decongestants, diuretics, painkillers, and tranquilizers). Moreover, ionizing radiation and chemotherapeutics, common therapies for cancer in older adults, can severely affect the salivary glands and the oral mucosa and may result in radiation caries.

Aging diabetic patients in particular are vulnerable to oral infections and impaired healing, which may lead to chronic destructive periodontal disease and other oral problems.29 Psychoses, affective disorders, and sleep disturbances, on the other hand, may affect the patient's willingness or ability to perform appropriate oral hygiene or seek dental services, thus affecting oral health, speech, or swallowing.29 Neurological problems, including stroke, Alzheimer's disease, and Parkinson's disease, can adversely affect oral functions.

Slower movements, reduced agility, arthritis, Alzheimer's disease, impaired vision and hearing, urinary dysfunction, and vascular insufficiency may all undermine the ability to follow recommendations for self-care. They may also make it impossible for an older individual to visit a dental office or to tolerate lengthy visits. Finally, diet, particularly fermentable carbohydrates, may have a considerable impact on oral conditions and root caries.

Orofacial Pain

Orofacial pain is a condition of great concern in that 20 to 25 percent of all chronic pain problems are localized in this region. Chronic and acute pain can adversely affect oral functions, which ultimately has a significant impact on general health and quality of life. These effects appear to be substantial for older adults; although the epidemiology of orofacial pain is not well documented, chronic and acute pain generally, and in the orofacial region specifically, appear to be more prevalent in the elderly. Within the oral region, pain related to "dry mouth," temporomandibular joint dysfunction syndrome, generalized orofacial pain, various arthroses, and oral cancers are known causes of chronic pain.

BURDEN PREVENTABILITY

Based on current projections, it is assumed that each succeeding cohort to enter the "second 50" will have more teeth and greater expectations regarding tooth retention. This dramatic change in the nature of oral health for aging individuals creates new challenges for research, education, and clinical care. In spite of major successes in dental research, treatment, and prevention over the past several decades, oral diseases of all kinds remain among the most costly of



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