Ageing is a complex process reflecting changes that occur over the lifespan. Life expectancy has increased remarkably during the latter half of the last century. The number of persons aged 60 or above will rise from 962 million globally in 2017 to 2.1 billion in 2050 and 3.1 billion in 2100.
Recognising the manifestations of age changes in the oral and dental tissues can help clinicians distinguish healthy ageing changes from pathological conditions, even though the incidence and prevalence of several oral disorders and conditions, such as oral lichen planus, oral ulceration, oral potentially malignant disorders, and oral cancer, frequently increase with age.
Increasing evidence supports that osteoporosis contributes to the loss of teeth via loss of alveolar bone and potentially basal bone. It can be difficult to distinguish ageing changes from those of osteoarthritis. The use of bisphosphonates to treat osteoporosis has been found to increase the incidence of osteonecrosis of the jaw in some cases. This relationship has been established in different populations throughout the world.
With ageing, an individual may lose some or all of their teeth. Teeth become worn, and muscles of mastication may be subject to atrophy. These changes lead to impairments in oral function, particularly speech and mastication.
Physical maturity is reached in the early 20s, and subsequently human facial soft tissues begin to undergo changes not as a consequence of growth but due to the onset of ‘ageing’, which involves a gradual decrease in skin elasticity, reduction in subcutaneous fatty tissue volumes, increase in muscle tone, and the effects of gravity.
These factors lead to an increase in skin folds ‘wrinkles’, usually perpendicular to facial muscle fibre direction, and a decrease in overall facial volume. Facial soft tissue thickness varies between different regions of the face, generally being thinnest over the tip and bridge of the nose and infraorbital rim and thickest over the lips, chin, cheek, and lower jaw.
Oral cavity and tongue
The oral cavity has unique structures to perform functions necessary for life (e.g. speech, respiration, mastication, taste, digestion, and deglutition). Anatomical changes may impact these functions. Changes to the oral mucosa with ageing are often unrecognisable. However, ageing makes the mucosa more susceptible to local trauma and oral diseases. Age-related hyposalivation may alter the clinical appearance of oral mucosa substantially.
Neurological impairment increases with advanced age. Taste and smell sensitivities often decline with ageing and may be associated with reduced appetite as the food becomes tasteless. This decline is thought to be due to apoptosis of cells in the taste buds of the oral cavity.
This may affect nutritional status, as individuals may add abundant seasoning (particularly salt or sugar that have potential harmful effects), or they may prefer very hot foods, which may burn the gingiva or palatal mucosae.
Also, there are groups of elderly with certain disorders affecting their ability to taste either as a response to the prolonged use of medications or to the course of the disease itself. Examples of these disorders include mouth, nose, or sinus infections, gingivitis and periodontitis, cancer, and chronic kidney or liver disease. Medications to manage hypertension (e.g. ACE inhibitors), hypercholesterolemia (e.g. statins), and depression may also affect the sense of taste.
Functional variations in salivary glands
The functions of saliva include lubricating and maintaining the integrity of the oral mucous membrane, soft tissue repair, balancing pH buffering, maintenance of ecological equilibrium, maintenance of tooth integrity, and physical and immunological protection.
Although salivary flow is said to diminish as an age-related process, salivary production in healthy elderly patients remains stable. Gender and weight can influence salivary flow as these factors are correlated with the size of salivary glands.
Males and overweight healthy people have larger major glands and subsequently have higher salivary flow. Gender-related salivary flow variations become more obvious with ageing and beyond the age of 55. It is important to note that hormonal changes in postmenopausal females reduce unstimulated salivary flow remarkably. However, controversy surrounds the impact of menopause on saliva production. Interestingly, the use of hormone replacement therapy in postmenopausal females is said to result in recovery of salivary flow.
Key messages
- Recognising the manifestations of age changes in the oral and dental tissues can help clinicians distinguish healthy ageing changes from pathological conditions
- The incidence and prevalence of oral lichen planus, oral ulceration, oral potentially malignant disorders, and oral cancer increase with ageing
- Taste and smell sensitivities often decline with ageing and may be associated with a reduction of appetite as the food becomes tasteless.
– References available on request
Author competing interests – the author is co-author and co-editor of Contemporary Oral Medicine: A Comprehensive Approach to Clinical Practice published by Springer from which excerpts are cited in this article and referenced.