Fortunately, the oral health, oral hygiene practices, and dental service utilization of older age groups have improved over the past several decades. Moreover, continued improvements are projected as the cohorts that swell the ranks of the older generations include a greater number and larger proportion of better educated, more affluent dentate individuals than ever before.7,15 An older individual who retains his or her own teeth, however, is at continued risk for oral diseases. An estimated 40 percent of older Americans during the next two decades will constitute an oral special needs category based on complex health problems and functional status.41 The chronic and progressive nature of oral diseases may result in tooth loss and disability. Prevention and early intervention are therefore critical, and impairments that are not addressed early have a greater likelihood of becoming disabling.
There is no epidemiological evidence to suggest that tooth loss or specific oral diseases are a necessary concomitant of the aging process, nor do all persons over age 50 fall into a single descriptive group in terms of oral health.7 Rather, it appears that there is a great deal of heterogeneity in the older population, depending on lifetime oral health experiences, related medical conditions, and social and economic status.
All adults enter their second 50 years at risk for multiple oral diseases and conditions. At age 50, 11 percent have lost their teeth, and the remainder have an average of only 22 teeth. Among those with teeth at age 50, 5 percent have untreated coronal caries, 42 percent have untreated root caries, 40 percent have gingivitis, and 17 percent have periodontitis.43 Salivary dysfunction apparently begins to increase in prevalence at this age. Individuals beyond age 50 exhibit rising levels of dysfunction through increased tooth loss, root caries, periodontal diseases, pain, and oral complications of general systemic conditions.
Physical impairments of the oral cavity most often affect chewing, swallowing, phonetics, and social functions. The nature of an individual's impairment, combined with various other risk factors, determines whether the impairment will become disabling or handicapping. The transition to disability and handicap, however, is in large part dependent on appropriate self-care and professional preventive care for older adults.32 Strategies must be developed to diminish oral diseases and injuries and to remove barriers to self-care and professional services. Descriptions of the major burdens faced by the older population, including prevalence data, are provided below.