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Volume1 Issue1
I
ssues and
P
eople
CanadianHealth
MeasuresSurvey
Oral problemscommonlyobserved
inelderlypeople includecaries,
periodontal diseases, tooth loss,
xerostomia, candidiasisandcancer.
11,12
TheCanadianHealthMeasuresSurvey
(CHMS), conducted fromMarch2007
toFebruary2009 sampled5,600
Canadians fromapproximately97%
of thepopulation, excludingpeople
livingonAboriginal reservesorCrown
lands,membersof theCanadianForces,
residentsof institutionsand residents
in some remote regions.
13
Dwellings
of knownhouseholdcomposition
were stratified into5agegroups: 6–11,
12–19, 20–39, 40–59and60–79years.
Veryyoung (<6years) andveryold
(>80years)peoplewereexcluded.
Eachparticipantwas interviewedand
underwent aphysical (includingoral)
examination.During the interviews,
questionsaboutoral healthwere
related to thecomfort andappearance
of themouthand teeth, theeffects
of oral disabilities, oral carehabits,
visits todental professionalsand
dental insurancecoverage. Theoral
examinationswereperformedby
dentistswhoseexamination skillswere
calibrated toachievehighagreement
(Cohen’s kappacoefficient≥0.6)with
clinical criteria recommendedby the
WorldHealthOrganization.During
theexamination, thedentistgathered
dataonocclusion,mucosal lesions,
accumulationofdebrisandcalculus,
gingivitis, edentulism, prosthesesand
trauma to the incisors. Theprevalence
and severityof carieswereestimated
from theaveragenumbersofdecayed
(D),missing (M) andfilled (F) teeth
(DMFT). Periodontal statuswas
representedby thedeepestprobing
depthon1of 10 indicator teethand
mean lossof attachmenton6 sitesof
indicator teeth. Thedatacollectedare
suitable fordevelopingpoliciesabout
oral healthneeds inCanadabut are
inadequate for clinical research.
OralHealthStatus
ofElderlyCanadians
TheCMHS revealed that almost
everyone in theoldest agegroup
(60–79years)hadat least1DMFT
(excludingwisdom teeth). Thisage
grouphad thehighestmeanDMFT
(15.7, consistingofD=0.4,M=5.6and
F=9.7) and thehighest rateof
edentulism (22%).
13
Nonetheless, earlier
studies invariouscountrieshave
identifieda trend toward the retention
ofmorenatural teeth inolder age,
14,15
and this trend is supportedbyevidence
fromStatisticsCanada that the rateof
edentulismamong thoseolder than65
yearsdeclined inCanada from43% in
1990 to30% in2003.
16
More recently,
theCHMS found thatoverhalf (58%)
of those60–79yearsof age retained
more than21natural teeth (mean=19).
Older adultsparticipating in the survey
claimed tobrushandflossas frequently
as theyounger participants, yetmore
thana tenth (11%) haduntreated root
caries, andnearlyone-third (31%) hadat
least oneperiodontal pocket of at least
4mm. Althoughoral problemswere
distributed similarly inboth theoldest
agegroupand in the40- to59-year age
group,
13
therewas agreater need for
professionallyadministeredpreventive
and restorative therapies, particularly to
prevent andcontrol caries. Thiscanbe
explainedbyaccelerating factors suchas
lossofgingival attachment, drymouth
and reduceddexterity, andpossibly
because thepathogenesisofdental
diseases followsadifferentpatternwith
advancingage.
Among those60 to79yearsof age,
more thana tenth (13%) avoided
dentists, andevenmore (16%) declined
treatment becauseof thecost. Thirteen
per cent of this agegroup, andnearlya
quarter (23%) of thosewithout natural
teeth reported that theyavoided
certain foodsbecauseof oral problems,
whileabout one-tenth (7%) of the
participants reportedpersistent pain.
13
Although suchcomplaintswerenot
highlyprevalent, these responses could
beanunderestimationof the true
prevalence, asolder people tendnot
to report oral pain, possiblybecauseof
increased toleranceof noxious stimuli
17
ormisattributionof pain tooldage.
18
Denture stomatitiswasobserved
in20%of edentulousmouths.
13
Contrary to thecommonbelief that
lossof teethends theneed for dental
visits,
19
a substantial proportionof the
edentulousparticipants (41%) needed
treatment for soft-tissueabnormalities.
14
Consequencesof
PoorOralHealth
Poor oral healthcanadversely
affect qualityof life
20
by imposing
aphysiological burden, particularly
amongelderlypeople. For example,
hyposalivation,which is common inold
age, arises fromhypofunctionof the
salivaryglands, themanifestationsof
systemicdiseases suchasdiabetes and
theadverseeffectsofmedicationsor
radiotherapy for cancer. Polypharmacy
is common inolder adults, andmultiple
medications can interact to inducedry
mouth. Nearlyone-third (29%) of adults
65yearsor older living independently
inOntario reported xerostomia.
21
Lossof thenatural cleansingeffect
of saliva increases theoral bacterial
load,whichpredisposes a frail
person todental problems andother
systemicconditions, suchas aspiration
pneumonia,
22
coronaryarterydisease
andcerebral infarction.
23
Moreover,
peoplewith subjective xerostomia
and tooth lossmayhave reduced
masticatoryability
24
; foodavoidance
fromfibre, protein, vitamins
25,26
and
minerals
27
; and impairment of speech.
28
Malnutritionmay reduce immunity
against infection
29
andhasbeen
associatedwithcardiovascular disease,
30
poor cognitiveperformance
31
and
periodontal disease inolder adults.
32
In turn, periodontal disease increases
the riskof root caries
33
and further
tooth loss. Indeed, this vicious cycle
of poor dentition,malnutritionand
