Running head: ORAL HEALTH CARE IN THE GERIATRIC POPULATION 1

Oral Health Care in the Geriatric Population

Laura Armistead

James Madison University

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Abstract

The importance of dental health in the geriatric population is often overlooked. There is an
elevated prevalence of caries and periodontal disease, including dry mouth, oral cancer, and
edentulism among the elderly (Gil-Montoya, Ferreira de Mello, Barrios, Gonzalez-Moles, &
Bravo, 2015). Good oral health has been shown to have positive effects on general health, quality
of life and nutritional status. This paper will look at oral health in the elderly and how it affects
health and nutrition. It will also look at the studies that have been done to show ways to improve
oral health for the geriatric population.
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Oral health for the geriatric population is often overlooked, but it is very important in

overall health and well-being. Over half of the senior population has been shown to have

moderate to severe periodontal disease (Raphael, 2017). Periodontal disease has been shown to

be linked with many chronic conditions such as stroke, diabetes, and heart disease (Raphael,

2017). Other issues related to poor oral hygiene include rheumatoid arthritis, kidney function,

pneumonia, and multiple sclerosis, and other systemic immune problems (Hoeksema et al.,

2016). Poor oral health is also associated with poor nutrition, embarrassment, and social isolation

(Raphael, 2017).

Nutritional intake is an important part in overall health for everyone, especially seniors.

Adequate nutrition is associated with a reduction in adverse events related to immobilization,

which often happens while hospitalized. Decreases in the number of pressure ulcers, venous

thrombosis, functional decline, and incontinence are found with better nutrition (Gil-Montoya,

Ferreira de Mello, Barrios, Gonzalez-Moles, & Bravo, 2015). Approximately 20% of seniors are

living without any teeth and this number increases with age (Raphael, 2017). Loss of teeth may

force people to make inadequate food choices, often eliminating fresh fruits, vegetables, bread,

and meats from their diets. Poor oral health status is one of the most common causes of

malnutrition because it affects chewing and swallowing that can lead to severe deficiencies in

energy and nutrient intake. It is thought that it can also indirectly affect both acute and chronic

conditions. For example, a person unable to chew due to lack of teeth may eat more sugar and

carbohydrate foods that are soft which can affect their diabetes and heart disease.
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Decreased in salivary flow can be caused by many different conditions and also by over

400 different medications. Dysphagia is often found with patients with decreased salivary flow,

candidiasis, and the presence of seven or less posterior occluding pairs of teeth. The loss of teeth

decreased the efficacy of chewing which atrophies the salivary glad and decreased flow. All of

this combines for poor nutritional intake.

Poor salivary flow and poor oral care have been found to play a part in the development

of aspirational pneumonia in the elderly population. This pneumonia has been linked to an

increase in respiratory pathogens in the oral cavity (Sharif-Abdullah, Chong, Surindar-Kaur,

Kamaruzzaman, & Ng, 2016). Good oral hygiene has been found to reduce the occurrences of

pneumonia and related deaths. The theories behind this include oral hygiene may improve cough

reflex sensitivity and that good oral hygiene leaves a patient without excess plaque with can be a

location of growth for respiratory pathogens (Poisson, Laffond, Campos, Dupuis, & Bourdel-

Marchasson, 2014).

Recently, oral care with chlorhexidine has been found to be an effective treatment in

reducing colonization and the incidence of pneumonia ((Sharif-Abdullah, Chong, Surindar-

Kaur, Kamaruzzaman, & Ng, 2016). Twice daily chlorhexidine mouthwashes were found to

reduce the microbes found in the oral cavity and were recommended to be implemented in

oral care routines of geriatric patients. Denture cares in the same solutions are being

recommended as well. These studies are still being performed, but there is strong push to

increase usage of chlorhexidine as its being found to improve quality of life for patients,

decrease length of hospitalization costs and be an effective and much less costly treatment
ORAL HEALTH CARE IN THE GERIATRIC POPULATION 5

compared to the cost of antibiotics needed to treat patients once they had pneumonia

(Sharif-Abdullah, Chong, Surindar-Kaur, Kamaruzzaman, & Ng, 2016).

Two barriers to care for the geriatric population are financial, including lack on

insurance coverage, and the decline of ability to care for ones self. Over 70% of the senior

population lack dental insurance (Raphael, 2017). Medicare and Medicaid offer little to no

help with dental needs to the geriatric population. Many seniors are on limited budgets and

without any insurance coverage and do not seek dental care for preventative or restorative

services.

When patients become unable to care for themselves, they typically have many

needs for caretakers to attend to. Oral care in the elderly is often considered low on the list

of priorities and poor oral health is considered normal for this population. Providing

education for care providers on the importance of good oral health is necessary to help this

become more of a priority during patient care.

With people living longer and the senior population increasing, further studies need

to be done to provide solid evidence that oral care programs should be implemented in

hospitals and medical facilities and be considered basic standard of care. Evidence based

studies showing how important good oral health care is to quality of life, mental health,

physical health, and how it affects nutrition are needed. Understanding of how good

nutrition affects acute and chronic conditions is also needed. Treating the whole person and

understanding how things affect so many levels of health and patient care is necessary.

These studies would be useful in lobbying for dental coverage for our seniors in the

Medicare and Medicaid programs. Providing these benefits to seniors may cost money, but
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the potential savings from lower hospitalization rates and decreased problems with co-

morbidities would be great.

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References

Gil-Montoya, J., Ferreira de Mello, A. L., Barrios, R., Gonzalez-Moles, M. A., &
Bravo, M. (2015). Oral health in the elderly patient and its impact on general well-being: a
nonsystematic review. Clinical Interventions in Aging, 461. doi:10.2147/cia.s54630

Hoeksema, A. R., Peters, L. L., Raghoebar, G. M., Meijer, H. J., Vissink, A., &
Visser, A. (2016). Oral health status and need for oral care of care-dependent indwelling elderly:
from admission to death. Clinical Oral Investigations, 21(7), 2189-2196. doi:10.1007/s00784-
016-2011-0

Nihtil, A., Tuuliainen, E., Komulainen, K., Autonen-Honkonen, K., Nyknen, I.,
Hartikainen, S., Suominen, A. L. (2017). Preventive oral health intervention among old home
care clients. Age and Ageing, 46(5), 846-851. doi:10.1093/ageing/afx020

Poisson, P., Laffond, T., Campos, S., Dupuis, V., & Bourdel-Marchasson, I. (2014).
dRelationships between oral health, dysphagia and undernutrition in hospitalised elderly patients.
Gerodontology, 33(2), 161-168. doi:10.1111/ger.12123

Raphael, C. (2017). Oral Health and Aging. American Journal of Public Health, 107(S1),
S44-S45. doi:10.2105/ajph.2017.303835

Sharif-Abdullah, S., Chong, M., Surindar-Kaur, S., Kamaruzzaman, S., & Ng, K. (2016).
The effect of chlorhexidine in reducing oral colonisation in geriatric patients: a randomised
controlled trial. Singapore Medical Journal, 57(05), 262-266. doi:10.11622/smedj.2016091