Retiring some myths about aging and oral health

Research on the oral health status of elderly populations has been limited in frequency and scope. There is a lack of good descriptive and longitudinal data on salivary gland function, oral mucosal status, and oral sensory performance in health and disease across the adult life span. Thus, confusion for practitioners and patients alike arises from unsubstantiated stereotypes about aging and oral health. There are some commonalities in the origins of the myths discussed in this article. First, many aging generalizations were based on studies that did not account for the health and medication status of the subjects. Second, most aging studies are cross-sectional designs which can result in misleading conclusions due to the age cohort effect. Third, many studies on the histology of aging oral tissues were laboratory animal studies, with results that cannot be generalized to human populations. Fourth, findings on oral health changes are often confounded or influenced by differences in functional status (e.g., the ability to care for oneself), nutritional health, health beliefs and expectations within the study subjects. Fifth, other changes due to aging may have an indirect effect on oral health, for example, an age-related decline in immune function. Sixth, the "older-old" group of elderly commonly labor under misconceptions of normal aging changes. Historically they have not sought dental care as often as the younger elders. This health care seeking behavior is expected to change dramatically when the baby boom generation joins the elderly ranks. The goals of oral health care for the elderly are consistent with those of other health care providers involved in geriatric care, namely maximizing functional performance, fostering independence, and enhancing their quality of life. Dental professionals would be well advised to apply a healthy dose of skepticism to any generalizations about debilitating changes in oral health due to aging alone. Most changes in oral health experienced by the elderly are not the result of age itself, but are the consequences of systemic disease, pharmacotherapy, functional disabilities, and cognitive impairment. When unexplained deleterious changes are seen in the oral health of elderly patients, the knowledgeable and reflective practitioner will account for local, systemic, and environmental factors in formulating a plan of care. In the opening paragraph, questions were posed about the mucosal integrity of a "little old lady." The most beneficial approach for her and all our older patients is to plan treatment utilizing current knowledge about aging and avoiding the traps created by myths and stereotypes. It is time to retire these myths before the baby boomers join the ranks of the retired.