7 Common altered oral functions in the elderly

 

Growing old is a natural physiological process. Ageing comes with its set of difficulties. Apart from slowing down, there are several physiological changes that you will notice within yourself. Your mouth is no exception. You can lose teeth to gum infections or be at a increased risk of tooth decay. There are other altered changes in your oral functions that you will notice.

Some of the normal everyday functions that are altered include

  1. Lip posture—- angular cheilitis
  2. Chewing muscles—-Efficiency of chewing
  3. Tongue function—-Speech, traumatic bite injury, snoring, sleep apnea
  4. Swallowing—-difficulty in swallowing, regurgitation, choking
  5. Taste—-Loss of taste or decreased taste
  6. TMJ issues—-associated with loss of vertical height of the face
  7. Salivation—–some dryness of mouth or excessive salivation called “Drooling”

 

Angular Cheilitis

Angular Cheilitis is inflammation of one or both corners of the mouth. Excessive saliva can pool at the corners of the mouth and cause itching and pain. You can also experience some crusting. Generally, you will notice a redness at the corners of the mouth without bleeding. If you are a denture wearer, the chances of developing angular cheilitis is higher. Severe teeth wear or loss of height of dentures can create creases at the corners of your mouth. The reduced vertical height also changes the lip posture with an increase in facial laxity. Your dentist will help with restoring the height by making new dentures or adding height to teeth with inlays and crowns. Increasing the vertical height to its normal reduces pooling of saliva and thus helps heal the corners of the mouth.

Efficiency of chewing

The chewing efficiency reduces because of a decrease in the muscle activity in normal ageing. You then will try to compensate for this by increasing the duration of chewing. As with the other muscles of the body, your chewing muscles also lose their mass and strength with advancing age, thus making the “softer food” your choice. Loss of teeth can further make chewing difficult. All these can reduce the quantity of food intake and make you frail. A modified textured diet plan can help you overcome some of the issues associated with chewing difficulties.

Tongue function

Your tongue is a muscular organ made up of not just one but many muscles. And it continues to grow with age. Tradiationally, the tongue was regularly examined for changes to diagnose systemic conditions. In the elderly with toothless mouths, your tongue can assume many functions of the teeth to make a food bolus that is easy to swallow. This can overwork the tongue and cause fatigue. The number of taste buds on the tongue reduce, and cause a certain loss of taste. Speech can be affected, especially with loss of teeth. When the lip position changes and the tongue is unsupported, it falls back to the throat. This can cause snoring in your sleep and in severe cases lead to a condition called sleep apnea.

Swallowing

Swallowing is a normal process of pushing your food bolus down the throat and the food pipe. The tongue and the other mouth muscles help you with swallowing. However, with advancing age or other medical conditions swallowing can become difficult. This condition of difficulty in swallowing is called “Dysphagia”. Not all the elderly develop this, but the efficiency of swallowing can come down because of the weakening of the tongue and the throat muscles. Dysphagia can lead to

  • Malnutrition
  • Dehydration
  • weight loss
  • Loss of appetite
  • Aspiration Pneumonia

Loss of taste

You can experience some loss of taste and smell after 60. However, other conditions like sinusitis, smoking, dental problems ( like gum disease, inflammation, dry mouth or ill-fitting dentures ), certain medications, head injuries, Parkinson’s disease and Alzheimer’s can reduce your sense of taste. So, why can the elderly lose their ability to taste as effectively? Typically, tastebuds are replaced every week or two. But post 50, these cells lose their sensitivity and the ability to regenerate, thus reducing in numbers. Loss of taste can lead to loss of appetite and dietary changes, albeit unconsciously. Since loss of taste is due to other conditions and by itself is not the problem, talk to your health care provider, who will help you overcome this issue.

TMJ Issues

TMJ disorders are more prevalent in the elderly women than men. These symptoms can range from headaches, Pain in the joints, clicking sounds of the joint, ear pain, tinnitus, vertigo, orofacial pain and lock jaw. Generally, TMJ disorders can be because of

Salivation

We often assume that salivation reduces with advancing age. About 25% of the elderly can experience dry mouth and the related dental problems like tooth decay, difficulty in swallowing, sticky lips, speech difficulties, taste aberration and poor oral hygiene.

However, excessive salivation, also called as ‘Drooling’ is also a common problem in the elderly.

Saliva in your mouth is a medium for digestion, speech, swallowing, cleaning and various physical and chemical processes. The right amount and consistency of saliva is important for normal functions. With ageing, you can have excessive saliva that causes drooling. Inability to control the saliva can also cause drooling. This can be a social embarrassment to some. Although harmless, drooling can lead to local infections.

Causes of Drooling

Excess saliva can be a side effect of medications, such as tranquilizers, epilepsy drugs and anticholinesterases, often used in treatment of early dementia. Some diseases also cause excess saliva, especially Parkinson’s disease and some strokes.

Inability to control saliva is caused by weakness in the mouth muscles, such as after a stroke or with Bell’s palsy. People who have chronic nasal congestion also may develop drooling. People with swallowing disorders may have drooling.

Because of the multiple potential causes and potential for significant problems, drooling should be carefully evaluated. This may require multiple providers with different expertise, including the primary care doctor, a dentist, ENT doctor, speech and swallowing expert, and neurologist. The treatment depends on the underlying cause, but it can include medicines to reduce saliva production, physical, speech and occupational therapy, and surgery.

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