Age-related Oral Changes and Their Impact on Oral Health-related Quality of Life among Frail Elderly Population: A Review
Sanjeev B Khanagar, Ali Al-Ehaideb, Madhuniranjanswamy Mahalakshmamma Shivanna, Ikram Ul Haq, Abdulaziz Abdullah Al Kheraif, Sachin Naik, Prabhadevi Maganur, Satish Vishwanathaiah
Age-related oral changes, Geriatric oral health, Oral health, Quality of life
Citation Information :
Khanagar SB, Al-Ehaideb A, Shivanna MM, Ul Haq I, Al Kheraif AA, Naik S, Maganur P, Vishwanathaiah S. Age-related Oral Changes and Their Impact on Oral Health-related Quality of Life among Frail Elderly Population: A Review. J Contemp Dent Pract 2020; 21 (11):1298-1303.
Background: In the present-day world, the aging elderly across the world are living longer. Most people are expected to live well into their sixties and even beyond. The increasing life expectancy of the aging population could be due to increased availability of healthcare facilities and improved quality care provided by them. Alongside increasing life expectancy, the individual\'s quality of life and also his/her oral health-related quality of life (OHR-QoL) are expected to improve so that they can enjoy their aging life. Aim and objective: The aim of this review article is to highlight aging-related oral health changes and their impact on the individual\'s quality of life. Review results: Age-related oral changes are seen in the tooth structure making the enamel more brittle resulting in severe attrition. Autoimmune diseases like Sjogren\'s syndrome are followed by decrease in the salivary gland function and the reason is unknown, and medications like antihypertensive and analgesics are associated with the decrease in salivary flow, which increases the patient\'s risk of developing dental caries, and also make the oral tissues more prone to mucosal infections. Edentulism has also been directly related to masticatory problems and nutritional problems. The studies reported on OHR-QoL of these frail elderly populations have shown lower scores. Conclusion: It is important for health professionals, especially those dealing with these frail elderly populations, to have a better understanding of their dental needs and also understand the physiologic changes undergone by them. The health professionals should understand and comprehend the oral health challenges these vulnerable people face. Clinical significance: Healthcare providers should conduct periodic oral examinations along with general examination and should avoid prescribing medications that have xerostomia as a side effect. The elderly individuals should be encouraged to keep their mouth moist using water or artificial saliva and maintain good oral and denture hygiene.
https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed on 20-02-2020.
Kiyak HA. Achieving successful aging: the impact of oral health. Geriatr Gerontol Int 2004;4(s1):S32–S33. DOI: 10.1111/j.1447-0594.2004.00142.x.
Khan ZA, Singh C, Khan T. Correlates of physical disability in the elderly population of rural North India (Haryana). J Fam Community Med 2018;25(3):199–204.
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(2):81–92. DOI: 10.1111/j.1600-0528.2004.00219.x.
Stewart Williams J, Norstrom F, Ng N. Disability and ageing in China and India - decomposing the effects of gender and residence. Results from the WHO study on global aging and adult health (SAGE). BMC Geriatr 2017;17(1):197.
Yen YY, Lee HE, Wu YM, et al. Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan. BMC Oral Health 2015;15(1):1. DOI: 10.1186/1472-6831-15-1.
Aghamohamadi S, Hajinabi K, Jahangiri K, et al. Population and mortality profile in the Islamic Republic of Iran, 2006–2035. Eastern Mediterranean Health J 2018;24(5):469–476. DOI: 10.26719/2018.24.5.469.
Talarska D, Tobis S, Kotkowiak M, et al. Determinants of quality of life and the need for support for the elderly with good physical and mental functioning. Med Sci Monit 2018;24:1604–1613. DOI: 10.12659/MSM.907032.
Kim EJ, Jung SW, Kim YE, et al. Assessing the impact of aging on burden of disease. Iran J Public Health 2018;47(Suppl 1):33–38.
Mohamed N, Saddki N, Yusoff A, et al. Association among oral symptoms, oral health-related quality of life, and health-related quality of life in a sample of adults living with HIV/AIDS in Malaysia. BMC Oral Health 2017;17(1):119. DOI: 10.1186/s12903-017-0409-y.
Soares GB, Garbin CAS, Rovida TAS, et al. Oral health associated with quality of life of people living with HIV/AIDS in Brazil. Health Qual Life Outcomes 2014;12(1):28. DOI: 10.1186/1477-7525-12-28.
Handelman SL, Baric JM, Espeland MA, et al. Prevalence of drugs causing hyposalivation in an institutionalized geriatric population. Oral Surg Oral Med Oral Pathol 1986;62(1):26–31. DOI: 10.1016/0030-4220(86)90066-6.
Jokanovic N, Tan ECK, Dooley MJ, et al. Prevalence and factors associated with polypharmacy in long-term care facilities: a systematic review. J Am Med Dir Assoc 2015(6):16. DOI: 10.1016/j.jamda.2015.03.003.
Bekiroglu N, Ciftci A, Bayraktar K, et al. Oral complaints of denture-wearing elderly people living in two nursing homes in Istanbul. Turkey Oral Health Dent Manag 2012;11:107–115.
Razak PA, Richard KM, Thankachan RP, et al. Geriatric oral health: a review article. J Int Oral Health 2014;6:110–116.
Dorri M, Sheiham A, Tsakos G. Validation of a persian version of the OIDP index. BMC Oral Health 2007;7(1):2. DOI: 10.1186/1472- 6831-7-2.
Carr AJ, John Gibson B, Robinson PG. Measuring quality of life: Is quality of life determined by expectations or experience?. BMJ Clinical Research 322(7296):1240–1243. DOI: 10.1136/bmj.322.7296.1240.
Astrom AN, Okullo I. Validity and reliability of the oral impacts on daily performance (OIDP) frequency scale: a cross-sectional study of adolescents in Uganda. BMC Oral Health 2003;3(1):5. DOI: 10.1186/1472-6831-3-5.
Dos Santos CM, Martins AB, de Marchi RJ, et al. Assessing changes in oral health-related quality of life and its factors in community-dwelling older Brazilians. Gerodontology 2013;30(3):176–186. DOI: 10.1111/j.1741-2358.2012.00656.x.
Hebling E, Pereira AC. Oral health-related quality of life: a critical appraisal of assessment tools used in elderly people. Gerodontology 2007;24(3):151–161. DOI: 10.1111/j.1741-2358.2007.00178.x.
Usha G, Thippeswamy H, Nagesh L. Comparative assessment of validity and reliability of the oral impacts on daily performance (OIDP) frequency scale: a cross-sectional survey among adolescents in Davanagere city, Karnataka, India. Int J Dent Hygiene 2013;11(1):28–34. DOI: 10.1111/j.1601-5037.2011.00540.x.
Emami E, de Souza RF, Kabawat M, et al. The impact of edentulism on oral and general health. Int J Dent 2013;7:1–7. DOI: 10.1155/2013/498305.
Kossioni AE, Hajto-Bryk J, Maggi S, et al. An expert opinion from the european college of gerodontology and the European Geriatric Medicine Society: European policy recommendations on oral health in older adults. J Am Geriatr Soc 2018;66(3):609–613. DOI: 10.1111/jgs.15191.
Vissink A, Spijkervet FK, Amerongen VA. Aging and saliva: a review of the literature. Spec Care Dent 1996;16(3):95–103.
Meurman JH, Frank RM. Progression and surface ultrastructure of in vitro caused erosive lesions in human and bovine enamel. Caries Res 1991;25(2):81–87. DOI: 10.1159/000261348.
Jaeggi T, Lussi A. Prevalence, incidence and distribution of erosion. Monogr Oral Sci 2014;25:55–73.
Carvalho TS, Luss A. Age-related morphological, histological and functional changes in teeth. J Oral Rehabilitat 2017;44(4):291–298. DOI: 10.1111/joor.12474.
Sener S, Cobankara FK, Akgunlu F. Calcifications of the pulp chamber: prevalence and implicated factors. Clin Oral Investig 2009;13:209–215.
Gulsahi A, Cebeci AI, Ozden S. A radiographic assessmentof the prevalence of pulp stones in a group of Turkish dental patients. Int Endod J 2009;42(8):735–739. DOI: 10.1111/j.1365-2591.2009.01580.x.
Schaffner M, Stich H, Lussi A. Denticles: dental pulp calculi. Swiss Dent J 2014;124:416–417.
Jespersen JJ, Hellstein J, Williamson A, et al. Evaluation of dental pulp sensibility tests in a clinical setting. J Endod 2014;40(3):351–354. DOI: 10.1016/j.joen.2013.11.009.
Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. part I: general information and thermal tests. Int Endod J 2010;43(9):738–762. DOI: 10.1111/j.1365-2591.2010.01754.x.
Farac RV, Morgental RD, Lima RK, et al. Pulp sensibility test in elderly patients. Gerodontology 2012;29(2):135–139. DOI: 10.1111/j.1741-2358.2012.00623.x.
Wyatt CC, Wang D, Aleksejuniene J. Incidence of dental caries among susceptible community-dwelling older adults using fluoride toothpaste: 2-year follow-up study. J Can Dent Assoc 2014;80:e44.
Thomson WM. Dental caries experience in older people over time: what can the large cohort studies tell us? Br Dent J 2004;196(2):89–92. DOI: 10.1038/sj.bdj.4810900discussion 87.
Närhi TO, Meurman JH, Ainamo A. Xerostomia and hyposalivation: causes, consequences and treatment in the elderly. Drugs Aging 1999;15(2):103–116. DOI: 10.2165/00002512-199915020-00004.
Slavkin HC. Maturity and oral health: live longer and better. J Am Dent Assoc 2000;131(6):805–808. DOI: 10.14219/jada.archive.2000.0281.
Beck JD. The epidemiology of root surface caries: North American studies. Adv Dent Res 1993;7(1):42–51. DOI: 10.1177/08959374930070010601.
Berkley DB. Current state of oral healthcare in institutionalized older adults. Spec Care Dent 1996;16(4):143–146. DOI: 10.1111/j.1754-4505.1996.tb00849.x.
Wyatt CCL, MacEntee MI. Dental caries in chronically disabled elders. Spec Care Dent 1997;17(6):196–202. DOI: 10.1111/j.1754-4505.1997.tb00896.x.
Krasse B. Caries risk: a practical guide for assessment and control. Chicago: Quintessence; 1985. pp. 41–44. 91–94.
Hajishengallis G. Too old to fight? Aging and its toll on innate immunity. Mol Oral Microbiol 2010;25(1):25–37. DOI: 10.1111/j.2041-1014.2009.00562.x.
Bodineau A, Folliguet M, Séguier S. Tissular senescence and modifications of oral ecosystem in the elderly: risk factors for mucosal pathologies. Curr Aging Sci 2009 Jul;2(2):109–120. DOI: 10.2174/1874609810902020109.
Baelum V, Luan WM, Chen X, et al. Predictors of destructive periodontal disease incidence and progression in adult and elderly Chinese. Community Dent Oral Epidemiol 1997;25(4):265–272. DOI: 10.1111/j.1600-0528.1997.tb00938.x.
Beck JD, Sharp T, Koch GG, et al. A 5-year study of attachment loss and tooth loss in community-dwelling older adults. J Periodontal Res 1997;32(6):516–523. DOI: 10.1111/j.1600-0765.1997.tb00567.x.
Kassebaum NJ, Bernabe E, Dahiya M, et al. Global burden of severe periodontitis in 1990– 2010: A systematic review and meta-regression. J Dent Res 2014;93(11):1045–1053. DOI: 10.1177/0022034514552491.
Polzer I, Schwahn C, Völzke H, et al. The association of tooth loss with all-cause and circulatory mortality. Is there a benefit of replaced teeth? A systematic review and meta-analysis. Clin Oral Investig 2012;16(2):333–351. DOI: 10.1007/s00784-011-0625-9.
Brown DW. Complete edentulism prior to the age of 65 years is associated with all-cause mortality. J Public Health Dent 2009;69(4):260–266. DOI: 10.1111/j.1752-7325.2009.00132.x.
Kassebaum NJ, Bernabé E, Dahiya M, et al. Global burden of severe tooth loss: a systematic review and meta-analysis. J Dent Res 2014;93(7 suppl):20S–28S. DOI: 10.1177/0022034514537828.
Petersen PE, Kandelman D, Arpin S, et al. Global oral health of older people – call for public health action. Community Dent Health 2010;27(4 Suppl 2):257–267.
Rodrigues SM, Oliveira AC, Vargas AM, et al. Implications of edentulism on quality of life among elderly. Int J Environ Res Public Health 2012;9(1):100–109. DOI: 10.3390/ijerph9010100.
Singh ML, Papas A. Oral implications of polypharmacy in the elderly. Dent Clin North Am 2014;58(4):783–796. DOI: 10.1016/j.cden.2014.07.004.
Leslie MD, Glaser MG. Impaired salivary gland function after radiotherapy compounded by commonly prescribed medications. Clin Oncol 1993;5(5):290–292. DOI: 10.1016/S0936-6555(05)80903-3.
Fischer D, Ship JA. Effect of age on variability of parotid salivary gland flow rates over time. Age Ageing 1999;28(6):557–561. DOI: 10.1093/ageing/28.6.557.
Taub DD, Murphy WJ, Longo DL. Rejuvenation of the aging thymus: growth hormone-mediated and ghrelinmediated signaling pathways. Curr Opin Pharmacol 2010;10(4):408–424. DOI: 10.1016/j.coph.2010.04.015.
Gerdin EW, Einarson S, Jonsson M, et al. Impact of dry mouth conditions on oral health-related quality of life in older people. Gerodontology 2005;22(4):219–226. DOI: 10.1111/j.1741-2358.2005.00087.x.
Hahnel S, Schwarz S, Zeman F, et al. Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study. J Dent 2014;42(6):664–670. DOI: 10.1016/j.jdent.2014.03.003.
Jainkittivong A, Aneksuk V, Langlais RP. Oral mucosal conditions in elderly dental patients. Oral Dis 2002;8(4):218–223. DOI: 10.1034/j.1601-0825.2002.01789.x.
Rekhi A, Marya CM, Oberoi SS, et al. Periodontal status and oral health-related quality of life in elderly residents of aged care homes in Delhi. Geriatr Gerontol Int 2016;16(4):474–480. DOI: 10.1111/ggi.12494.
Rabiei M, Kasemnezhad E, Masoudi Rad H, et al. Prevalence of oral and dental disorders in institutionalized elderly people in Rasht, Iran. Gerodontology 2010;27(3):174–177. DOI: 10.1111/j.1741-2358.2009.00313.x.
Mozafari PM, Dalirsani Z, Delavarian Z, et al. Prevalence of oral mucosal lesions in institutionalized elderly people in Mashhad, Northeast Iran. Gerodontology 2012;29(2):e930–e934. DOI: 10.1111/j.1741-2358.2011.00588.x.
Porter J, Ntouva A, Read A, et al. The impact of oral health on the quality of life of nursing home residents. Health Qual Life Outcomes 2015;13(1):102. DOI: 10.1186/s12955-015-0300-y.
Rekhi A, Marya CM, Nagpal R, et al. Assessment of oral health related quality of life among the institutionalized elderly in Delhi, India. Oral Health Prev Dent 2018;16:59–66.
Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risk to oral health. Bull World Health Organ 2005;83(9):661–669.
https://www.123dentist.com/are-seniors-more-at-risk-for-oral-cancer accessed on 22-02-2020.
Torres-Carranza E, Infante-Cossío P, Hernández-Guisado JM, et al. Assessment of quality of life in oral cancer. Med Oral Patol Oral Cir Bucal 2008;13(11):E735–E741.
Jones J, Duffy M, Coull Y, et al. Older people living in the community—nutritional needs, barriers and interventions: a literature review. Scottish Govern Soc Res 2009. 63 www.scotland.gov.uk/socialresearch. accessed on 22-02-2020.
Montgomery SC, Streit SM, Beebe ML, et al. Micronutrient needs of the elderly. Nutr Clin Pract 2014;29(4):435–444. DOI: 10.1177/0884533614537684.
Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutr 2001;4(3):797–803. DOI: 10.1079/PHN2000116.
Sheiham A, Steele JG, Marcenes W, et al. The relationship among dental status, nutrient intake, and nutritional status in older people. J Dent Res 2001;80(2):408–413. DOI: 10.1177/00220345010800020201.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25(4):284–290. DOI: 10.1111/j.1600-0528.1997.tb00941.x.
Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994;11:3–11.
Kim HY, Jang MS, Chung CP, et al. Chewing function impacts oral health-related quality of life among institutionalized and community-dwelling Korean elders. Community Dent Oral Epidemiol 2009;37(5):468–476. DOI: 10.1111/j.1600-0528.2009.00489.x.
Kotzer RD, Lawrence HP, Clovis JB, et al. Oral health-related quality of life in an aging Canadian population. Health Qual Life Outcomes 2012;10(1):50. DOI: 10.1186/1477-7525-10-50.
Santucci D, Attard N. The oral health-related quality of life in state institutionalized older adults in Malta. Int J Prosthodont 2015;28(4):402–411. DOI: 10.11607/ijp.4185.
Kshetrimayum N, Reddy CVK, Siddhana S, et al. Oral health-related quality of life and nutritional status of institutionalized elderly population aged 60 years and above in Mysore city, India. Gerodontology 2013;30(2):119–125. DOI: 10.1111/j.1741-2358.2012.00651.x.
Limeback H. The relationship between oral health and systemic infections among elderly residents of chronic care facilities: a review. Gerodontology 1988;7(3-4):131–137. DOI: 10.1111/j.1741-2358.1988.tb00318.x.
Beck JD, Offenbacher S. The association between periodontal diseases and cardiovascular diseases: a state-of-the-science review. Ann Periodontol 2001;6(1):9–15. DOI: 10.1902/annals. 2001.6.1.9.
DeStefano F, Anda RF, Kahn HS, et al. Dental disease and risk of coronary heart disease and mortality. BMJ 1993;306(6879):688–691. DOI: 10.1136/bmj.306.6879.688.
Kandelman D, Petersen PE, Ueda H. Oral health, general health, and quality of life in older people. Spec Care Dentist 2008;28(6):224–236. DOI: 10.1111/j.1754-4505.2008.00045.x.