AMA VICDOC Spring 2023 - Magazine - Page 42

A M U LT I D I S C I P L I N A R Y A P P R O A C H
AGEING
ORAL
HEALTH
-
INSIGHT:
As GP's commonly have
strong relationships with
older patients, they can play
an important role identifying
the early signs of oral
disease and referring for
appropriate care.
REPORT DR SAMANTHA LEW DR JAMES FERNANDO
ORAL HEALTH COMMITTEE, AUSTRALIAN DENTAL
ASSOCIATION VICTORIAN BRANCH
T
wo of the most common
diseases in elderly
Australians are tooth
decay and gum disease.
Recent data shows a quarter of
Australians aged 75 years and
over have untreated tooth decay,
and 70 per cent have moderate
to severe gum disease.
The factors contributing
to the increased oral disease
in older patients are generally
complex. They include impacts
compounded over time, such as
a lack of fluoride exposure and
access to dental care, changes
in diet, the death of a spouse,
changes in saliva flow and quality,
and a decrease in self-care due to
cognitive or mobility changes.
As general practitioners commonly
have strong relationships with
older patients, they can play an
important role identifying the
early signs of oral disease and
referring for appropriate care.
STRONG LINKS BETWEEN
GENERAL AND ORAL HEALTH
There is growing evidence
of the association between
systemic health and oral health,
highlighting the significance of
a multidisciplinary approach to
42
AMA VI C TO RIA
geriatric healthcare. Periodontal
(gum) disease, also called
periodontitis, has a significant
impact on general health. The
oral inflammation of periodontal
disease directly exacerbates
systemic inflammatory responses,
contributing to an increased risk in
the development of cardiovascular
disease, cerebrovascular disease,
Alzheimer’s disease, cancer, and
diabetes mellitus.
Diabetes mellitus and
periodontal disease have a
bidirectional relationship.
Untreated periodontal disease
worsens glycaemic control and
increases the risk of diabetes
complications, while chronic
hyperglycaemia increases the
severity of periodontitis and
results in an impaired response
to its treatment. Making elderly
patients at risk aware of the
association between systemic and
periodontal disease and referral
for management with appropriate
health practitioners can improve
health outcomes.
INFECTIONS
Infections, including pneumonia,
are the leading cause of
hospitalisation in Australia for
people living in residential aged
care. Poor oral health and hygiene
is associated with large plaques
of micro-organisms building up
in the mouth, and inhalation
of these organisms is theorised
to contribute to aspirational
pneumonia, and in some cases,
pneumonia-related deaths. More
recently, it has been suggested that
poor oral hygiene and periodontal
disease may lead to an increased
severity of COVID-19 infection.
The seriousness of these infections
and their link to oral health
emphasises the significance of
preventive oral care in high risk
settings such as aged care and in
the general elderly population.
IMPACT OF SALIVA
DEFICIENCY
Saliva deficiency (hyposalivation)
and the feeling of oral dryness
(xerostomia) are both more
common in the elderly than any
other age group and correlated
with depression or poor quality
of life. Saliva deficiency is also
known to increase the risk of
tooth decay, oral infections,
speech/eating difficulties,
denture problems and sleep
impairment. Identifying and

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