Older Adults With Chronic Conditions at Higher Risk for Tooth Loss

Maintaining good oral care is vital to overall health, as poor oral hygiene can lead to inflammation, which increases a person’s risk for developing diabetes or heart disease. For older adults with chronic conditions, a twice-daily self-care oral hygiene routine could mean the difference between severe tooth loss and preserving one’s teeth.

A new analysis published in Morbidity and Mortality Weekly Report that reviewed three measures of extensive tooth loss among older adults (age 50 and older) with specific chronic conditions found that these conditions were associated with increased tooth loss. The findings indicate the importance of maintaining oral health for this patient population. 

“This is important because oral health is critical to overall health, and having extensive tooth loss can limit food choices, which can exacerbate other chronic conditions,” explains Marcia Parker, DMD, MPH, U.S. Centers for Disease Control and Prevention dental public health resident. “Limited dietary choices can lead to obesity or weight loss. Tooth loss can also detract from physical appearance and impede speech, factors that can restrict social contact, inhibit intimacy, and lower self-esteem. However, tooth loss is preventable with self-care and routine dental visits,” she adds. 

Researchers used measures of tooth loss during 1999–2004 (6,283 subjects) and 2011–2016 (7,443 subjects) from the National Health and Nutrition Examination Survey (NHANES) among adults age 50 years and older with specific chronic conditions: edentulism, severe tooth loss (having eight or fewer teeth), and lacking functional dentition. 

During the 2011–2016 survey, the prevalences of complete edentulism and severe tooth loss were higher among older adults with each selected chronic condition (with the exception of obesity) than they were among those who did not have such conditions. Additionally, the prevalence of edentulism was at least twice as high among adults with fair or poor general health, emphysema, heart disease, or stroke history, as it was among those without the condition. Researchers also reported the prevalence of severe tooth loss was 50% higher for adults with fair or poor general health, rheumatoid arthritis, asthma, diabetes, uncontrolled diabetes, emphysema, heart disease, liver condition, or stroke, compared with those who did not have the condition. 

The researchers note prevalence of edentulism, severe tooth loss, and lacking functional dentition were 10.8%, 16.9%, and 31.8%, respectively.

“Major causes of tooth loss, gum disease and caries are preventable with healthy behaviors, such as brushing with fluoride toothpaste and routine dental care. Compared to adults without chronic conditions, those with chronic conditions have higher levels of unmet treatment needs for gingival disease and caries, which may be due to a lack of access to a dentist,” Parker says. Data show that more than 40% of adults over 65 had a past-year visit to a physician, but no visit to a dentist. 

Unfortunately, older adults may skip dental visits due to high costs, lack of dental insurance, barriers to transportation, or mobility issues. Many may not understand the link between dental health and overall well-being, opening the door for healthcare professionals to provide education on this topic.  

Because older adults are more likely to visit their doctors for annual visits than a dentist, interprofessional collaboration is key to helping patients understand how to improve self-care. Primary care physicians of patients with chronic diseases can discuss how these diseases put them at increased risk for tooth loss, and refer them to a dentist for treatment. 

Additionally, integrating dental professionals into the medical team will allow them to deliver preventive oral health services in nondental settings, such as primary care offices and long-term care facilities, according to the authors. 

In their role, clinicians should screen for dental disease and use health history forms to gain knowledge of a patient’s chronic condition status to deliver patient-centered care. Dental hygienists can provide guidance on healthy behaviors, food intake, and oral hygiene care to promote oral health.

Another notable finding was that providing recommendations for routine dental care for specific conditions, such as diabetes, can have positive effects on oral health. 

Parker notes, “One of the most notable improvements and change in the lack of a functional dentition were found among adults 50 years and older with diabetes. Diabetes is the only condition that has recommendations for routine dental visits as the standard of care. There is evidence that treating periodontitis can improve outcomes (e.g., glycemic control) among people with diabetes. Although 60% of persons with diabetes have some form of periodontal disease, this report has shown a notable increase in people with diabetes keeping their teeth longer, which could be due to this recommendation for routine dental visits.”