The association between general

and oral health in older people

Marina Kotsani
Internist-Geriatrician
Nursing Home Coordinator Physician, EHPAD LNA, Cagnes-sur-Mer, France
PROGRAMMING COST Action 21122 Chair

22.02.2024
No conflict of interest
How many among you routinely perform
an oral check to your patients?

Do not miss it!

Presentation layout:
Oral health and….

• Comorbidities/medication
• Nutrition
• Quality of life
• Geriatric Medicine
Oral health and
comorbidities/medication
Comorbidities and poor oral hygiene
• Physical impairment:
 arthritis,
 Parkinsonism,
 dexterity issues,
 restricted access to dental care
 …

• Cognitive impairment
Aspiration pneumonia
 Oral health problems and comorbidities(a)

Periodontitis and…
• Diabetes (bidirectional)
• Cardiovascular disease and atherosclerosis
• Cognitive impairment/Dementia

Systemic host response to periodontal disease:

• Inflammatory mechanisms
• Bacterial mechanisms (tissue invasion)
• Vascular mechanisms (pathogens in
circulation→ PLT aggregation/thrombus)
Oral health problems and comorbidities(b)

Hyposalivation and…
• COPD
• Cancer (head/neck radiotherapy)
• Sjogren’s syndrome
Xerostomia
• Medication
 Antihypertensives
 Antidepressants
 Antipsychotics
• Major risk factor
• dental caries
• plaque
• periodontal disease
• candidiasis
• denture-related issues
• Causes dysphagia, dysgeusia, speaking/chewing difficulties
• Negative impact on QoL
Osteoporosis and oral health
• Shared risk factors
(smoking, caffeine, improper diet…)

•Jawbone damage predisposition to

periodontitis and tooth loss

• Ill fitting dentures

•Bisphosphonates and
osteonecrosis of the jaw
Oral health and
Nutrition
 Yes it does!

1,156 persons
There is a relationship
between oral health
problems and nutritional
status

3220 nursing home residents

Poor oral health, mostly problems
with eating due to artificial teeth
problems, was associated with an
almost 2fold risk for malnutrition
Dental status and nutritional status ✓ In the sample living independently, intakes of most
nutrients were lower in edentate than dentate
subjects.
✓ Intake of non-starch polysaccharides, protein,
calcium, non-heme iron, niacin, and vitamin C was
significantly lower in edentate subjects.
✓ People with 21 or more teeth consumed more of
most nutrients, particularly of non-starch
polysaccharide.

✓ People with fewer than 28 teeth had

significantly lower intakes of carrots, tossed
salads, and dietary fiber than did fully dentate
people, and lower serum levels for beta
carotene, folate, and vitamin C.

✓ The intake of protein as well as most vitamins and

minerals were positively associated with the total
number of natural teeth
✓ inverse association for carbohydrate intake
✓ Diet quality was inversely associated with tooth loss
 Dental status and nutritional status
Well-nourished subjects had a
significantly higher number of
pairs of teeth/Functional Teeth
Units (FTU) in comparison to
individuals with risk of
malnutrition or malnutrition.

>20 teeth →healthier diet

Better nutritional choices for better
oral health
Oral health and
quality of life
Oral health and…

• Self esteem
• Social interactions
• Quality of life
2401 older residents recruited from all long-term
care wards in Helsinki);
OS: chewing and swallowing difficulties and dry
mouth;

OS: 25.4% had one OS and 16.6% two or three OS.

Oral health and
Geriatric Medicine
Rapid Oral Health Deteriotation
(ROHD): the 7 D’s
• Dementia,
• Depression,
• Demotivation
• Dexterity,
• Drugs,
• Diabetes,
• Diet.
Oral health and Geriatric Syndromes
• Malnutrition
• Dysphagia
• Sarcopenia
• Frailty
• Delirium • Self care dependence

• Impaired communication-difficulties in symptoms description

• Dementia
• Impaired collaboration-difficulties in dental care
• …
• Behavioural problems

• Delirium
Unusual suspect…

• Infection/Pain

• Behavioural problems

• Decrease in nutritional intake

• Altered general status