THE MERCK MANUAL OF GERIATRICS, Ch. 104, Dental and Oral Disorders

Section 13. Gastrointestinal Disorders
Chapter 104. Dental and Oral Disorders
Topics: Introduction \| Caries \| Periodontal Disease \| Tooth Loss \| Alveolar Bone Loss \| Benign Mucosal Lesions \| Burning Mouth Syndrome \| Oral Cancer \| Temporomandibular Joint Disorders \| Oral Motor Disorders \| Taste Dysfunction \| Salivary Gland Disorders

Oral Motor Disorders

Geriatric Essentials

Reduction in masticatory muscle strength and coordination is common with aging and may lead to a tendency to swallow larger food particles, which can result in choking or aspiration.

Chewing, swallowing, tasting, and communicating are all oral motor skills that require intact, coordinated neuromuscular function in the mouth, face, and neck. Oral motor function in particular declines measurably with aging, even in healthy individuals, and may have many manifestations. Reduction in masticatory muscle strength and coordination is common with aging, especially in those with partial or complete dentures, and may lead to a tendency to swallow larger food particles, which can increase the risk of choking or aspiration. Drooping of the lower face and lips caused by decreased circumoral muscle tone and, in edentulous people, reduced bone support, is an aesthetic concern and can lead to drooling, spilling of food and liquids, and difficulty closing the lips while eating, sleeping, or resting; sialorrhea (saliva leakage) is often the first symptom. Swallowing also undergoes age-related changes; it takes longer to move food from mouth to oropharynx, which increases the likelihood of aspiration.

After age-related changes, the most common causes of oral motor disorders are neuromuscular disorders (eg, cranial neuropathies from diabetes, stroke, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis). Iatrogenic causes also contribute. Drugs (eg, anticholinergics, diuretics), radiation therapy to the head and neck, and chemotherapy can greatly impair saliva production. Hyposalivation is a major cause of delayed and impaired swallowing.

Treatment

Oral motor dysfunction is best managed with a multidisciplinary approach. Coordinated referrals to specialists in prosthetic dentistry, rehabilitative medicine, speech pathology, otolaryngology, and gastroenterology may be needed.

Prevention

Evaluating a patient's drug history may prevent oral motor dysfunction or identify an iatrogenic cause.

This topic was last updated September 2005.