Oral health is necessary for prosperity and general health. A person’s oral health signifies individual life’s quality and their normal health (Beard & Bloom, 2015).
Mouth diseases can affect regular health and their progression may result in the rise of various co-morbid conditions or may worsen the condition. Eatables whether it’s solid or liquid if not cared causes growth of germs in the mouth as the mouth is crowded with bacteria. The food present in the mouth is used by the germs, and while breaking foods or sugars present, they form acid. The acidogenic properties may raise dental erosion and tooth decay which can harm the teeth resulting in the formation of a cavity. The progression of such problem may further results in inflammation around the teeth which is known as periodontitis. If periodontitis remains untreated, it may lead to critical and harmful chronic disease. Periodontal disease is a worldwide health disease which occurs due to an unmaintained balance between pathogen and person defense ability which is altered by surrounding factors.
Elder’s immune system fall with the rise in age. Due to the weakening of cells and cells mediated process, the homeostasis or normal functioning in the presence of pathogens are compromised which results in abnormal health and hence rise in oral problems (Patil, Varekar, Patil & Shigli, 2016). Various associations have enlisted poor oral problems or symptoms that may be identified in elderly patients, few of them are:
The world population of aged people is increasing at a higher rate. It is assumed that by the year 2050, people having age 60 or above will account for half of total population
And in old people, the risk of chronic disease is more. So the bad oral condition adds up the poor general health (O. Griffin, A. Jones, Brunson, M. Griffin & D. Bailey, 2012). Older people are having age 60 or above; there are very lesser no. of natural teeth or absence of teeth. So oral care was about to decrease. In elder people, root caries or cervical caries which is around the neck of the tooth are the most common oral problem. As age increases, the prevalence of periodontitis increases which increase the number of pathogens and hence leads to poor general health (Thomsan, 2014).
The relation between oral health and general health has been rising over the decades.
It is explained as a disorder in which ability of thinking, remembrance, behavior and everyday activity performance becomes reduced or diminished. It explained some symptoms which affect the brain. At any age, dementia can occur, but it mainly affects older people. Around 64% of person who have age 65 or above possess chronic periodontitis. Pro-inflammatory molecules which are generated by periodontitis enter in systemic circulation, and it can be transported in the brain either by the systemic circulation or neural pathways (Tsakos & Watt, 2014). It leads to high levels of brain cytokine due to which inflammation occurs in the brain. These changes result in the collection of brain amyloid, and hence dementia or cognitive dysfunction occurs in that person (Okamoto & Morikawa, 2010). A study revealed that individual having who have age 65 or above have small memory and calculation power having the periodontal disorder as compare to the person who did not suffer from the periodontal disorder. It is checked by blood test (Foltyn, 2015).
On moving toward the older age, teeth are lost naturally. Huge tooth loss reduces the chewing efficacy. It can lead to limitation of food choices and enjoyment of eating. In the breakdown of food, chewing has the major role. From this, it can be correlated that oral problem might affect nutrition and diet intake of the person. It is considered that 20 teeth are must for chewing process. Thus on decreasing teeth, old people have face problem to intake food which is rich in fiber, vitamin C. It may lead to weight loss or malnutrition and affect the health of an aged person.
As the age increases, a chance for heart diseases increases. In Australia, it is reported that around 3.5 million people suffer from cardiovascular diseases in 2007-2008. A study explained that a person is having teeth lesser than 10, has seven times more chances of death due to coronary heart disease compared to the person having teeth of more than 25 (Holmlund, Holm & Lind, 2010). In people having age 65 or above, it is estimated that out of five deaths four deaths is due to heart disease because as age increase the capacity of working of heart going decreasing. In older age, the walls of heart solidify and arteries become stiff, so the heart does not efficiently pump blood to the muscle of the body (Alman et al., 2011).
As above explained the chances of peritonitis get increased in older age. So it may also affect the incident of the heart disorder in geriatrics. Because periodontal disease increases the level of systemic inflammatory marker e.g. C–reactive protein. Inflammation leads to atherosclerosis, which results in thickening of arteries and hence heart disorder. Inflammatory responses can be produced in many ways, e.g. in periodontitis bacteria get born which evacuate the bacterial byproducts like lipopolysaccharide.
And one more reason of connection of oral infection and cardiovascular disorder is molecular mimicry. On having peritonitis, the bacteria generated in this case produce antibodies, they cross-react with the host cells. Like there is protein named as heat shock protein 60 it causes atherosclerosis which is infection inducted by this protein (Lennon & Ramsay, 2015).
Moreover, oral microbes can directly affect the mediators of heart diseases e.g. atherosclerosis production, hypercoaguability or both.
It is explained as a number of disorders represented by an increased level of glucose in blood and irregular metabolism of protein, carbohydrate, and fat. In diabetes, proper insulin does not produce in body or insulin does not act on glucose to metabolize it, which increases the blood sugar level in a body (albert & Ward, 2012). Periodontal disease is regarded as the sixth complication of diabetes. In aged person the chances of periodontitis are high. Periodontal disorder increases bacteria production and inflammation due to which insulin resistance becomes high, and hyperglycemic conditions occur. It can be measured by hemoglobin A1c levels which come higher in a person having periodontitis which signifies the increase of blood sugar level. And it may further lead to cardiovascular diseases (Li & Williams, 2011).
However, some researches explain that the periodontal disease and diabetes are bidirectional. It means due to diabetes, periodontitis can occur in aged person. In diabetes the collagen gets deposited in vessels, blood flow to gingiva is reduced which results in periodontitis (Taylor & Borgnakke, 2010).
There is some finding which suggests that due to periodontal disease end-stage kidney problem rises in a diabetic person.
People having age 65 or above are at higher risk of the kidney diseases because of inflammation occurs in kidney which is due to glomerulonephritis. In older people, as discussed above prevalence of diabetes is more, so it can cause harm to blood vessel and nerves which become the reason for kidney failure. With increasing age, urinary tract infection level increases particularly in women, which also enhance the chances of kidney disorder.
As we discuss, on aging, oral health becomes poor, chances of periodontal disease become high, and teeth become less in no. in older age. Alteration in the mouth, leads to kidney problems. Worse conditions of oral health in older age provide a signal of chronic kidney disease in early stage. As due to periodontitis, inflammation of blood vessel occurs, so this will raise the problem of chronic kidney disease in aged person (Akar, Akar & Carrero, 2011). Moreover signal of poor oral health are common in the patient having kidney disorder e.g. inflammation, infection, thickening of arteries, diabetes, so it may enhance the death rate of a person. In kidney problem, the immune function gets lower, which also increases the problems of oral health and periodontitis.
As age increases, there is higher sensitivity to periodontitis, and no. of teeth decrease. The periodontal tissue and the no. of teeth present in mouth have the key role in respiratory infection. In aged people, there is greater susceptibility of pneumonia because of aspiration of oral microbes. There are a no. of mechanism which explains the poor oral health leads to respiratory disease in an aged person.
Periodontal organism e.g. Porphyromonas gingivalis and Aggregatibacter actinomycetemomitans are responsible for pneumonia. In the oral cavity, there is a number of harmful bacteria. Salivary enzymes which are linked with periodontal disease transform the mucous surface of the respiratory tract and increase the colonization and binding by respiratory pathogens by the inhalation into lungs and hence cause lung infection.
Periodontopathic bacteria contain hydrolytic enzymes which may damage the salivary film which acts as a safeguard against the harmful bacteria. For example, periodontopathic bacteria produces hydrolytic enzyme P. gingivalis which destroy the salivary molecules and the enzymes which protect the salivary film resulting in binding of a pathogen to respiratory receptors.
In periodontitis, a wide variety of cytokines and other biologically active molecules released in a continuous manner which may change the respiratory epithelium and increases the colonization of harmful agents in respiratory tract which results in respiratory infection due to up regulation of binding of these harmful bacteria to the respiratory receptor.
Evidence are available which proves that the better oral hygiene and continuous oral health care decreases the rate of respiratory diseases in an aged person who are admitted in nursing home specifically in intensive care unit (ICU).
It is defined as a blockage of blood vessels which leads to impairment of blood flow to the brain. In this condition, the brain does not get the proper amount of nutrient and oxygen and hence stop working and die. Due to stroke, there is an accumulation of fat around the vessel walls which results in thickening of arteries.
From the oral problems, the chances of stroke increases. Bad oral hygiene is correlated with improper blood supply to the brain. As previously explained, periodontitis, tooth infection are of bacterial origin. When an oral problem occurs, it results in the production of harmful bacteria which may enter in circulatory system i.e. in blood. And even when chewing process is occurring, and there is tooth infection, it also increases the chances of bacteria to enter in blood. These bacteria produce infection in blood and alter the body chemistry which may produce a clotting deposition. Due to bacterial infection in the blood, the immune system gets decreased. In tooth decay, root canal infection occurs which provide the pathogen with blood supply. And these sites are responsible for stroke (Yoshida & Murakami, 2011).
There are more than 700 different kinds of bacteria present in the mouth, in which some are beneficial and while some are harmful. Mostly gram-negative bacteria are present in the mouth, and its one example is Helicobacterium (H.) pylori which grow best at the line of tooth gum. These gram-negative bacteria and H.pylori produces the formation of periodontitis and gingivitis (inflammation and bleeding gums). In poor oral condition, H. pylori develop especially in periodontitis which is more in aged person (Veiga & Pereira, 2015). These bacteria then enter in the stomach, and it attacks the lining of the stomach. The lining of stomach protects the stomach from the acid and helps in digestion of food. When H.pylori gets damage the lining of the stomach, more acid accumulates in the stomach which results in a lesion and hence leads to a stomach ulcer. These conditions can move the food from the digestive tract. This finding explains that mouth may be a source for H. pylori and bad oral condition may lead to stomach ulcer by these bacteria (Rolands, 2014).
Aged people have the periodontal disorder. The study explain a survey that person who is suffering from periodontal disease have 14 percent more chances of acquiring cancer than the patient having no periodontitis. In aged people, tooth loss is occurring, and it raises the problem of constant stress and inflammation of oral mucus membrane. It may lead to carcinogenesis. The chances of oral cavity cancer are correlated with bleeding gums. Due to periodontal inflammation, tooth loss, chances of head and neck cancer also increased (Fitzpatrick & Kat, 2010). Periodontal disorder releases inflammation factors such as cytokines which leads to accumulation of cancer. Lost teeth can cause esophageal cancer as the person cannot chew larger pieces of food in older age, and if it happens, it may irritate the esophagus and leads to esophagus cancer (Aida, Kondo, Yomato & Hirai, 2011).
Huge or complete loss of teeth may decrease the person social contact and communication. Due to the tooth loss person cannot speak properly which restricts the social interaction. It may lower the self-confidence. Due to the tooth loss, the problem of chewing occurs, which can restrict a person from various foods. The poor oral condition produces pain in person’s mouth which can impact his daily life. It may disturb his sleep also. The oral problem may lead to loss of potency from professional life (Iain & Roger, 2017).
In elder people, oral health can be maintained by giving the regular care to the patients, by identifying disease at the primitive possible level which needs the regular patient contact. The components which affect aged people usage of oral services can be described as follows:
Chlorhexidine cleanse has various application for an oral cure in elders. It is mainly used for the cure of gingivitis. It is potent against many plaque pathogens which boost up the person automatic plaque elimination. It plays a greater role in the person having mental and physical dysfunction. It also play a greater role in immune suppressed person like who are taken chemotherapy by diminishing oral mucositis and candidiasis.
Fluoride protects the oral cavity against by three different systems. Firstly it suppresses the growth of caries by indulging into growing enamel in the mode of fluoraptite. Secondly, it increases the remineralization of enamel having caries. Thirdly it is effective against the pathogen. It is used in the pattern of gel, rinses and dentifrices in the older patient having caries.
Conclusion
Oral health and general health are correlated by following ways-
On increasing age, the risk of oral problems gets increased which results in poor general health.
By maintaining proper hygiene conditions and taking precautions, oral diseases can be cured or made it preventable. It can be done by inhibiting natural teeth decay and periodontal disease with the help of early assessment of oral health. By developing oral health education, oral diseases can be prevented.
References:
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