What is the epidemiology of oral health conditions in older people?
William Murray Thomson
The main conditions of interest when considering the epidemiology of oral diseases among older people are tooth loss, dental caries, periodontitis, dry mouth and oral pre-cancer/cancer, along with oralhealth-related quality of life (OHRQoL).
Purpose of the Article
This article presents an overview of what is known about the epidemiology of each of the main conditions of interest among older populations.
- Although complete tooth loss is declining, incremental tooth loss continues and is an important determinant of poor OHRQoL.
- Dental caries continues to be the most prevalent condition and is known to be active in the older age groups.
- Periodontitis is apparent to some degree in most older people, with a substantial minority having more advanced disease.
- Oral cancer is not common, but it can be catastrophic for sufferers. It occurs more frequently in less developed countries.
- Dry mouth is reasonably common. OHRQoL tends to be poorer among those who wear dentures, have higher numbers of missing teeth or decayed teeth, or have dry mouth. Most older people cope through adaptation and stoicism, despite difficulties in chewing.
When considering tooth loss, a distinction needs to be made between edentulism (the state of having lost all of the natural teeth) and the more common incremental loss of teeth which tends to occur throughout adult life.
The reasons for edentulism are both disease-related and societal. (1) Edentulous people have been shown to have poorer diets and associated nutrition than those with natural teeth. (2, 3) Not only are there nutritional disadvantages to being edentulous, the day-to-day lives of edentulous people may be affected – especially in relation to the domains of chewing and eating – by having no teeth or wearing poor dentures. (4, 5)
Incremental tooth loss is altogether more common than edentulism, among adults of all ages. It is less predictable and therefore more of a prosthodontic challenge, given that its sequelae can include the drifting or over-eruption of the teeth which remain.
A number of reports have appeared in the last decade or two from prospective cohort studies of population-based samples of community-dwelling older people. (6 – 9)
Their findings showed that dental caries is active among older people, with a mean increment of about 1 surface per year (10, 11) which is similar to that observed through life until the early thirties. (12)
There are challenges in describing the occurrence of periodontitis in older people and in determining whether there have been changes over time as the indices and methods which are used have changed in recent decades. (13)
A review by Locker et al. (14) found that most older people have some experience of the disease, with moderate levels of attachment loss. A substantial minority have advanced attachment loss, but that affects relatively few sites. The study considered the issue of whether ageing per se is a risk factor for attachment loss and concluded that the available evidence supported that notion.
Recent prevalence estimates from representative samples are scarce, but it has been observed that most cases of oral cancer occur
among older people and that they are more frequent in less developed countries than developed ones. (15)
Tobacco is the most well-known risk factor and is known to exert a synergistic effect with heavy alcohol use5. Recent work has also implicated human papillomavirus (HPV) in the occurrence of oropharyngeal cancer, particularly among younger adults. (16, 17)
Risk factors for dry mouth include medication use as the most important one at the epidemiological level, with higher prevalence rates observed in those taking particular classes of medication. Prominent among those are antidepressants, respiratory agents, opiate-containing analgesics, or some cardiac or antihypertensive drugs. (18, 19)
- Thomson WM. Monitoring edentulism in older New Zealand adults over two decades: a review and commentary. Int J Dent 2012; 2012.
- Moynihan P, Snow S, Jepson N, Butler TJ. Intake of non-starch polysaccharide (dietary fibre) in edentulous and dentate persons: an observational study. Brit Dent J 1994; 177: 243–7.
- Nowjack-Raymer RE, Sheiham A. Association of edentulism and diet and nutrition in US adults. J Dent Res 2003; 82: 123–6.
- Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994; 11: 3–11.
- Slade GD, Spencer AJ. Social impact of oral conditions among older adults. Aust Dent J 1994; 39: 358–64.
- Gilbert GH, Miller MK, Duncan RP, Ringelberg ML, Dolan TA, Foerster U. Tooth-specific and person-level predictors of 24-month tooth loss among older adults. Community Dent Oral Epidemiol 1999; 27: 372–85.
- Hand JS, Hunt RJ, Beck JD. Coronal and root caries in older Iowans: 36-month incidence. Gerodontics 1988; 4: 136–9.
- Hawkins RJ, Jutai DK, Brothwell DJ, Locker D. Three-year coronal caries incidence in older Canadian adults. Caries Res 1997; 31: 405–10.
- Thomson WM, Spencer AJ, Slade GD, Chalmers JM. Is medication a risk factor for dental caries among older people? Evidence from a longitudinal study in South Australia. Community Dent Oral Epidemiol 2002; 30: 224–32.
- Griffin SO, Griffin PM, Swann JL, Zlobin N. Estimating rates of new root caries in older adults. J Dent Res 2004; 83: 634–8.
- Thomson WM. Dental caries experience in older people over time: what can the large cohort studies tell us? Brit Dent J 2004; 196: 89–92.
- Broadbent JM, Thomson WM, Poulton R. Trajectory patterns of dental caries experience in the permanent dentition to the fourth decade of life. J Dent Res 2008; 87: 69–72.
- Haisman-Welsh RJ, Thomson WM. Changes in periodontitis prevalence over two decades in New Zealand: evidence from the 1988 and 2009 national surveys. N Z Dent J 2012; 108: 95–100.
- Locker D, Slade GD, Murray H. Epidemiology of periodontal disease among older adults: a review. Periodontol 2000 1998; 16: 16–33.
- Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005; 33: 81–92.
- Chaturvedi AK. Epidemiology and clinical aspects of HPV in head and neck cancers. Head Neck Patho 2012; 6: S16–24.
- Cleveland JL, Junger ML, Saraiya M, Markowitz LE, Dunne EF, Epstein JB. The connection between human papillomavirus and oropharyngeal squamous cell carcinomas in the United States: implications for dentistry. J Amer Dent Assoc 2011; 142: 915–24.
- Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AM. Associations between labial and whole salivary rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2010; 38: 422–35.
- Thomson WM, Chalmers JM, Spencer AJ, Slade GD. Medication and dry mouth: findings from a cohort study of older people. J Public Health Dent 2000; 60: 12–20.
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