Tooth Loss

Geriatric Essentials

• Partial and complete tooth loss is an age-related condition that is caused primarily by dental caries and periodontal disease.
• Tooth loss impairs chewing, swallowing, and speaking, which can lead to nutritional deficiencies, aspiration complications, social isolation, and depression.
• Partial tooth loss is treated with fixed (eg, bridges, implants) or removable (eg, partial dentures) appliances. Complete tooth loss is treated with complete dentures.
• Dentures are associated with many oral health problems, including irritation, ulceration, gingival overgrowth, candidal infection, and pain.
• Removable appliances must be evaluated at least annually for adjustment and realignment as needed. They also require special attention to plaque removal to maintain oral health.
• Tooth loss does not preclude the need for regular oral health care visits for appliance evaluation and screening for oral, head, and neck cancer.
• A main role for the health care practitioner providing primary care for an edentulous patient is to ensure consultation with a dental specialist at least every 6 mo.

The likelihood of reaching age 65 yr with all or most teeth intact is much greater than in previous generations. Still, about 1/3 of adults >= age 65 are missing all their teeth (edentulism). Severe periodontal disease can lead to severe bone loss necessitating tooth extraction. Severe dental caries, the other primary cause of tooth loss, also necessitates extraction when loss of tooth structure is so severe that rehabilitation is not possible. Tooth loss mainly impairs chewing, swallowing, and speaking, which can lead to nutritional deficiencies, aspiration complications, social isolation, and depression.

Treatment is with dental prostheses. Options for partially edentulous patients include fixed appliances that do not require removal (eg, bridges, implants) or appliances that require removal during sleeping hours (eg, partial dentures). Complete dentures are the only options for totally edentulous patients.

Fixed appliances offer greater stability and better function for chewing, swallowing, and speaking than do dentures. Well-designed and well-fabricated fixed appliances can provide years of pain-free use and are usually not associated with any significant oral diseases unless the supporting teeth or implants develop an infection. However, more thorough hygiene is required to keep these devices free of plaque and to prevent gingivitis.

Dentures do not provide the same amount of chewing stability and proprioception that natural teeth provide, but dentures can be enhanced by the placement of implants that support a prosthesis. Removable devices are associated with many more oral health problems than are fixed appliances. For example, the mucosal surfaces that support these devices are susceptible to mucosal irritation and ulceration, gingival overgrowth, fungal infections (eg, candidiasis), and pain. Teeth supporting partial dentures are most likely to develop dental caries and gingivitis. Because dentures are made of acrylic and the supporting edentulous jaw bones resorb with time, dentures must be evaluated at least yearly and adjusted and realigned on a regular basis to maintain stability and retention. Elderly patients with severely resorbed jaw bones may not be able to wear full dentures because of the lack of supporting soft and hard tissues.

Many elderly patients wearing complete dentures do not visit the dentist on a regular basis because they believe that they no longer need professional dental services. However, dentures lose their stability and retention with time. Further, and most importantly, the risk of developing oral cancer increases with aging, and these patients (similar to elderly patients with teeth) require at least annual screenings for oral, head, and neck cancer by dental professionals who are trained specifically to examine oral, head, and neck structures and to diagnose and treat disorders affecting these regions. Therefore, the health care practitioner providing primary care for an edentulous patient needs to ensure consultation with a dental specialist at least every 6 mo.

This topic was last updated September 2005.