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See reference 14.

See reference 14.

impairments, cataracts, glaucoma, and hearing impairments increase in frequency with advancing age.'1 Nearly halt ol people aged 65 * years have arthritis.Jl Most older adults have at least one chronic condition and many have several chronic conditions.1 In 1994 the number ol chronic conditions that occurred most often per 100 older persons were as follows: arthritis (50), hypertension (.36), heart disease ( 32), hearing impairments (29), cataracts 117), orthopedic impairments (16), sinusitis (15), and diabetes (10). Heart disease remains the leading cause of death among older adults. Approximately 7 in 10 deaths among older adults were caused by heart disease, cancer, or stroke.-0

Hie prevalence of sensory impairments and arthritis can have dramatic influences on the oral health of older adults. It is more difficult for older adults with hearing, visual, and dexterity limitations to effectively communicate oral health care needs and concerns and perform good oral hygiene.

Social and Psychologic Issues Affecting Dental Treatment

I lie education level of older adults is increasing. In 1995, only 64% of noninstitutional older adults completed at least high school and 13% possessed a bachelor's degree. By the year 2015, it is estimated that 76% ol older adults will have completed at least high school, with 20% obtaining a bachelor's degree. I hose with higher education tend to be better off financially than those with low education. Poverty is less prevalent today among older adults for all race, gender, and ethnic groups.1"'0 In general, older adults have the highest disposable income of all age groups and they spend more money on luxury items such as vacations and automobiles.2* Higher educational achievement with lower poverty levels suggests an inc rease in demand for oral health care among older adults.10

Dentate Status

Over the past several decades, the prevalence of tooth loss and edentulism has been dec lining in the U.S. Table .39-1 shows the most current estimates of tooth loss and retention in the U.S. Iliese dala indicate that 75% of adults aged 65 to 69 years are dentate and just over half of adults aged 75 I years «ire dentate.n

Periodontal Status

Recent data suggest that older adults who retain teeth are likely to be less susceptible to periodontitis.6 Advanced periodontal disease among older adults is not as common as once thought." Moderate levels of attach ment loss are seen in a high proportion of older adults;

however, severe loss is detected in only a small propor tion of older adults.1 ' I he amount of periodontal disease that is associated with age does not appear to he clinically significant, and it is unclear whether the higher prevalence of periodontal disease is a function of age or time.12 Pigs. 39-2 to 39-4 illustrate periodontal disease data from Phase I of the I bird National Health and Nutrition I xamination Survey (NHANKS III) conducted in the U.S. from 1988 to 1991/ Pig. .39-2 shows that gingival recession increases with advancing age, with one third (.35%) of persons aged 55 to K4 years and less than half (46%) of persons aged 85 » years having .3 mm or more of gingival recession. I ig. 39-.3 shows that pocket depth of 6 mm or greater was detected in 7% of persons aged 45 to 54 years, 8% of persons aged 55 to 64 years, and 7% ol persons aged 65+ years. Attachment loss, which is displayed in l;ig. 39-4, increases with age. Less than half of persons aged 65+ years had loss of attachment measuring 5 mm or greater.

I'he prevalence of periodontal disease increases with age and appears to be age associated.1 Age increases the risk for periodontal destruction but is probably consistent with successful aging, not pathology.12 Periodontal disease in older adults is probably not due to greater susceptibility but instead is the result of cumulative disease progression over timg."

IWiodontuI Ircutmcnt ftti Older Adults ■ ( HAITI R 39 553

How Measure Gingival Recession

Fig. 39-2 Percentage of persons with gingival recession, 1988-91. (From Brown I J, Brunelle |A, Kingman A: Periodontal status in the United States, 1988-1991: Prevalence, extent, and demographic variation. | Dent Res 1996; 7S(Spec lss):677.)

Fig. 39-2 Percentage of persons with gingival recession, 1988-91. (From Brown I J, Brunelle |A, Kingman A: Periodontal status in the United States, 1988-1991: Prevalence, extent, and demographic variation. | Dent Res 1996; 7S(Spec lss):677.)

Periodontal Disease And Caries

Ficj. 39-3 Percentage ot persons with pocket depths by acje, 1988 91. (From Brown l.|, Brunelle |A, Kingman A: Periodontal status in the United States, 1988 1991 Prevalence, extent, and demographic variation. | Dent Res 1996; 75(Spec lss):672.)

Caries Status

Root caries is a disease that is particular to older adults. Exposed root surfaces in combination with compromised health status and use of multiple medications make older adults at high risk for root caries. Caries examinations from the Phase I of NIIANI.S III indicate that root caries prevalence increased greatly with age. Decayed or filled root surfaces were detected in 47% of persons aged 65 to 74 years and in 55.9% of persons 75 -f years.

Dental Visits

Dental visits by older adults are correlated with having teeth, not age.'1 Data from the 1995 Behavioral Risk l ac-tor Sum-ilia nee System (BRISS), which is a continuous state-based, random-digit-dialed telephone survey of the U.S. noninstitutional population aged 18 ^ years, indicate that older adults are frequent users of dental services. Of all persons responding to the oral health section, 69% reported having a dental visit in the past year. Among adults aged 65 I years. 62% reported having a dental visit during the previous year. However, 75% of adults aged 65+ years with natural teeth reported a dental visit in the past year. Dental expenditure data indicate that older adults have a higher cost per visit than younger persons and «ire willing to make a significant investment in dental care.-*

Xerostomia

Saliva plays an essential role in maintaining oral health. Many older adults take medications for chronic medical conditions and disorders. More than 500 prescription and over-the-counter medications are associated with

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