The Epidemiology, Consequences and Management of Periodontal Disease in Older Adults

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ABSTRACT

Background

This review summarizes the literature on periodontal disease (PD) in older adults. The authors focused on significant sequelae of PD and therapy in this population.

Types of Studies Reviewed

The authors conducted a search on PubMed for human studies using the terms “periodontal disease OR periodontitis” and “older adults.” They retrieved 649 articles and excluded studies that had poor experimental design. For each topic of the review, they selected one to three of the most recent studies or reviews for inclusion and cited classic articles where appropriate.

Results

PD is a common oral chronic inflammatory disease often found in older adults. In older patients, PD may lead to root caries, impaired eating and socialization. It also may increase patients' risk of developing systemic diseases such as diabetes mellitus, lung disease, heart disease and stroke. Treatment is not limited by chronological age but depends on the patient's medical and emotional status and the availability of financial resources.

Clinical Implications

General dentists usually can treat the majority of older people with mild or moderate PD. For older adults who are medically compromised and dependent, the literature supports treatment that prevents PD progression.

Section snippets

Case report

A 69-year-old woman who had moderate generalized chronic periodontitis came to the postgraduate periodontics clinic at the School of Dental Medicine, University at Buffalo, The State University of New York in May 2007 (Figure 1). She denied having any current symptoms of oral disease; however, she reported that over the last 20 years, her anterior teeth “have moved slightly out of place.” She was taking metoprolol, hydrochlorothiazide and atorvastatin for treatment of hypertension and

EPIDEMIOLOGY OF PERIODONTAL DISEASE IN OLDER ADULTS

This case report is typical of mild PD seen in older adults, and PD is common in older adults throughout the world (Table).1, 2, 3, 4, 5, 6 Net tissue destruction (for example, bone loss) due to PD is cumulative with age. Since 52 percent of adults in the United States have lost fewer than five teeth, most older adults are at risk of developing PD. Conversely, only 26 percent of Americans are edentulous and, therefore, not at risk of developing PD; in some states such as Hawaii and California,

ORAL SEQUELAE OF PERIODONTAL DISEASE IN OLDER ADULTS

The high prevalence of PD in older adults should be of concern because PD directly increases the patient's risk of developing root caries, as well as tooth loss with resulting deficient masticatory ability, nutrition and speech, which can worsen the patient's quality of life.

When combined with xerostomia, poor oral hygiene due to arthritis and deficient oral care, as well as uncontrolled dietary sugar consumption, gingival recession and the resulting exposed root surfaces, can lead to the

SYSTEMIC SEQUELAE OF PERIODONTAL DISEASE IN OLDER ADULTS

More subtle and sinister are the medical consequences of PD, in which PD might set the stage for the patient's experiencing diabetes mellitus, respiratory disease, stroke and myocardial infarcts. It also appears to be connected to other chronic diseases such as osteoporosis, arthritis and Alzheimer's disease.

GUIDELINES FOR THE TREATMENT OF PERIODONTAL DISEASE IN OLDER ADULTS

Periodontal infection and inflammation interact with many other ailments experienced by older adults, and they likely diminish oral function, reduce quality of life, imperil nutrition and increase the patient's risk of developing several chronic systemic diseases. Since the consequences of PD are severe, general dentists need to help older adults preserve their periodontal health.

Most evidence indicates that older adults generally respond to periodontal therapy similar to they way younger

CONCLUSIONS

Older adults often have a variety of chronic medical conditions and take many medications. At the same time, they often have poor oral hygiene and PD, which may promote additional oral health problems such as root caries and exacerbate systemic complications related to poor nutrition and progressive chronic systemic diseases. Therefore, dentists should make every reasonable effort to prevent PD progression as the case report demonstrates. Good communication between patients' general dentists,

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    Dr. Boehm is a research assistant, Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, and a resident, Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, The State University of New York.

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