Keep My Mouth Young In Old Age!

By Arvind M. Dhople, Ph.D., Professor Emeritus, Florida Tech

Keep My Mouth Young In Old Age!

                The idiom “getting long in the tooth”, meaning to age, is believed to have first been coined to describe how horses’ teeth seemed to grow as their gums shrunk with age, but is increasingly becoming an accurate descriptor of human aging.  Receding gum lines resulting from untreated oral disease means that as we age, we also become literally long in the tooth.  The burden of oral disease in older people is global and increasing.

                The global strategy from the World Health Organization (WHO) resolution on oral health considers a life course approach, aging populations and putting the mouth back into the body.  The opportunity lies in acknowledging this earlier, before people become old and have problem, to have a good oral health throughout life and good behavioral patterns.

                Oral health is much more than sparkling white teeth.  According to the latest World Dental Federation, the new definition of oral health reflects its multifaceted nature and importance.  Oral health is now defined, amongst other things, as including “the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex”.  For older people especially, there is a direct link between oral and general health, with oral health being both a predictor and marker of frailty.

                The interplay between oral health and frailty is probably mediated by nutritional status: having fewer teeth, reduced masticatory force, or oral pain is likely to reduce nutrient intake, with frailty developing from muscle wasting and bone weakening.  This occurrence probably produces a negative feedback loop, with sarcopenia then reducing the ability to chew and swallow.  Notably, oral health of older people has been shown to decline when they first enter assisted living irrespective of their previous health status: although the exact causes are unknown, possible reasons include side effects of polypharmacy (eg, having a dry mouth), or an inability to carry out personal dental care from physical or mental disability.  Furthermore, frailty is not the only systemic condition affected by poor oral health.  There is also an evidence showing the interplay between periodontitis and common chronic inflammatory diseases of aging, aspiration pneumonia, and cardiovascular disease.

                There is a growing unmet burden of oral disease that needs to be addressed, especially in older people.  The recent Global Burden of Diseases study indicates that oral disorders contribute 8 million years lived by disability among people aged 50-74 years.  This burden has almost certainly increased because of the COVID-19 pandemic, which has reduced routine access to dental care and disproportionately affected older people.  The world is gradually awakening this issue.

                In low-income and middle-income people, there is a high burden of preventable oral disease.  Untreated oral diseases have more than double between 1990 and 2020 in these people and affect about 3.5 billion people.  There are strong economic arguments for recognizing the importance of oral health: the global economic burden due to poor oral health and disease is about $ 545 billion, and as the global population ages, this economic burden will almost certainly increase.  However, unlike other preventable, non-communicable diseases, oral health is rarely discussed in the context of global health or aging populations.  To a large degree, this is because of the separation of dental care from other routine medical interventions, leading to dental health practitioners to call for “the mouth to be put back in the body”, ie for recognition of the importance that oral health plays in general health.

                Oral health typifies the issues which face older people navigating health-care systems.  Like many diseases, oral health is crucial for ensuing general health, yet dental care is separate and sliced from general medical practice.  To ensure that older people receive affordable access to dental care, health-care systems need to reform to ensure cross-talk between dental and general medical practitioners: we must put the mouth back in the older body.

                Finally, as a greater proportion of people in midlife and early later life retain more of their natural teeth as they age, opportunities arise for undertaking interventional studies to access if maintaining and promoting good oral health in this cohort also has a beneficial effect on improving physical and social functions and wellbeing in later life.