cardiovascular diseases and

obesity, gastrointestinal disorders,

ulcers, diabetes, chronic kidney

disease, decreased daily function &

physical activity which ultimately

leading to poorer quality of life. Also

association between edentulism and

sleep- disordered breathing, including

obstructive sleep apnea is seen.

Edentulism is also associated with

tardive dyskinesia, a type of dyskinesia

occurring among between patients chronically treated with antipsychotic drugs. Edentulism

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can be accompanied by functional and sensory deficiencies of the oral mucosa, oral

musculature, and the salivary glands.

Edentulism has a series of deleterious consequences for oral and general health. Oral

consequences vary from the well known residual ridge resorption to an impaired masticatory

function, an unhealthy diet, social disability, and poor oral health quality of life. Edentulous

individuals are also in greater risk for different systemic diseases and an increase in mortality

rate. Therefore, oral health care providers should prevent tooth loss with proper dental

education, oral health promotion, and a high level of dental care in an attempt to assure the

existence of a physiologic dentition.

People during senior years, dental cavities, gum disease and tooth loss may make it difficult

to chew and swallow food and because changes in texture and temperature of foods, they get

deprived of nutritional requirements. Eating soft or minced foods that are appetizing and

dense in protein, vitamins and minerals may help in weight loss and nutritional deficiencies.

2. DENTURE STOMATITIS:

Denture stomatitis (DS), also known as denture-induced stomatitis, denture induced

stomatitis or chronic erythematous candidosis, is an oral condition that presents clinically as

erythemateous and inflamed areas of mucosa exclusively limited to those sites covered by

denture. 67% of denture wearers suffer from some degree of Dental stomatitis. Denture

stomatitis is usually aymptomatic, although some patients may complain of itching, burning,

discomfort and occasional bleeding. In its mildest form, Denture stomatitis may arise from a

poor fit of the denture. However, the aetiology of Denture stomatitis is likely to be complex

in more clinically severe cases. In addition to physical irritation, potential precipitating

factors include, poor denture hygiene, continuous wearing of dentures, poor denture quality,

undiagnosed or poorly controlled diabetes mellitus, reduced salivary gland function, tobacco

use, hypersensitivity reactions to denture materials, immune-suppression or immune-

compromised states, and Candida infection. With regards to the latter, Denture stomatitis is

considered to be most prevalent form of oral candidosis.

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Importantly, it has been shown that

the visible mucosal inflammatory

changes associated with Denture

stomatitis actually reduce following

treatment with either topical or

systemic antifungal therapy. This

response provides strong evidence

for the role of Candida in the

aetiology of Candida in the

aetiology of Denture stomatitis.

However, inflammation usually

rapidly recurs following cessation of such antifungal treatment, an observation that, in part,

probably reflects the failure to eradicate the presence of Candida, on the denture surface.

Therefore to control this, it is likely to be necessary to simultaneously reduce mucosal

inflammation and the microbial colonisation of the denture. As a consequence, dentures

should be removed during sleep, since this will reduce any physical irritation and permit

access of saliva to the mucosa. It is also important to keep the dentures in a clean storage

container so that denture is not re-colonised. In addition, adequate denture hygiene should be

regularly maintained such as through the regular soaking and brushing of dentures using a

denture cleanser in an attempt to eliminate the infection.

Since stomatitis could be a result of the collection of toxins in the body, for long term relief

from this condition, it is important for people to follow a diet that is high in healthy stomatitis

foods. However, in the beginning, a stomatitis diet requires the patient to consume nothing

but water and orange juice for around 3 to 4 days. For best results, the orange juice should be

diluted in an equal part of warm water, before it is consumed. This mixture should be

consumed every two hours or so, so that the body does not suffer from a lack of nutrition. For

those people who do not like orange juice, carrot juice diluted in water should be used

instead. However, people may need to take a warm water enema to cleanse the bowels during

this phase.

After the duration of 3 to 4 days, people can switch over to a diet, comprising healthy

stomatitis foods to eat, such as fresh fruits like peach, pear, grapefruit, apple, papaya,

pineapples, oranges and grapes. After that, the patient needs to follow a stomatitis diet that

mainly comprises fruits, vegetables, grains, nuts and seeds. Special emphasis should be laid

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on whole grains, cereals, fruits and vegetables that are either raw or cooked lightly. Sprouted

seeds like green gram beans and alfalfa are also healthy stomatitis foods to eat.

There are certain stomatitis foods that should be strictly avoided too, such as candies,

processed food, pickles, ice cream, soft drinks, refined foods, meat, coffee, tea, white flour,

sugar and condiments. However, before adding any foods to a regular diet, or eliminating

any, it is absolutely essential to consult a doctor and get an approval.

3. DENTAL CARIES:

Caries is the demineralization of the inorganic part of the tooth with the dissolution of the

organic substance due to multifactorial etiology. The demineralization of the enamel and of

organic acids that form in the dental plaque is because of bacterial activity, through the

anaerobic metabolism of sugars from the diet. Tooth decay is the process that results in the

gradual destruction of a tooth and is caused by the combination of bacteria (dental plaque)

and sugar (diet). Decay often occurs rapidly at that time of a life crisis such as chronic

diseases or loss of partner. In older people this process can be painless.

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Decay/ Dental caries may occur in the enamel cap, around and under fillings and (especially

in older people) in the softer root dentine exposed as guns recede. This root decay may only

be spotted by X- ray examination in its early stages, and is a serious problem for older people

with natural teeth. The types of sugar ingested through diet also influence the onset of illness.

In fact, studies on the pH of the dental plaque have shown that lactose produces less acidity in

comparison to other sugars.

The main causes of dental caries/ decay are:

Poor or lack of tooth brushing with fluoride toothpaste

Lack of cleaning between teeth

Snacking of foods high in sugar

Frequent intake of sweetened drinks, including fruit juices and fizzy drinks

Dry mouth

The warning signs are:

Tooth covered in debris and food

Holes in teeth

Broken teeth

Brown or discoloured teeth

Brown or discoloured teeth

Tooth sensitivity to hot or cold foods

Difficulty with eating or chewing

Toothache

Bad breath

Swelling in the face and jaw area

Dental caries can be prevented by brushing daily with fluoride toothpaste, reduction of

sweetened foods and drinks, especially in between meals

Diet can be a good ally in the prevention of caries:

.(i)Increase in the consumption of fibres: diminution of the absorption of sugars contained in

other food.

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(ii)Diets characterized by a ratio of many amides/little sugar have very low levels of caries.

(iii)Cheese has cariostatic properties.

(iv)Calcium, phosphorus and casein contained in cow milk inhibit caries.

(v)Wholemeal foods have protective properties: they require more mastication, thus

stimulating salivary secretion.

(vi)Peanuts, hard cheeses, and chewing gum are good gustative/mechanical stimulators of

salivary secretion.

(vii)Black tea extract increases the concentration of fluorine in the plaque and reduces the

cariogenicity of a diet rich in sugars.

(viii) Fluorine remains a milestone in the prevention and in the control of dental caries. It has

a pre-eruptive mechanism of action (incorporation in the enamel during amelogenesis) and a

post-eruptive mechanism (topical action).

4. PERIODONTAL DISEASE/ PERIODONTITIS:

Periodontitis is the destructive form of gum disease. Untreated gingivitis can advance to

periodontitis as, with time, plaque can spread and grow below the gum line. The pathogenesis

of periodontal disease involves bacteria and the host response to these bacterial by products

(toxins and enzymes). Toxins produced by the plaque bacteria cause an inflammatory

response which destroys the periodontal fibres and bone supporting the teeth. As the disease

progresses, more gum tissue and bone are destroyed. Eventually, the tooth becomes loose and

falls out or may have to be removed. In short, periodontal disease range from mild forms,

such as gingivitis, to severe forms of periodontitis that results in the destruction of

periodontal supportive tissue and ultimately tooth loss.

Periodontitis is characterized by red swollen or tender gums, receding gums, or gums that

pull away from the teeth, loose teeth, pus formation between the gum and the tooth, bad

breath, change in the way teeth fit together when biting, or even during wearing dentures.

The following are the preventive measures to be taken:

Brushing twice daily with fluoride toothpaste

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Regular cleaning between teeth if part of care plan

Reduction of sweetened foods and drinks, especially in between meals- and replacing

with “tooth safe” alternatives such as water rather than fruit juices or fizzy drinks.

Regular professional check-ups and cleaning

Health professionals should consider certain factors and develop a comprehensive inter-

professional approach when addressing nutritional care and diet counselling from screening

to assessment to intervention to monitoring to referral, as appropriate to maximize patient/

client care outcomes.

5. DRY MOUTH/ XEROSTOMIA:

Dry mouth or xerostomia is a condition where the mouth becomes very dry due to reduced

saliva flow. It is caused by certain medical conditions and is also a side effect of medications

such as antihistamines, painkillers, high blood pressure medications, diuretics,

antidepressants and others. People suffering from dry mouth are more susceptible to tooth

decay, gum disease and bad breath. The soft tissues in the mouth are more prone to irritation

for those who wear dentures.

The most common causes are:

Certain medications

Radiation and chemotherapy

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Conditions such as Sjogren’s syndrome and Alzhemier’s disease

Warning/ Alarming signs for dry mouth/ xerostomia are:

Difficulty in swallowing and speaking

Dryness in mouth

Burning sensation or sore feeling in the mouth

Bad breath

Preventive measures to be taken to combat the problem:

Follow strict daily oral hygiene routine using soft brush with fluoride toothpaste and

cleaning between teeth (if this is part of Oral Care plan).

Salt and bicarbonates (baking soda) rinses can be used as often as required during the

day to remove any mucus or debris in the mouth.

Discuss the medications with the doctor to find suitable alternatives (if that is

possible) that are less likely to cause dry mouth.

Drink plenty of water to avoid dehydration

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Avoid drinking sweetened drinks, especially in between meals

Special products are available in the market to restore moisture in the mouth.

Therefore, a product is recommended in the Oral Care plan.

6. ORAL CANCER:

Oral cancer includes cancer of lip, tongue, cheeks and other sides of the mouth. Ulcers lasting

for more than two weeks must be screened for oral cancer. The association between diet and

oral cancer is extremely serious. It is a pathology that is diagnosed in three hundred thousand

new cases in the world every year and presents the greatest incidence in people who smoke,

chew tobacco and consume alcohol. The use of tobacco can alter the distribution of nutrients

such as antioxidants,

which develop a protective

action toward the cells:

smokers present levels of

carotenoids and vitamin E

in the blood that are

superior to those in the

oral mucous and, in

addition, have a different

distribution in comparison

to the norm; the levels of

folates in the blood and in

the cells of the oral tissues of smokers are inferior to those of nonsmokers; the inside of the

cheeks of smokers presents numerous micronuclei (modifications typical of pre- and

neoplastic lesions). The study of the incidence of this illness has underlined the possibility

that diet can represent an important etiological factor for oral carcinogenesis. Vitamins A, E,

C, and Beta Carotene have antioxidant properties.

(i)They neutralize metabolic products.(ii)They interfere with the activation of

procarcinogens.(iii)They inhibit chromosomal aberration.(iv)They potentially inhibit the

growth of malignant lesions (leukoplakia).

The mechanism that connects smoke to this disease has not been discovered but some

progress has been made: smoke modifies the distribution of protective substances such as

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folates and some antioxidants. A rebalancing of nutrients obtained through diet can modify

the altered distribution caused by the consumption of tobacco. In an imbalanced diet there is a

depletion of antioxidant nutrients. Fruit and vegetables have, vice versa, important

antioxidant properties. Many micronutrients (vitamins in particular) are used in

chemoprevention programs formulated by the US National Cancer Institute.

The National Cancer Institute and the American Cancer Society have established some

prudential dietary recommendations for the choice of food:

(1)maintain a desirable body weight,

(2)eat a varied diet,

(3)include a new variety of fruits and vegetables in the daily diet,

(4)consume a greater quantity of foods rich in fibre,

(5)decrease the total intake of fats (30% less than the total calories),

(6)limit the consumption of alcohol,

(7)limit the consumption of salted food or food preserved with nitrates.

In patients with an advanced tumour disease, protein-caloric malnutrition is a recurrent

problem due to factors such as a form of anorexia that is established, maldigestion,

malabsorption, and to a difficulty in mastication and deglutition. Foods should be provided

that aim to correct nutritional deficits and ponderal reduction when consumed in a large

enough quantity to cover protein and caloric requirements. Malnutrition also interferes

negatively with humoral and cellular immunocompetence and with tissue and reparative

functions. In addition, the alteration of the liver function can change the way drugs are

metabolized. Therefore, malnutrition can interfere with oncological therapy and increase the

severity of the collateral effects.

Some studies show a small effect of dietary supplementation on cancer incidence, while

others show that supplementation with antioxidant vitamins may have an adverse effect on

the incidence of cancer and cardiovascular diseases or no effect.

Increasing attention has been given to the potential protective roles of specific antioxidant

nutrients found in fruits and vegetables.

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In a recent research El-Rouby showed that lycopene can exert protective effects against 4-

nitroquinoline-1-oxide induced tongue carcinogenesis through reduction in cell proliferation

and enhanced cellular adhesion, suggesting a new mechanism for the anti-invasive effect of

lycopene.

In a recent report Edefonti et al. showed that diets rich in animal origin and animal fats are

positively, and those rich in fruit and vegetables and vegetable fats inversely related to oral

and pharyngeal cancer risk

7. ORAL ULCER:

Oral ulcers are painful areas that appear inside the mouth. They are usually red or yellowish

in colour. Ulcers can be caused by trauma due to biting the cheek or tongue, poorly fitted

dentures, sharp broken teeth or dental fillings.

ORAL ULCER

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These areas heal spontaneously or when the cause of the ulcer is removed. If the ulcer does

not heal within two weeks it is important to consult a dentist. Use of topical analgesics like

gels, Replacement of old broken fillings, adjustment of poorly fitting dentures, rinsing the

mouth to keep clean are common treatments to be kept in mind

8. GINGIVITIS:

Gingivitis is a common form of gum

disease and is often left unnoticed as it

is not painful. Gingivitis can be treated

and reversed but if left untreated can

develop into periodontal disease which

can lead to premature tooth loss.

Inadequate or lack of tooth brushing

and lack of cleaning between teeth are

the common causes of gingivitis.

Gingivitis is characterised by red,

swollen or tender gums, bleeding while

brushing or flossing and bad breath.

General oral health care practices are to

be followed.

9. SENSITIVITY/ TOOTH WEAR:

Enamel is the outer surface of the tooth crown, and it protects the sensitive dentine

underneath. Young and middle-aged people can complain of tooth sensitivity during brushing

and while eating very hot or cold foods. This is usually due to some exposed dentine being

stimulated. This is rare in older people because the nerves of teeth are protected by insulating

tissues, which have formed in earlier years. There is therefore, little value in using

toothpastes designed for sensitive teeth for older people. If an older person has sensitive teeth

it is usually because of decay, and so they should be seen by a dental professional.

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Along with decay the other causes of loss of tooth structure in older people is “fair wear and

tear”. This usually occurs in the form of pieces of tooth breaking away from fillings, and

teeth chipping and becoming sharp to the tongue. These conditions should be referred to and

managed by a dental professional as worn teeth that are functional and supported by healthy

gums are superior in all respects to dentures.

Regular dental check-ups are important to spot and treat the causes of sensitive teeth such as

decay, broken teeth or fillings.

10. ORAL THRUSH/ CANDIDIASIS:

This is a fungal infection of the mouth. This is seen as patches of white film or red dots that

can be painful. It can also a sign of Vitamin B12, folate or iron deficiency. A significant

correlation has been evinced with a lack of iron. This causes alterations in the epithelium with

consequent atrophy and alteration in cellular turn-over, an alteration in the iron-dependent

SENSITIVITY

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enzymatic system depression in cell-mediated immunity, phagocytosis, and in the production

of antibodies. The correlation between candidiasis and the lack of folic acid, vitamins A, B1,

B2, vitamins C, K, zinc, and a diet rich in carbohydrates is also significant.

Weak immune system, dry mouth, leaving dentures in the mouth for a long time without

adequate cleaning, long- term administration of antibiotics are the common causes of oral

thrush. Candidiasis is characterised by white patches that cannot be wiped away, small red

inflamed dots on the tongue and inflammation or redness of palate (in front of the mouth).

Eating a well balanced diet, allowing the gum tissues to rest from wearing dentures and use

of anti- fungal medications are some preventive measures.

12. ANGULAR CHEILITIS:

CANDIDIASIS

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Angular cheilitis is a

bacterial or fungal infection

that usually appears as red

inflamed sores and cracks at

the corners of the mouth, is

associated with 0.7- 3.8% in

elderly people. Poorly

fitting dentures, dentures

not cleaned properly or

sometimes underline

immune or nutritional

deficiency are the common

causes. It can begin as a small fissure without much inflammation and may eventuate into

deep inflamed fistures. The problem may be a symptom of Riboflavin deficiency or may be

resultant of other chronic diseases. Angular cheilitis often represents an opportunistic

infection of fungi and/or bacteria, with multiple local and systemic predisposing factors

involved in the initiation and persistence of the lesion. It is important to appreciate that most

of the cases of this problem are infectious and should be treated

The treatment is highly dependent on the cause. For idiopathic causes, the treatment could be

as simple as applying petroleum jelly to the affected areas. Denture replacement for those

without teeth has been found to treat angular cheilitis effectively and for people with

dentures, it is important that oral prostheses be of appropriate size and shape.

It can be also important to consider other factors such as avoiding contact irritants, ensuring

proper salivation and treating structural abnormalities, if present

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If people start following these steps themselves or with assistant help, they will be able to

fight against the various problems discussed above.

BASIC ORAL HYGIENE

RULES TO BE FOLLOWED

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An unhealthy diet has been implicated as risk factors for several chronic diseases that are

known to be associated with oral diseases. Studies investigating the relationship between oral

diseases and diet are limited. Therefore, this study was conducted to describe the relationship

between healthy eating habits and oral health status. The dentistry has an important role in the

diagnosis of oral diseases correlated with diet. Consistent nutrition guidelines are essential to

improve health. A poor diet was significantly associated with increased odds of oral disease.

Dietary advice for the prevention of oral diseases has to be a part of routine patient education

practices. Inconsistencies in dietary advice may be linked to inadequate training of

professionals. Literature suggests that the nutrition training of dentists and oral health training

of dietitians and nutritionists is limited.

The concept of oral health correlated to quality of life stems from the definition of health that

the WHO gave in 1946. Health is understood to be “a state of complete physical, mental, and

social well-being and not merely the absence of disease or infirmity”. The programs for the

prevention of oral diseases concern teaching about oral hygiene and healthy eating, fluoride

prophylaxis, periodic check-ups, sessions of professional oral hygiene, and secondary

prevention programs. The term “bionutrition” refers to the important interactions which exist

between diet, use of nutrients, genetics, and development. This term emphasizes the role of

nutrients in maintaining health and preventing pathologies at an organic, cellular, and

subcellular level.

There exists a biunique relationship between diet and oral health: a balanced diet is correlated

to a state of oral health (periodontal tissue, dental elements, quality, and quantity of saliva).

Vice versa an incorrect nutritional intake correlates to a state of oral disease. Diet influences

the development of the oral cavity: depending on whether there is an early or late nutritional

imbalance, the consequences are certainly different. In fact, an early nutritional imbalance

influences malformations most. Moreover, the different components of the stomatognathic

NUTRITION AND

ORAL HEALTH

25

apparatus undergo periods of intense growth alternated with periods of relative quiescence: it

is clear that a nutritional imbalance in a very active period of growth will produce greater

damage.

A shortage of vitamins and minerals in the phase before conception influences the

development of the future embryo, influencing dental organogenesis, the growth of the

maxilla, and skull/facial development

An insufficient supply of proteins can lead to the following:

(i)atrophy of the lingual papillae,

(ii)connective degeneration,

(iii)alteration in dentinogenesis,

(iv)alteration in cementogenesis,

(v)altered development of the maxilla,

(vi)malocclusion,

(vii)linear hypoplasia of the enamel.

An insufficient supply of lipids can lead to the following:

(i)inflammatory and degenerative pathologies,

(ii)parotid swelling—hyposalivation,

(iii)degeneration of glandular parenchyma,

(iv)altered mucosal trophism.

An insufficient supply of carbohydrates can lead to the following:

(i)altered organogenesis,

(ii)influence of the metabolism on the dental plaque,

(iii)caries,

(iv)periodontal disease.

Diet influences the health of the oral cavity, conditioning the onset of caries, the development

of the enamel, the onset of dental erosion, the state of periodontal health, and of the oral

mucous in general.

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The proportion of older people continues to grow worldwide, especially in developing

countries. Non-communicable diseases are fast becoming the leading causes of disability and

mortality, and in coming decades health and social policy-makers will face tremendous

challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic

disease and most oral diseases share common risk factors. Globally, poor oral health amongst

older people has been particularly evident in high levels of tooth loss, dental caries

experience, and the prevalence rates of periodontal disease, xerostomia and oral

precancer/cancer. The negative impact of poor oral conditions on the quality of life of older

adults is an important public health issue, which must be addressed by policy-makers. The

means for strengthening oral health programme implementation are available; the major

challenge is therefore to translate knowledge into action programmes for the oral health of

older people.

The World Health Organization recommends that countries adopt certain strategies for

improving the oral health of the elderly. National health authorities should develop policies

and measurable goals and targets for oral health. National public health programmes should

incorporate oral health promotion and disease prevention based on the common risk factors

approach. Control of oral disease and illness in older adults should be strengthened through

organization of affordable oral health services, which meet their needs. The needs for care are

highest among disadvantaged, vulnerable groups in both developed and developing countries.

In developing countries the challenges to provision of primary oral health care are

particularly high because of a shortage of dental manpower. In developed countries

reorientation of oral health services towards prevention should consider oral care needs of

older people.

Education and continuous training must ensure that oral health care providers have skills in

and a profound understanding of the biomedical and psychosocial aspects of care for older

people. Research for better oral health should not just focus on the biomedical and clinical

ORAL HEALTHCARE

SERVICES

27

aspects of oral health care; public health research needs to be strengthened particularly in

developing countries. Operational research and efforts to translate science into practice are to

be encouraged. WHO supports national capacity building in the oral health of older people

through intercountry and interregional exchange of experiences.

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• The proportion of older people continues to grow worldwide.

• Non-communicable diseases are fast becoming the leading causes of disability

and mortality, and in coming decades health and social policy-markers will face

tremendous challenges posed by the rapidly changing burden of chronic diseases

in old age.

• Globally, poor oral health amongst older people has been particularly evident in

high levels of tooth loss, dental caries experience, and the prevalence rates of

periodontal disease, xerostomia and oral pre-cancer/cancer.

• Education and continuous training must ensure that oral health care providers

have skills in and a profound understanding of the biochemical and psychosocial

aspects of care for older people.

• National public health programmes should incorporate oral health promotion

and disease prevention based on the common risk factors approach.

• Also, control of oral disease and illness in older adults should be strengthened

through organization of affordable oral health services, which meet their needs.

CONCLUSION

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