Numerous oral mucosal conditions are prevalent among older adults. Sometimes they are secondary to systemic disease; at other times they occur as a result of side effects of medication, ill-fitting dentures, and substance abuse (e.g., tobacco and alcohol).10 In a series of screenings conducted between 1957 and 1972 among older white adults in Minnesota, 10 percent had at least one oral lesion that was unusual enough to be recorded. In this population the prevalence of leukoplakia, a precancerous condition, was 29.1 per 1,000, and the prevalence of oral cancer was 0.9 per 10,000.11 Herpes virus, papilloma, and pemphigus are also common among older adults.
Oral cancers are life threatening and cause severe handicaps. In the United States each year, 9,400 persons die of oral cancer, and some 30,000 people develop the disease. Although oral cancers constitute only 3 to 4 percent of all cancers in the United States, only one-half of the affected population are alive five years after diagnosis.1 Most survivors suffer serious functional impairment and have an exceptionally high risk of subsequent primary and secondary malignancies; thus, they are at great risk for further disabilities or handicaps. The prevalence of oral cancer is greater among men than women and increases with age, with the great majority of cases occurring after the age of 40.
The long-term impact of tobacco use and alcohol on the condition of teeth and the development of soft-tissue lesions—specifically, oral cancer—are more apparent in older individuals. It has been estimated that 75 percent of oral cancers can be attributed to using tobacco and drinking alcohol. The risk of oral cancer for tobacco users is 4 to 15 times greater than for nonusers, increasing with both duration and frequency of tobacco use. Individuals with lower educational levels or infrequent dental visits are also more likely to suffer from soft-tissue lesions.10
Dental caries contribute directly to impairments through pain and discomfort; they contribute indirectly through tooth loss. Severe and persistent caries can become disabling or handicapping. Dental caries in older adults are manifest primarily as (1) cervical caries associated with plaque accumulation at the gingival margin; (2) root caries associated with gingival recession; (3) secondary phenomena to medical conditions or pharmaceutical challenges; and (4) recurrent