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“Scientific and epidemiological research supports the lifelong synergy between nutrition and the integrity of the oral cavity in health and disease” (1). This position of the Academy of Nutrition and Dietetics is particularly relevant with respect to older adults. Local oral factors such as being edentulous (tooth loss) and having ill-fit- ting dentures, dental caries, and soft- tissue disorders such as gingival recession can impact the normal func- tions of the oral cavity. Likewise, oral manifestations of systemic disease and side effects of medications can impact the integrity of the oral cavity and subsequent function and sensory perception. Oral health is related to systemic health and overall well- being in the older adult (2,3). Poor oral health can contribute to compromised nutritional status due to altered chewing and eating abili- ties (4) and can contribute to compromised diet quality, inadequate intake, and the ability to consume a balance of nutrients from all food groups (5). Malnutrition can impact the integrity of the oral cavity, which influences wound healing and the ability to recover from infection and surgery. Research suggests a potential link between poor oral hygiene, respiratory problems, pathogens, and risk for aspiration pneumonia for those living in long- term care facilities (6,7).

9 THE BIG PICTURE

Oral health is important in promoting systemic health, well-being, and quality of life in older adults (5). The Centers for Disease Control and Prevention (CDC) reports that being disabled, homebound, or institution- alized increases the risk for poor oral health (6,7). Tooth loss, chewing ability, and a reduced sense of taste can have a negative impact on the older person’s eating habits (1,8). Approximately 30% of older adults worldwide and 15% in the United States aged 65 to 74 are edentulous (8). Missing teeth, dentures, and overall poor oral health can contribute to decreased meal intake (9,10). Those with partial (missing some teeth) or full (missing all teeth) edentulism and those wearing

Consequences of Poor Oral Health

ill-fitting dentures are at greater nutritional risk. Poor oral health has been shown to be a significant contribu- tory factor in involuntary weight loss and compromised diet quality (1,11-14).

An increasing percentage of older adults are retain- ing more natural teeth throughout their life span (11). Older adults who retain more natural teeth are at an increased risk for coronal and root caries (15,16). With the increasing incidence of chronic disease in older adults, oral manifestations of select chronic diseases such as diabetes may impact oral health and the integrity of the oral mucosa. Xerostomia (dry mouth), a common side effect of more than 600 medications, may occur sec- ondary to the type and number of medications used by the older adult. Xerostomia may also occur as a result of dehydration, autoimmune disease, or undetected damage to the salivary glands (16,17). The relationship between osteoporosis and tooth loss has been documented; this may impact risk of periodontal disease among older adults, particularly women (1,18-20). Osteoporosis is known to influence alveolar bone height, making it of utmost importance for the registered dietitian nutritionist (RDN) and nutrition and dietetics technician, registered (NDTR) to encourage older adults to consume food sources of calcium and vitamin D and supplements of these nutrients if needed (21).

FUNCTIONAL ABILITY OF THE ORAL CAVITY

Use of any type of prostheses—complete dentures, implant-supported dentures, or partial dentures—can lead to taste and temperature alteration, increased risk for choking, and modifications in dietary consumption. Older adults with dentures are more likely to experi- ence difficulty chewing hard foods such as fruits, vege- tables, and some meats, thus affecting food choices (10,22). Moynihan et al reported that older adults with full dentures have approximately 20% the chewing ability of their counterparts with natural dentition (23).