Bacterial Colonization of Saliva and Plaque in the Elderly

The growth of the geriatric portion of the population of North America is a well-established fact. In the 1990s the needs of people over the age of 60 have become a major focus of health care in the United States and Canada. The care of these patients is a major cost factor faced by many health care planners. Older people are keeping their teeth longer, so the need for dental treatment of caries and periodontal disease persists well into old age. The increased use of multiple medications in the elderly may be particularly detrimental since it exacerbates the tendency toward xerostomia [1, 2]. The increased use of prosthetic devices, oral radiation, and immunosuppressive agents renders the elderly vulnerable to more-serious complications of oral infection or bacteremias of oral origin [3]. The presence of antibiotic-resistant flora may complicate the prophylaxis needed to prevent seeding of prosthetic devices or cardiac valves during dental or oral procedures [4]. In geriatrics, the cooperation of physicians, dentists, oral biologists, and immunologists is critical for the integration of emerging information on salivary and oral flora. Dental care givers know about the connections among Streptococcus mutans, saliva, and decay [5] and between key anaerobic flora and periodontal disease [6-8]. Since functionally impaired elderly patients often receive poor oral care [9], they can also have salivary or pharyngeal bacterial colonization with aerobic flora such as gram-negative aerobic bacilli or staphylococci.