Most common condition seen at old age.

1. 1
DENTAL PROBLEMS IN
OLD AGE
JYOTI PACHISIA
M.SC 1ST YEAR FOOD AND
NUTRITION
ROLL NO. 07
J D BIRLA INSTITUTE

2. 2
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

4. 4
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. 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
PERIODONTA
L DISEASE
XEROSTOMI
A/ 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

17. 17
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

19. 19
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

21. 21
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

22. 22
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

23. 23
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

24. 24
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. 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.

26. 26
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. 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.

28. 28
• 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

29. 29
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