NMDA Journal Summer 2018

20 New Mexico Dental Journal, Summer 2018 of the oral cavity many diseases can be detected at early stages. This is why to geriatricians the mouth is considered to be a “mirror” in revealing many systemic conditions.  16 The reality is that with age comes a higher susceptibility to systemic conditions predisposing other changes systemically in the body that exhibit oral manifestations.  10 Chronic inflammation seen in diabetic patients increases the risk of infection and inflammation, especially in the oral tissues that usually go untreated. Diabetes is a chronic inflammatory disease that is linked to periodontitis.  17 Medical research addresses the linkbetweenacute infection and diabetes, particularly on the impact of the disease from inflammation.  18–20 Inflammation is measured primarily by the amount of C reactive protein (CRP) circulating in the blood to which insulin is sensitive. This CRP is a marker for the development of diabetes, making chronic inflammation such as periodontitis a risk factor for diabetes.  17, 18 Other oral health risks for diabetic patients are increased risk of caries, tooth abscesses, and dry mouth. Oral health professionals play an important role in early detection and treatment. According to the American Academy of Oral Medicine, due to susceptibility to systemic conditions as mentioned previously, older adults are predisposed to develop oral and maxillofacial diseases that can “directly or indirectly lead to malnutrition, altered communication, increased susceptibility to infectious diseases, and diminished quality of life.”  1 Other systemic conditions with oral manifestations commonly seen in the elderly include: Parkinson’s, erythema multiforme, and the auto- immune disorder Sjögren’s syndrome. Salivary dysfunctions, such as drug- induced xerostomia and Sjögren’s syndrome, contribute to a higher prevalence of dental caries. Sjögren's syndrome is a chronic autoimmune connective tissue disorder. This auto- immune disorder affects the lacrimal and salivary glands causing a lack of secretions.Itisthemostcommonsystemic condition associated with xerostomia and salivary dysfunction. About one million people in the U.S. are living with this disorder.  21 It is largely diagnosed in patients 40 and older. Dental caries is the second most frequently occurring negative oral manifestation seen in older adults.  10, 11 While the retention of natural adult teeth in the aging population is generally a positive, it also comes with an increase in the prevalence of tooth decay when prevention is not in balance. Deficiencies in salivary secretions enable microorganisms that cause tooth decay to colonize due to the inability of saliva to maintain a neutral pH. Tooth decay can cause mild to severe tooth pain which impairs the ability to chew, resulting in a change in diet in older adults. Soft diets filledwith cariogenic foods promotemore tooth decay (Fig 3). At the minimum, in order to prevent tooth decay, the patient should be encouraged to brush after every meal, floss daily and use a fluoride- containing toothpaste. When brushing is not possible, chewing sugarless gum (such as those containing xylitol) after eating may stimulate saliva. Frequent small sips of water throughout the day is also advisable.  21 Two prescription drugs (pilocarpine/Salagen® and cevimeline/ Evoxac®) reduce symptoms of dry mouth and increase salivary secretion for a few hours in most patients taking them. Both drugs have side effects; they may not prevent tooth decay and are not suitable for everyone. NeutraSal® is another prescription product that may be used for the relief of dryness of the oral mucosa when dry mouth occurs due to Sjögren's.  21 TheAmericanAcademyofPeriodontology reports that older adults have a higher prevalence to periodontal disease.  20 Advanced periodontitis is responsible for loss of attachment of the periodontium. It is accompanied by inflammation of the gingiva and changes in oral microflora (increase in gram negative bacteria) that release toxins causing destruction of the periodontium. This destruction is measured by the amount of bone attachment loss and categorized as initial, moderate, or severe periodontitis. Consequently, periodontitis is another significant problem in older adults  20 (Fig 4). In the United States, oral malignancies and candidiasis are two of the three most common reasons for referrals by general dentists in older adults. Inflammatory vesicular lesions are the third reason. Oral cancer affects 10 in every 100,000 adults and accounts for 3% of all cancers in the country, but of greater concern is that its mortality rate is around 50%.  22 A vast 90% of squamous cell carcinomas occur mostly in persons aged 50 years continued from page 19 Fig 3— The Mouth as “Mirror” of Health . Root caries, broken and non-restorable teeth, gingival inflammation, tobacco-stained teeth, plaque, evidence of poor oral hygiene. (Photograph by Dr. Charles Tatlock, DDS, MPH) Fig 4—Clinical photograph of an elderly patient depicting presence of advanced periodontal disease, as well as the presence of root caries on teeth #7, 8, 9, 10, 11. This clinical presentation is not unusual among institutionalized elderly patients. (Photograph courtesy of Stephen Wagner, DDS, FACP) Oral Changes Associated with Aging