188宝金博页面版

Common Oral Conditions in Older PersonsWanda C. Gonsalves, Md, Medical University of South Carolina, Charleston, South Carolinaa. stevens WriGhtson, Md, University of Kentucky College of Medicine, Lexington, Kentuckyrobert G. henry, dMd, MPh, Veterans Affairs Medical Center and University of Kentucky College of Dentistry, Lexington, Kentucky it is estimated that 71 million ameri-cans, approximately 20 percent of the population, will be 65 years or older by 2030. 1 an increasing number of older persons have some or all of their teeth intact because of improvements in oral health care, such as community water fluoridation, advanced dental technology, and better oral hygiene. 1 however, this population is at risk of chronic diseases of the mouth, including dental infections (e.g., caries, periodontitis), tooth loss, benign mucosal lesions, and oral cancer. Table 1 summarizes common oral conditions in older patients. 1-20 increasing evidence has linked oral health and general health, suggesting a relationship between periodontal disease and diabetes, cardio-vascular disease, pneumonia, rheumatologic diseases, and wound healing. 8,21-24Poor oral health is often associated with lower economic status; lack of dental insur-ance; being homebound or institutionalized; and the presence of physical disabilities that limit good oral hygiene, such as arthritis and neurologic impairment. 25 because older patients are more likely to visit a physician than a dentist, primary care physicians have an opportunity to improve oral health in this population by assessing oral health risk, iden-tifying and treating common oral conditions, and referring patients to a dentist, if needed.Oral Health Assessmentan abbreviated history checklist that patients may fill out in the physician’s office or at home can help physicians assess oral health risk. there are also screening tools that can be administered by non-dental professionals in a residential care facility. Figure 1 is a simple, valid, and reliable dental screening tool. 26 the only materials needed to perform the assessment are a penlight, gloves, and a tongue blade. eight oral health categories are marked as healthy, changed, or unhealthy to help determine the next steps in the patient’s care. smiles for life: a national oral health Curriculum for Family Medicine is an edu-cational resource developed by the society of teachers of Family Medicine Group on oral health. 27 the Web site (http://www.smilesforlife2.org) includes free pocket cards and personal digital assistant downloads.Age-Related Oral ChangesWith aging, the appearance and structure of teeth tend to change. 28 yellowing (Figure 2) or darkening of the teeth is caused by changes in the thickness and composition of the underlying dentin and its covering, the enamel. abrasion and attrition also con-tribute to changes in tooth appearance. 29 the number of blood vessels entering a tooth and Older persons are at risk of chronic diseases of the mouth, including dental infections (e.g., caries, periodontitis), tooth loss, benign mucosal lesions, and oral cancer. Other common oral conditions in this population are xerostomia (dry mouth) and oral candidiasis, which may lead to acute pseudomembranous candidiasis (thrush), erythematous lesions (denture stomatitis), or angular cheilitis. Xerostomia caused by underlying disease or medication use may be treated with over-the-counter saliva substitutes. Primary care physicians can help older patients maintain good oral health by assessing risk, recognizing normal versus abnormal changes of aging, performing a focused oral examina-tion, and referring patients to a dentist, if needed. Patients with chronic, disabling medical conditions (e.g., arthritis, neurologic impairment) may benefit from oral health aids, such as electric toothbrushes, manual toothbrushes with wide-handle grips, and floss-holding devices. (Am Fam Physician. 2008;78(7):845-852. Copyright © 2008 American Academy of Family Physicians.)▲ Editorial: “Promoting Oral Health: The Family Physician’s Role,” p. 814.Downloaded from the American Family Physician Web site at www.aafp.org/afp. Copyright © 2008 American Academy of Family Physicians. For the private, noncommercial use of one individual user of the Web site. All other rights reserved. Contact copyrights@aafp.org for copyright questions and/or permission requests.