A physician should always examine the mouth and be able to recognize major oral disorders, particularly possible oral cancers Oral Squamous Cell Carcinoma Oral cancer refers to cancer occurring between the vermilion border of the lips and the junction of the hard and soft palates or the posterior one third of the tongue. Over 95% of people with... read more . However, consultation with a dentist is needed to evaluate patients with nonmalignant changes as well as tooth problems. Likewise, patients with xerostomia Xerostomia Xerostomia is dry mouth caused by reduced or absent flow of saliva. This condition can result in discomfort, interfere with speech and swallowing, make wearing dentures difficult, cause halitosis... read more or unexplained swelling or pain in the mouth, face, or neck require a dental consultation.
Children with abnormal facies (who also may have dental malformations requiring correction) should be evaluated by a dentist.
In fever of unknown origin Fever of Unknown Origin (FUO) Fever of unknown origin (FUO) is body temperature ≥ 38.3° C (101° F) rectally that does not result from transient and self-limited illness, rapidly fatal illness, or disorders with clear-cut... read more (FUO) or a systemic infection of unknown cause, a dental disorder should be considered.
A dental consultation is necessary before head and neck radiation therapy and is advisable before chemotherapy.
Common dental disorders Caries Caries is tooth decay, commonly called cavities. The symptoms—tender, painful teeth—appear late. Diagnosis is based on inspection, probing of the enamel surface with a fine metal instrument... read more , dental emergencies Overview of Dental Emergencies Emergency dental treatment by a physician is sometimes required when a dentist is unavailable to treat the following conditions: Fractured and avulsed teeth Mandibular dislocation Postextraction... read more , and other dental and oral symptoms, including toothache Toothache and Infection Pain in and around the teeth is a common problem, particularly among patients with poor oral hygiene. Pain may be constant, felt after stimulation (eg, heat, cold, sweet food or drink, chewing... read more , are discussed elsewhere in THE MANUAL. This chapter focuses on
Geriatric changes that affect oral health
Resting salivary secretion rarely diminishes significantly solely due to aging. Xerostomia Xerostomia Xerostomia is dry mouth caused by reduced or absent flow of saliva. This condition can result in discomfort, interfere with speech and swallowing, make wearing dentures difficult, cause halitosis... read more or hyposalivation in the older patient is almost always a side effect of drugs Etiology Xerostomia is dry mouth caused by reduced or absent flow of saliva. This condition can result in discomfort, interfere with speech and swallowing, make wearing dentures difficult, cause halitosis... read more , although meal-stimulated salivary flow is usually adequate.
The flattened cusps of worn teeth and weakness of the masticatory muscles may make chewing tiresome, impairing food intake.
Loss of bone mass in the jaws (particularly the alveolar portion), dryness of the mouth, thinning of the oral mucosa, and impaired coordination of lip, cheek, and tongue movements may make denture retention difficult.
The taste buds become less sensitive, so the older patient may add abundant seasonings, particularly salt (which is harmful for some), or they may desire very hot foods for more taste, sometimes burning the often atrophic oral mucosa.
Gingival recession and xerostomia contribute to development of root caries Caries Caries is tooth decay, commonly called cavities. The symptoms—tender, painful teeth—appear late. Diagnosis is based on inspection, probing of the enamel surface with a fine metal instrument... read more .
Despite these changes, improved dental hygiene has greatly decreased the prevalence of tooth loss, and most older people can expect to retain their teeth.
Poor oral health contributes to poor nutritional intake, which impairs general health. Dental disease (particularly periodontitis Periodontitis Periodontitis is a chronic inflammatory oral disease that progressively destroys the tooth-supporting apparatus. It usually manifests as a worsening of gingivitis and then, if untreated, with... read more ) is associated with a 2-fold increased risk of coronary artery disease Overview of Coronary Artery Disease Coronary artery disease (CAD) involves impairment of blood flow through the coronary arteries, most commonly by atheromas. Clinical presentations include silent ischemia, angina pectoris, acute... read more . Edentulous patients cannot have periodontitis because they do not have a periodontium, although periodontitis may have resulted in their tooth loss. Aspiration pneumonia Aspiration Pneumonitis and Pneumonia Aspiration pneumonitis and pneumonia are caused by inhaling toxic and/or irritant substances, usually gastric contents, into the lungs. Chemical pneumonitis, bacterial pneumonia, or airway obstruction... read more in patients with periodontitis can involve anaerobic organisms and has a high mortality rate. Severe bacteremias secondary to acute or chronic dental infection may contribute to brain abscesses Brain Abscess A brain abscess is an intracerebral collection of pus. Symptoms may include headache, lethargy, fever, and focal neurologic deficits. Diagnosis is by contrast-enhanced MRI or CT. Treatment is... read more , cavernous sinus thrombosis Cavernous Sinus Thrombosis Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Symptoms and signs include pain, proptosis... read more , endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more , prosthetic joint infections Prosthetic Joint Infectious Arthritis Prosthetic joints are at risk of acute and chronic infection, which can cause sepsis, morbidity, or mortality. Patients often have a history of a recent fall. Symptoms include joint pain, swelling... read more , and unexplained fevers.