A Tool for Screening Nutritional and Oral Health of Elderly Residents in Long-Term Care Facilities

Nutritional and dental services are two components of the total medical care in nursing homes. Appropriate nutritional and dental care affect the level of functioning and quality of life for older people who reside in nursing homes. Coordination between the dietitian and the dentist may help to identify, solve, and even prevent nutritional as well as dental problems. A screening tool, such as the one presented in this paper, can identify those residents at high risk for nutritional deficiencies caused by poor oral health status. Screening identities the level of risk and which residents should be further investigated by the dietitian, the dentist, or both.     

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

There is a growing burden of oral disease among older adults that is most significantly borne by minorities, the poor, and immigrants. Yet, national attention to oral heath disparities has focused almost exclusively on children, resulting in large gaps in our knowledge about the oral health risks of older adults and their access to care. The projected growth of the minority and immigrant elderly population as a proportion of older adults heightens the urgency of exploring and addressing factors associated with oral health-related disparities. In 2008, the New York City Health Indicators Project (HIP) conducted a survey of a representative sample of 1,870 adults over the age of 60 who attended a random selection of 56 senior centers in New York City. The survey included questions related to oral health status. This study used the HIP database to examine differences in self-reported dental status, dental care utilization, and dental insurance, by race/ethnicity, among community-dwelling older adults. Non-Hispanic White respondents reported better dental health, higher dental care utilization, and higher satisfaction with dental care compared to all other racial/ethnic groups. Among minority older adults, Chinese immigrants were more likely to report poor dental health, were less likely to report dental care utilization and dental insurance, and were less satisfied with their dental care compared to all other racial/ethnic groups. Language fluency was significantly related to access to dental care among Chinese immigrants. Among a diverse community-dwelling population of older adults in New York City, we found significant differences by race/ethnicity in factors related to oral health. Greater attention is needed in enhancing the cultural competency of providers, addressing gaps in oral health literacy, and reducing language barriers that impede access to care.     

Opportunities for oral cancer screening among older African-American women

BACKGROUND: Older persons with smoking histories are important targets for oral cancer screening. Although older persons in low-income communities often lack regular dental care, little is known about the characteristics of groups at greatest risk for poor screening. METHODS: Survey data from 576 African-American women aged 45-93 were used to identify predictors of smoking and recency and type of dental care. RESULTS: Fifty-nine percent of respondents were current or former smokers, and 62% reported dental care within the past 3 years. Among smokers, no recent dental care was associated with older age, worse health, not working, no regular medical provider, and no recent mammography. CONCLUSIONS: These results suggest that episodic visits to non dentist providers offer opportunities for oral screening in high-risk populations.     

Predictors of food variety and dietary diversity among older persons in Botswana

OBJECTIVE: We investigated whether food variety and diversity are associated with physical and cognitive functioning in older adults in Botswana and designed a simple set of screening questions that predict food variety in this population. METHODS: Data were collected (1998) as a national household survey of 1085 subjects 60 y and older. A food variety score, based on a food frequency checklist, was calculated by summing the frequency of weekly intakes of 16 food items (0 to 66). A dietary diversity score was calculated as the number of food groups consumed weekly (0 to 5). A representative subsample (n = 393) was randomly selected for the clinical component of the survey, and measurements on dependency and cognitive function were conducted. RESULTS: Low food variety was found: 35.2%, 59.3%, and 22.4% of subjects consumed no dairy products, fruits, and vegetables, respectively. A higher food variety score was associated with urban residence, ownership of cattle, higher education, and more frequent meals, and these indicators were used to construct a nutritional risk indicator. Higher food variety score was associated with better self-reported health and better cognitive function. Similarly, a higher score on the nutritional risk indicator screening tool was associated with desirable health outcomes. CONCLUSION: A limited number of foods is consumed, leading to an overall pattern of poor food variety. Higher food variety was associated with improved physical and cognitive functions. A screening tool that predicts food variety in this population has been developed and is recommended to be incorporated at a primary care level to identify older adults most at risk of a poor quality diet.     

Practical Guidelines for Physicians in Promoting Oral Health in Frail Older Adults

Good oral health in old age is particularly important for maintaining adequate oral function, preventing pain and discomfort, controlling localized or systemic inflammation, sustaining social interaction, and preserving quality of life. Given that oral health is an integral part of general health and well-being, and that major chronic systemic and oral diseases share common risk factors, oral health prevention and promotion should be embedded within routine medical assessment and care provision. The role of medical physicians, particularly primary care physicians, geriatricians, and elderly care physicians, in community and long-term care facilities in assessing and promoting oral health in frail older adults is critical and has been emphasized in recent European recommendations. All physicians should appreciate the importance of oral health and incorporate an initial oral health screening into routine medical assessment and care. A short interview with patients and carers on current oral health practices may help to assess the risk for rapid oral health deterioration. The interview should be followed by an oral health assessment, using validated tools, for nondental health care providers. Based on these findings, the physician should decide on necessary follow-up procedures, which may include oral health counseling and/or dental referral. Oral health counseling should include advice on daily oral, mucosal, and denture hygiene; denture maintenance; dietary advice; smoking cessation; limitation of harmful alcohol consumption; management of xerostomia; and frequent dental review. To enable physicians to perform the tasks recommended in this publication, appropriate teaching at both undergraduate and postgraduate levels must be delivered in addition to provision of appropriate continuing education courses.     

Association between oral health status and nutritional status in south Brazilian independent-living older people

OBJECTIVE: Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population. METHODS: A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression. RESULTS: Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA. CONCLUSION: In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.     

Residential Rurality and Oral Health Disparities: Influences of Contextual and Individual Factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.     

Measuring Nutrition-Related Unmet Needs in Recently Hospital-Discharged Homebound Older Adults

Functional limitations in homebound older adults may cause difficulties with obtaining and preparing adequate healthy food. Services exist to help with these difficulties, however, not all individuals who could benefit receive them. This secondary analysis of observational data, obtained via questionnaires from homebound, recently hospital discharged older adults (n?=?566), aimed to identify the prevalence and correlates of unmet need for such services, and to examine the disagreement between self-reported need for a service and functional limitation that could be addressed by that service. One-fifth of respondents reported unmet need for vision services and oral health services, and one-tenth reported unmet need for transportation services and physical therapy. There was a significant association between reported need and functional limitation (p?相似文献   

Nutritional status and dysphagia risk among community-dwelling frail older adults

Objectives

Although the presence of dysphagia is a key determinant of nutritional status among older adults, few studies have focused on the association between malnutrition and dysphagia risk in community-dwelling frail older adults. This study estimated the prevalence of malnutrition and quantified the association between malnutrition and dysphagia risk among community-dwelling older Japanese adults requiring long-term care.

Design

Cross-sectional study.

Setting

This study was conducted with the cooperation of the Japan Dental Association and local dental associations in all 47 prefectures from January to February 2012.

Participants

Individuals aged ≥65 years capable of oral nutrient intake who were living at home and receiving home dental care and treatment.

Measurements

Individual demographic characteristics and factors associated with health loss-related functional decline were obtained through interviews by home-visit dentists and self-administered questionnaires. Nutritional status and dysphagia risk were evaluated using the Mini Nutritional Assessment Short Form and the Dysphagia Risk Assessment for the Community-dwelling Elderly.

Results

Among 874 respondents (345 men and 529 women), 24.6% were malnourished, 67.4% were at risk of malnutrition, and 8.0% were well nourished. Dysphagia risk was related to an increased likelihood of malnutrition at an old age, even after adjusting for covariates (PR = 1.30, 95% CI = 1.01–1.67).

Conclusion

Malnutrition is highly prevalent among community-dwelling frail older adults, and dysphagia risk is independently associated with malnutrition. Dysphagia may be an important predictor of malnutrition progression in aged populations.     

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults.METHODS We undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation.RESULTS Of older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (influenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.     

Tobacco use: a modifiable risk factor for dental disease among the elderly.

OBJECTIVES. Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS. Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS. Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS. Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.     

Colorectal cancer screening attitudes and practices in the general population: a risk-adjusted survey.

OBJECTIVES: To characterize self-reported colorectal cancer (CRC) screening behavior, and to identify characteristics of CRC screening practices, stratified by risk. METHODS: Using random-digit-dial methodology, we conducted telephone surveys in US adults 50 years of age and older. Respondents provided data on utilization of CRC screening tests; demographic characteristics; and awareness, concerns, attitudes and beliefs about the tests, CRC, and health care. On the basis of available guidelines, three definitions of adequate screening were considered. RESULTS: Among persons reporting having ever had a CRC screening exam, the exam was more likely to have been a fecal occult blood test than a radiologic or endoscopic exam (p < .0001). Subjects at increased CRC risk were more likely to have met the screening criteria (p < .001) compared with average-risk subjects. Receipt of information or advice about cancer screening tests, male gender, and concern about managed care were positively associated with adequate screening. Smoking, low health self-monitoring, and an average risk for CRC reduced the probability of CRC screening. CONCLUSIONS: Lack of awareness about screening remains common, regardless of CRC risk. Providing information and advice about cancer screening may be the single most important tool available to improve screening rates.     

Toward improving the oral health of Americans: an overview of oral health status,resources, and care delivery. Oral Health Coordinating Committee,Public Health Service.

Dental and oral diseases may well be the most prevalent and preventable conditions affecting Americans. More than 50 percent of U.S. children, 96 percent of employed U.S. adults, and 99.5 percent of Americans 65 years and older have experienced dental caries (also called cavities). Millions of Americans suffer from periodontal diseases and other oral conditions, and more than 17 million Americans, including 10 million Americans 65 years or older, have lost all of their teeth. Preventive dental services are known to be effective in preventing and controlling dental diseases. Unfortunately, groups at highest risk for disease--the poor and minorities--have lower rates of using dental care than the U.S. average. Cost is the principal barrier to dental care for many Americans. Of the $38.7 billion spent for dental services in 1992, public programs, including Medicaid, paid for less than 4 percent of dental expenditures. More than 90 percent of care was paid for either out-of-pocket by dental consumers or through private dental insurance. Americans are at risk for other oral health problems as well. Oropharyngeal cancer strikes approximately 30,000 Americans each year and results in an estimated 8,000 deaths annually. Underlying medical or handicapping conditions, ranging from rare genetic diseases to more common chronic diseases, affect millions of Americans and can lead to oral health problems. Among persons with compromised immune systems, oral diseases and conditions can have a significant impact on health. Oral diseases and conditions, though nearly universal, can be prevented easily and controlled at reasonable cost.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dental Care Coverage and Use: Modeling Limitations and Opportunities

Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.According to 1 report, about 48% of adults with any private health insurance during 2000 had at least 1 dental visit, compared with about 29% of those with public health insurance and only 19% of those who were uninsured for the full year.1 The health insurance and dental care use association appears weak until one realizes that the insurance in question is actually medical insurance and not dental insurance. So, in fact, the reported rate is below that of other findings, which show that about 56% of adults with any private dental insurance had at least 1 dental visit, compared with about 22% of those who were uninsured for the full year.2 That there is any relationship between having medical insurance and seeking dental care at all is surprising because few medical insurance plans cover dental care services.3 Because medical insurance does not usually provide reimbursement for dental care, the medical insurance variable must represent some non–insurance-related unobserved health-seeking behavior that results in increased dental care use. However, several studies have examined the relationship between dental insurance coverage and dental care use, controlling for numerous socioeconomic and demographic variables.4–12 These studies show that, as expected, dental insurance is an important factor in the decision to seek and use dental services.Although the role of dental insurance coverage as a determinant of dental care use is now well established, less is known about the magnitude of its effect or how its effect may be modulated by other observed or unobserved factors. In 1 study, analysts measured the extent of the dental care coverage effect by analyzing Medical Expenditure Panel Survey data. Their results showed that the effect of dental care coverage is significant and increases the likelihood of a dental visit by 13%.13 A study examining Health and Retirement Study (HRS) data found that providing universal dental care coverage for an older US population would increase dental care use only 1% to 8% after applying a nonparametric approach to account for errors in measuring self-reported dental care coverage and unobserved factors for aversion to risk and future dental care needs (B. Kreider, J. Pepper, R. Manski, and J. Moeller, unpublished data, 2012). In this study the increase in dental care use was significant but not as large or far-reaching as initially expected. Although the analyses confirmed that dental care coverage increases the likelihood of dental care use, the results also suggested that the effect of providing dental care coverage on use may be surprisingly lower than expected.We have provided empirical evidence and a theoretical model to help explain why the effect of dental care coverage on use may be less than expected and to more fully describe dental care use in relation to dental care coverage and other relevant determinants of use. Our findings may help research analysts, program developers, and policy planners better understand problems associated with policies and programs designed to encourage greater use of dental care among the population.     

Dental Care Coverage and Use: Modeling Limitations and Opportunities

Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage.Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use.Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth.Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use.According to 1 report, about 48% of adults with any private health insurance during 2000 had at least 1 dental visit, compared with about 29% of those with public health insurance and only 19% of those who were uninsured for the full year.1 The health insurance and dental care use association appears weak until one realizes that the insurance in question is actually medical insurance and not dental insurance. So, in fact, the reported rate is below that of other findings, which show that about 56% of adults with any private dental insurance had at least 1 dental visit, compared with about 22% of those who were uninsured for the full year.2 That there is any relationship between having medical insurance and seeking dental care at all is surprising because few medical insurance plans cover dental care services.3 Because medical insurance does not usually provide reimbursement for dental care, the medical insurance variable must represent some non–insurance-related unobserved health-seeking behavior that results in increased dental care use. However, several studies have examined the relationship between dental insurance coverage and dental care use, controlling for numerous socioeconomic and demographic variables.4–12 These studies show that, as expected, dental insurance is an important factor in the decision to seek and use dental services.Although the role of dental insurance coverage as a determinant of dental care use is now well established, less is known about the magnitude of its effect or how its effect may be modulated by other observed or unobserved factors. In 1 study, analysts measured the extent of the dental care coverage effect by analyzing Medical Expenditure Panel Survey data. Their results showed that the effect of dental care coverage is significant and increases the likelihood of a dental visit by 13%.13 A study examining Health and Retirement Study (HRS) data found that providing universal dental care coverage for an older US population would increase dental care use only 1% to 8% after applying a nonparametric approach to account for errors in measuring self-reported dental care coverage and unobserved factors for aversion to risk and future dental care needs (B. Kreider, J. Pepper, R. Manski, and J. Moeller, unpublished data, 2012). In this study the increase in dental care use was significant but not as large or far-reaching as initially expected. Although the analyses confirmed that dental care coverage increases the likelihood of dental care use, the results also suggested that the effect of providing dental care coverage on use may be surprisingly lower than expected.We have provided empirical evidence and a theoretical model to help explain why the effect of dental care coverage on use may be less than expected and to more fully describe dental care use in relation to dental care coverage and other relevant determinants of use. Our findings may help research analysts, program developers, and policy planners better understand problems associated with policies and programs designed to encourage greater use of dental care among the population.     

Disparities in Unmet Dental Need and Dental Care Received by Pregnant Women in Maryland

To examine prenatal dental care needs, utilization and oral health counseling among Maryland women who delivered a live infant during 2001–2003 and identify the factors associated with having a dental visit and having an unmet dental need during pregnancy. Pregnancy Risk Assessment Monitoring System is an ongoing population based surveillance system that collects information of women’s attitudes and experiences before, during, and shortly after pregnancy. Logistic regression was used to model dental visits and unmet dental need using predictor variables for Maryland 2001–2003 births. Less than half of all women reported having a dental visit and receiving oral health advice during pregnancy. Twenty-five percent of women reported a need for dental care, of which 33 % did not receive dental care despite their perceived need. Multivariate modeling revealed that racial minorities, women who were not married and those with annual income <$40,000 were least likely to have a dental visit. Women who were not married, had low annual income, were older than 40 years of age, had an unintended pregnancy and received prenatal care later than desired were most likely to have an unmet dental need during pregnancy. Despite reported needs and existing recommendations to include oral health as a component of prenatal care, less than half of pregnant women have a dental visit during their pregnancy. One-third of women with a dental problem did not have a dental visit highlighting the unmet need for dental care during pregnancy.     

Self-rated oral health among Brazilian adults and older adults in Southeast Brazil: results from the SB-Brasil Project, 2003

The aim of this study was to determine which characteristics (predisposing and enabling, oral health, perceived need for dental treatment, and behavior) are independently associated with self-rated oral health among adults and older adults in Southeast Brazil. The study was based on 3,240 participants in the SB-Brasil Project/ Southeast. The characteristics of those who rated their oral health as good/very good were compared to those who rated it as fair, poor, or very poor. The following characteristics were significantly and independently associated with better self-rated oral health among adults: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, place of residence in cities with > 50,000 inhabitants, and visit to the dentist > 3 years previously. Among older adults the factors were: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, and 1-19 permanent teeth. Our results confirm those observed in other countries, showing associations between self-rated oral health and predisposing and enabling factors, oral health, perceived need for dental treatment, and behavior.     

A dietary screening questionnaire identifies dietary patterns in older adults

Dietary patterns reflect habitual exposure of foods and nutrients and are a preferred means to assess diet and disease relations. Our objective was to design a screening tool to assess diet quality and dietary patterns among older adults and to relate the patterns to markers of general health and nutrition status. We used a population-specific data-based approach to design a diet screening instrument that was tested among subjects sampled from the Geisinger Rural Aging Study cohort (n=205). All participants attended a local clinic and had biochemical, anthropometric, and other health data collected. Dietary information was obtained via 24-h recall. We used principle components analysis to derive dietary patterns, which were then compared with nutritional outcomes using Pearson partial correlations, controlling for energy, age, BMI, and supplement use. Two dietary patterns were derived; 1 represented by more healthful foods and 1 by less optimal food choices. The healthy pattern was associated with more favorable biomarkers, more nutrient-dense diets, and lower waist circumference, whereas the converse was true for the second pattern. A screening tool can be used by older adults to identify dietary patterns that may relate to nutritional risk.     

Burden of Oral Disease Among Older Adults and Implications for Public Health Priorities

Dental disease is largely preventable. Many older adults, however, experience poor oral health.National data for older adults show racial/ethnic and income disparities in untreated dental disease and oral health–related quality of life. Persons reporting poor versus good health also report lower oral health–related quality of life.On the basis of these findings, suggested public health priorities include better integrating oral health into medical care, implementing community programs to promote healthy behaviors and improve access to preventive services, developing a comprehensive strategy to address the oral health needs of the homebound and long-term-care residents, and assessing the feasibility of ensuring a safety net that covers preventive and basic restorative services to eliminate pain and infection.Oral health is vital to the general health and well-being of all Americans.1 The mouth reflects a person''s health and well-being throughout life. Oral diseases can have an impact on many aspects of general health and health conditions can in turn have an impact on oral health. Oral and other diseases also share common risk factors. Because the risk of chronic conditions increases with age, it is important to examine the interplay of these diseases with oral disease, and their combined impact on overall health among older adults.We describe the scope of the problem of dental and periodontal diseases among older adults and how they can profoundly diminish quality of life and have an adverse impact on general health. Next, we characterize the burden of oral diseases with current national data and published studies. Finally, we explore roles for the public health system in improving the oral health of older US adults. Although oral cancer disproportionately affects older adults and has a high burden,2 it is excluded because of space constraints.