Impact of Oral Health on Quality of Life in the Elderly

Author: Emily Lamb

Word Count in Body of Text: 1059

Journal Referencing Format: Clinical Interventions in Aging

ABSRACT

Purpose: Evidence suggests an association between oral health and the quality of life an elderly

individual experiences. The purpose of this paper is to examine the current research pertaining to this

association; specifically, the impact that oral health has on the process of aging and individual

perceptions of well-being among the elderly.

Methods: I utilized an online search engine to find information related to the search terms “oral health

elderly” and “cognitive decline and well-being”. From these searches I found articles from databases

such as PubMed and Wiley Online Library. These resources offered articles that afforded me the

opportunity to compare and corroborate information, which further allowed me to establish a general

sense of the validity of the research and analyses I was reading.

Results: Poor oral health has been associated with many adverse health effects including systemic

diseases, cognitive decline, social anxiety and depression. There is also research that suggests that

socioeconomic status plays a role in an individual’s oral health status, as well as their perception of well-

being. Understanding the relationship between an individual’s oral health and their perception of well-

being is a developing aspect of health in the field of geriatrics.

Conclusions: Among the research I reviewed, there exists a concern for the impact that oral health has

on other health outcomes within the elderly population. Additional research may clarify understanding

and solidify associations between well-being and oral health.

INTRODUCTION

The degree to which oral health impacts both an individual’s perception of well-being and their

true state of health is of growing interest in the field of geriatrics. Oral infections, such as periodontitis,

have been associated with systemic diseases, while other oral health problems are antecedent to

malnutrition and depression.[1] Instruments, such as the Health- and Oral Health-Related Quality of Life

(OHRQoL), have been created to measure the impact of health on an individual’s ability to function and

their perception of well-being.[1] Additionally, exams such as the Modified Mini-Mental State

Examination (3MS) have been utilized in the process of investigating the relationship between

periodontal disease and cognitive decline. Cognitive decline has been associated with diminished well-

being, specifically in areas of purpose in life that involve behavioral regulation.[4]

Factors that influence an individual’s oral health consist of genetics and lifestyle,[3] both of

which are affected by an individual’s socioeconomic status.[1,5] Education remains the most important

preventative measure for assuring oral health over a lifetime, but socioeconomic status and the lack of

affordable dental care in the U.S. makes accessing care difficult for many Americans. For many

individual’s, primary oral health care measures, such as brushing and flossing one’s teeth, will not

eliminate the development of dental caries or periodontitis, which, when left uncared for, can result in

edentulism. This loss of teeth has been directly correlated to malnutrition, as mastication becomes more

difficult, and to social anxiety and depression, as one’s self esteem is impacted by their absence of

teeth.[1] Additionally, edentulism has been proposed as a good predictor of mortality.[1]

METHODS

I utilized the Portland State University Library search engine for databases and articles. Using the

search terms “oral health elderly” I was able to find peer-reviewed articles from journals such as the

Journal of the American Geriatrics Society. From these resources I was able to compare and corroborate

information which allowed me to establish a general sense of the validity of the research and analyses I

was reading. In addition, I conducted a separate search in the same search engine for the terms

“cognitive decline and well-being” to better understand the associations described by articles from my

previous search between well-being and oral health as specific oral infections and diseases were

suggested to result in cognitive decline.

RESULTS

Oral health is mediated by many factors including behavioral, nutritional, and lifestyle. Like

many aspects of health, determining a causal relationship can be difficult as many factors are

compounding. An individual’s perception of well-being and quality of life is an example of this. As a

result, considerations for the roles that other influences, besides oral health, play in an individual’s life

have been made by the people employing these subjective instruments; such as the OHRQoL.[1] After

controlling for factors such as general health, income and marital status, it has been discovered that oral

problems affecting older populations (e.g. dry mouth, edentulism, and problems with mastication) are

correlated with a worsened quality of life.[1] The OHRQoL is a subjective measurement that considers

an individual’s perception of well-being. The OHRQoL has been used to measure the effectiveness of

treatments in dental research and clinical practices of dentistry by comparing participant’s OHRQoL

scores before and after interventions.[1]

Edentulism the loss of teeth, often due to caries and periodontitis that have been left untreated.

Periodontitis is a type of gum infection that causes damage to the soft tissue and bone that supports the

teeth. Antibodies to common periodontal pathogens are associated with an increased risk of

atherosclerosis, heart attack and stroke. There is even research developing on the relationship between

periodontal disease and cognitive decline.[2] Cognitive decline in the elderly is associated with various

health issues from disability to death. Efforts have been made to better understand the effect that

cognitive decline has on an individual’s well-being.[4] A 2013 study that conducted annual clinical

evaluations on its participants for an average of five to six years, observed that, among other things,

lower levels of cognitive function and increased rates of cognitive decline resulted in lower levels of

well-being.[4]

Access to dental care and the use of preventative oral health care measures has been shown to

affect the self-reported oral health status of an individual and suggests a correlation with socioeconomic

status.[5] In an analyses of data from two cohort studies, associations were found between the level of

prestige of a man’s occupation (women were not mentioned as the cohort consisted only of men) and

the number of teeth they had. Men who made less than $40,000 annually had an average of 19.5 teeth

and rated their oral health more poorly than did men making more money annually (compare at an

average of 21.9 teeth).[5] From this same analyses, men that had a preventative visit in the past year

had an average of 22.4 teeth compared to 16.1 teeth for those who had not had a preventative visit in

the past year. 88% of men with higher income had gone for a preventative visit in the past year

compared to 75% of men from lower income jobs.[5]

DISCUSSION

Oral health influences aspects of an individual’s health including their physical, mental and social

health. Even when confounders have been controlled, poor oral health status and the existence of

adverse oral health characteristics have been correlated with aggravating quality of life. Instruments

such as the OHRQoL have been used in studies that seek to better understand this correlation. While the

OHRQoL has been used as an effective instrument in dental research and clinical practice, it is important

to remember that due to its subjective nature, data rendered from it should be interpreted with care.

For purposes of better understanding associations and establishing relationships between well-being

and oral health, it would be advantageous for well-being to become clinically defined, making it easier to

objectively measure.

The possible role of socioeconomic status in the oral health status and outcomes of an individual

is an area in need of further exploration. The implications of such an interaction would be indicative of a

need for public health outreach in the form of education and dental health care services to low-income

and under-served populations. Additionally, better understanding limitations that elderly populations

may face when accessing dental care in terms of transportation, making appointments and

remembering directives from dentist, would be necessary for implementing effective preventative oral

health care measures.

REFERENCES

1 Gil-Montoya, J. A., de Mello, A. L., Barrios, R., Gonzalez-Moles, M. A., Bravo, M. (2015), Oral

health in the elderly patient and its impact on general well-being: a nonsystematic review.

Clinical Interventions in Aging, 10: 461–467. doi: 10.2147/CIA.S54630

2 Stewart, R., Weyant, R. J., Garcia, M. E., Harris, T., Launer, L. J., Satterfield, S., Simonsick, E.

M., Yaffe, K. and Newman, A. B. (2013), Adverse Oral Health and Cognitive Decline: The

Health, Aging and Body Composition Study. Journal of the American Geriatrics Society,

61: 177–184. doi: 10.1111/jgs.12094

3 Niessen, Linda C. (1998), Aging Successfully: Oral Health for a Lifetime. Journal of Esthetic

and Restorative Dentistry, 10: 226-228. doi: 10.1111/j. 1708-8240

4 Wilson, Robert S.; Boyle, Patricia A.; Segawa, Eisuke; Yu, Lei; Begeny, Christopher T. (2013),

The Influence of Cognitive Decline on Well-Being in Old Age. Psychology and Aging, 28.2:

304-313. doi: 10.1037/a0031196

5 Huntington, N. L., Krall, E. A., Garcia, R. I. and Spiro, A. (1999), SES and Oral Health Status in

an Elderly Population. Annals of the New York Academy of Sciences, 896: 451–454.

doi: 10.1111/j.1749-6632.