Special Needs: The Older

Adult
Course Offered: Second Year, Spring
Semester
Janelle Urata BA, RDH,
Graduate Learner MS in Dental Hygiene
August 26, 2014
Janelle.Urata@ucsf.edu

Grandma & Grandpa

Learning Objectives
By the end of lecture Dental Hygiene Learners will
be able to:
Recognize 3 important factors of oral-systemic
relationships that are unique to older adults.
Describe 3 myths associated with aging and the
mouth.
Identify 3 common oral conditions found in an older
client.
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The Aging Client: A Growing

Population
People aged 65 and older is the fastest
growing population.1
Currently 43 million older adults live in
the US.1-3
By 2050, older adults will comprise
over 19% of the total population.2,3
4

Why Oral Health Matters

Older Adults oral and systemic health
are tightly interwoven:6
Poor OH associated with increased chance
of pneumonia.
Medications cause dry mouth, increased
risk of dental caries.
Poor oral health is a common cause of
weight loss, malnutrition and influences
quality of life.
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Risk of Inadequate Oral Care

Chronic Conditions5
80% have at least 1 chronic health
condition

Low income2
14% live in poverty
Most lack dental insurance

Homebound or Institutionalized4
1 mil receive homecare, 1.25 mil living in
facilities
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Definitions

Chronological age: Age as measured by

calendar time.

Functional age: Based on performance

capabilities.

The Answer:
Functional ability should be the
standard that we use to measure
capability, not chronological age.5

Oral Conditions in the Older

Adult
Hard to differentiate between disease
and consequences of taking of
medications.5
We will address each topic by:
Age-related changes
Pathology-induced changes

Oral Changes: Age-Related

Changes in chemical composition occur
in:5
Enamel
Pulp

Dentin

Cementum

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Oral Changes: PathologyInduced

Research suggests older adults more
likely to develop new coronal & root
caries.5
Local Factors:5
Exposed root surfaces and tooth
longevity factors
Changes in amount of saliva from meds

11

Periodontal Changes: Agerelated5

in metabolism and healing
capabilities
Alveolar bone quality affects ability
to wear oral prosthetics and
mastication.

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Periodontal Changes
Age-Related MYTH #1
Risk of periodontitis DOES NOT increase
with age

Studies show an association between

age with:
Increase in recession
Increase in loss of attachment
Higher prevalence of gingival
inflammation
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Application to the RDH

Things to Consider for Older Clients:
1. At the dental appointment
2. Use of fluoride both in office and
at home
3. Nutritional counseling

14

Oral Mucosal Changes:

MYTH #2
Age-related:
Aging DOES NOT lead to changes5

Pathology-Induced:
Fungal infections (candidiasis)
Gingival Enlargement

15

Oral Mucosal Changes cont.

Changes to the lips
Angular Cheilitis

16

Oral Mucosal Changes cont.

Ill-fitting dentures or poor OH
Chronic atrophic candidiasis = denture
sore mouth
Up to 65% of older adults wearing dentures
suffer 6

17

Oral Changes: Tongue

Age-related:
decrease papillae
decrease in sense of smellnutrition may
not be met.

Pathology-Induced:
Due to nutritional factorsanemia
Atrophic glossitis

18

Drug-Induced Oral Changes

On average, older adults take 3+

therapeutic agents.
Institutionalized individuals use 5-7
at the same time.

19

Salivary Gland Changes

Age-related:
MYTH #3
Decrease in salivary flow result of
normal aging

Pathology-Related:
Xerostomia: Saliva is vital in proper oral
function
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Application to RDH
Older clients are more susceptible to
experience adverse reactions with
meds.
Recommendations to xerostomia
sufferers:5
Salivary substitutes
increase water intake
Consultation with MD
increase recall frequency to assess

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To Review:
How is the older populations oral and
systemic health are tightly interwoven?
What are 3 myths associated with age
and changes in the mouth?
What are some common conditions in
an older client we must consider?
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References
1. Oral Health in America: A Report of the Surgeon General (Executive
Summary) Retrieved, 8/16/2014, 2014, Retrieved from
http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/
executivesummary.htm
2. Profile of Older Americans Retrieved, 8/16/2014, 2014, Retrieved from
http://www.aoa.gov/aoaroot/aging_statistics/Profile/2010/16. aspx
3. Minority Aging Retrieved, 8/16/2014, 2014, Retrieved from
http://www.aoa.gov/aoaroot/aging_statistics/minority_aging /
4. Educational Objectives Retrieved, 8/16/2014, 2014, Retrieved from
http://www.smilesforlifeoralhealth.org/buildcontent.aspx?pagekey=8
0326&lastpagekey=80461&userkey=11603539&sessionkey=2318711&tut=667
&customerkey=84&custsitegroupkey=
0
5. Darby, Michele Leonardi, and Margaret M. Walsh. "Chapter 55: The Older
Adult." Dental Hygiene: Theory and Practice. 4th ed. St. Louis, MO:
Saunders/Elsevier, 2015. 986-1005. Print.
6. Dharamsi, S., Jivani, K., Dean, C., & Wyatt, C. (2009). Oral care for frail
elders: knowledge, attitudes, and practices of long-term care staff. Journal
of Dental Education, 73(5), 581-588. doi:73/5/581 [pii]
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Image References
1. Common Oral Conditions in Older Persons - American
Family Physician Retrieved, 8/17/2014, 2014, Retrieved
from http://www.aafp.org/afp/2008/1001/p845.html
2. Flashcards - Red, Ulcerative, etc - Red lesions Atrophic
[erythemytous] Candidiasis | StudyBlue Retrieved,
8/17/2014, 2014, Retrieved from
http://www.studyblue.com/notes/note/n/red-ulcerative
-etc/deck/1928705
3. Product Price Markups : Top 10 Biggest Price Markups
Retrieved, 8/17/2014, 2014, Retrieved from
http://www.toptenz.net/top-10-biggest-price-markups.p
hp
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