Protecting Aging Smiles
Health complications and financial worries can make maintaining good oral health difficult for older adults.
5/01/09
By Beth Dunham

Dr. Roseann Mulligan

Dr. Veronica Greene

Older adults face a myriad of obstacles to good health, including challenges to their oral health. But given the right oral health regimen and access to dental care, older individuals can have healthy smiles throughout their golden years, according to USC School of Dentistry faculty members.

Because the mouth is central to many crucial activities, such as eating and talking, poor oral health can greatly affect an individual’s quality of life, said Roseann Mulligan, associate dean of Community Health Programs. Unfortunately, the normal aging process can itself usher in new risks to an older adult’s oral health, even when no other health problems are involved.

“As an individual ages, his or her teeth become less vascularized, more brittle and are more subject to insult,” Mulligan said. “If the gums recede due to periodontal disease the root will be exposed and vulnerable to decay.”

Motor skills can also decline with age, illness or injury and make oral hygiene activities such as brushing and flossing difficult or painful to perform on a regular basis, Mulligan added. Declining eyesight can add to the challenge of maintaining proper oral hygiene. Falling out of an oral hygiene routine can be dangerous for older adults; besides keeping oral infection and decay at bay, brushing and flossing keeps the high number of bacteria in the mouth in check and can help prevent serious illnesses throughout the rest of the body.

“Bacteria from the mouth can be aspirated into the lungs and cause pneumonia, and the inflammatory cascade caused by oral infection has been linked to cardiovascular problems such as heart attack and stroke,” she said. “Daily oral hygiene keeps the oral bioload down, but without that routine the chance of local or systemic disease increases.”

The various physical and mental health challenges that heavily affect older populations, as well as many of the methods used to treat them, can have negative oral side effects, Mulligan said. Common medications, including those that address high blood pressure, allergies, depression and osteoporosis can cause oral problems ranging from dry mouth, which increases the risk for tooth decay, to jawbone death due to osteonecrosis. Many systemic diseases, such as diabetes, can have oral repercussions as well.

Cancer is another major worry for older adults, especially among those with many years of exposure to risk factors like smoking, Mulligan said. Oral cancer is among the deadliest of cancers – usually due to diagnoses that come too late – and can especially diminish quality of life as breathing, eating and speaking are hindered; other cancers that originate in other areas of the body can metastasize to the mouth as well. In addition, the chemotherapy and radiation therapy used to fight cancer cells can also inadvertently kill the rapidly dividing cells of the mouth and wipe out the secretory function of the salivary glands, causing debilitating mouth pain and dry mouth. Such treatments can also result in jaw necrosis.

Beyond the physical complications that hurt oral health, mental illness and cognitive challenges can also impede oral care, said Veronica Greene, Director of the School of Dentistry’s Hollenbeck Palms rotation. Individuals facing depression or developing Alzheimer’s disease may have trouble maintaining health routines and may need family members or other caregivers to assist them both with oral hygiene at home and traveling to obtain professional dental care.

The interplay between oral health and overall well-being means that a patient’s team of caregivers should not only include a physician but also a dentist who is aware of all health issues the patient is facing, Mulligan said.

“We want to help our physician colleagues realize that it’s not just teeth that we’re worried about,” she said.

Dentists recommend regular dental checkups for everyone as well as having all necessary dental work completed before major treatments or surgical procedures. But financial worries are also obstacles for older adults trying to maintain good oral health, especially those living on a limited income, Greene said. Major cuts to the adult portion of California’s Denti-Cal program have compounded those fears.

“Only a very small percentage of older adults can afford oral health care,” she said. “It’s a major public health issue.”

Fortunately, as the members of the baby boomer generation become older adults, more dentists are being educated on their specialized health needs. The USC School of Dentistry has been a trailblazer in the field of special care dentistry, which includes the care of medically compromised older patients. The School has provided its students with special care dentistry experience for decades, Greene said, with every student completing at least one rotation within the School of Dentistry’s Special Patients Clinic during the four-year doctorate of dental surgery program.

“We were among the first to offer this type of education to dental students, but more dental schools are now including special needs and geriatric dentistry training in their DDS programs,” she said.

The USC School of Dentistry Clinic is a great option for older adults looking for a lower-cost, high-quality dental care home, she added. Each patient’s health is assessed meticulously before treatment; patients with more serious medical challenges or other risks may receive care in the School’s Special Patients Clinic or in a hospital clinic. The School’s expert faculty members observe every stage of treatment as patients receive care from student doctors and residents.

Greene said that the students and faculty dentists within the School’s clinics work to tailor their care to best benefit a patient’s entire well-being. For older patients, this often involves providing education on wide- ranging issues, from nutrition and exercise to social and mental health. School of Dentistry clinicians also keep caregivers informed of and involved in all treatment and home care decisions.

“It’s about way more than just dentistry,” Greene said.

School of Dentistry Makes an Impact at Special Care Dentistry Association Annual Meeting

On April 17-19, USC School of Dentistry Community Health Programs Faculty and three USC Dentistry Residents presented at the Special Care Dentistry Association Annual Meeting in Baltimore, MD. The presentations by USC participants were:

Featured Presentation:
"Beyond Oral Health of Older Adults: The Dentist, Overall Care and Quality of Life"
Roseanne Mulligan, DDS, MS; Veronica Greene, BA, DDS, MPH; Mina Habibian, DMD, MS, PhD; Janet Lent, DDS; Piedad Suarez, DDS; Jaqueline Venturin, DDS; Ana Wannarka, DDS

Lunch and Learn Presentation:
"Ethical Decision Making in the Elderly and Patients with Special Needs in Dentistry"
Ana Wannarka, DDS.

Table Clinics:
"Dental Students’ Attitudes Towards Homeless Patients While Providing Care"
Mina Habibian,DMD, MS, PhD; Laura Elizondo, DDS; Roseann Mulligan, DDS, MS

"Osteoradionecrosis and Bisphosphonate-related Osteonecrosis Treatment Modalities"
Jeff Tanner, DDS; Melina Adamian, DDS; Krystal Benyamein, DDS; Lindsay Pfeffer, DMD, MBE; Richard Green, DDS, MSEd