Oral health is an integral part of general health and well-being, but older adults often neglect it. U.S. adults over the age of 65 have an average of 18.9 remaining teeth, and 27% have no remaining teeth. Seniors who have fewer remaining teeth are more likely to be current smokers, to be of black ethnicity, and to have lower incomes and less education; those with these characteristics and those who are female are more likely to have no remaining teeth. According to the National Health and Nutrition Examination Survey, the overall prevalence of partial and total tooth loss in older adults has decreased since the early 1970s. This decline is the result of major improvements in oral health resulting from community water fluoridation, advanced dental technology, better oral hygiene, and more frequent use of dental services. More than 100 million Americans still do not have access to water that contains enough fluoride to protect their teeth, however.
Twenty-three percent of U.S. adults aged 65 to 74 years have severe periodontal disease, and 92% have dental caries. Those who are black or Hispanic, are current smokers, and have smaller incomes and less education are more likely to have periodontal disease, which is associated with diabetes and possibly cardiovascular disease and stroke. About 30% of older adults are edentulous, versus 46% in the early 1970s. These and other oral-health problems in seniors can lead to needless pain and suffering; difficulty with speaking, chewing, and swallowing; and loss of self-esteem. At any given time, 5% of seniors are living in a long-term care facility where dental care is problematic. Many older adults lose their dental insurance when they retire. The situation is worse for older women, who generally have lower incomes and may never have had any dental insurance. Medicare does not cover routine dental care.
Despite great improvements in oral health over the past few decades, disparities still exist. Twenty-three percent of adults aged 65 years or older have not seen the dentist in the last five years, and fewer black and Hispanic seniors and those with lower incomes and less education have done so. One-quarter of older adults report excellent teeth and mouth condition, and 16% report poor condition; those who are black or Hispanic and those who have smaller incomes and less education report the condition of their teeth and mouth as poor.
Healthy People 2010 acknowledges the advances in oral health made over the last half-century, but emphasizes its aim to improve quality of life and eliminate health disparities. The Centers for Disease Control and Prevention, which is responsible for promoting oral health through public-health interventions, has been funded by Congress to the tune of $12.4 million for this purpose in 2008. Older adults can improve their oral health and reduce tooth loss by drinking fluoridated water and using fluoride toothpaste; practicing good oral hygiene; getting professional oral health care; avoiding tobacco; limiting alcohol; and getting dental care before undergoing chemotherapy or radiation to the head or neck. Health professionals can add to this effort by increasing patients' level of awareness of the importance of oral health and the benefits of fluoride.
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