Aging is the physiologic change that occurs over time. In humans, this change occurs at different rates and are related to lifestyle, environment and genetics. It can be challenging to differentiate normal aging from disease. In the oral cavity, with increasing age the teeth demonstrate wearing of the enamel, chipping and fracture lines, and a darker color. The pulp chamber and canals are reduced in size as a result of the deposition of secondary dentin. Coronal or root caries, however, represent disease. A limited amount of periodontal attachment loss occurs in association with aging, usually manifesting as recession on the buccal surface of teeth. Severe periodontitis occurs in 10.5-12% of the population, with the peak incidence being observed at 35-40 years of age. Changes to the mucosal tissue that occur with age include reduced wound-healing capacity. However, environmental factors, such as smoking, dramatically increase the risk of mucosal pathology. Reduced salivary gland function is often seen in association with medication usage, as well as with disorders such as diabetes mellitus. Both medication use and chronic disorders are more common in older adults. Masticatory function is of particular importance for older adults. Maintenance of a nutritionally complete diet is important for avoiding sarcopenia and the frailty syndrome. Successful oral aging is associated with adequate function and comfort. A reduced, but functional, dentition of 20 teeth in occlusion has been proposed as a measure of successful oral aging. Healthy oral aging is important to healthy aging from both biological and social perspectives.

Many factors contribute to human tooth loss, including oral hygiene practices, trauma, smoking, health status, socio-economic status and individual preferences. Loss of teeth impairs quality-of-life measures, including the eating of most foods that require full masticatory function. A recent study of centenarians found that at age 65-74 years, those who lived to be 100 had a lower rate of edentulism than did younger members of their birth cohort at ages 65-74 years. Oral health was consistent with compression of morbidity toward the end of life. This article explores the hypothesis that factors associated with oral disease and noncommunicable diseases may increase the risk of tooth loss and lead to diminished longevity as a result of multifactorial interactions. It specifically addresses two critical questions. The first is: 'Can we conclude that the number of teeth in aging humans can affect longevity and life expectancy?' The answer is yes. The second is: 'Is tooth loss a predictor of shortened longevity?' Again, the answer is yes. Edentulism and partial edentulism are discussed as a disability, and how the philosophy/belief systems of dental providers and patients toward retaining teeth influences the outcome of tooth loss is also examined. Osteoporosis and cognitive impairment provide examples of modifying risk factors.

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BACKGROUND Poor oral health has been associated with age-related diseases such as cardiovascular disease and diabetes. Given that centenarians and their offspring significantly delay or escape age-related diseases compared to their respective birth cohorts, we hypothesized that oral health is better in these two cohorts relative to published birth-cohort matched results for centenarians and in an offspring cohort referent sample. DESIGN Observational cross-sectional study. SETTING The New England Centenarian Study (NECS). PARTICIPANTS Seventy-three centenarians, 467 offspring, and 251 offspring generation referent cohort subjects from the NECS. MEASUREMENTS A self-report questionnaire measured oral health in all three groups, with edentulous rate as the primary outcome measure. Socio-demographic and medical history were made available by the NECS. Centenarian results were compared to published birth-cohort matched results. Data from offspring and referent cohorts were analyzed to determine differences in oral health and associations between oral health measures and specific medical conditions. RESULTS The edentulous rate of centenarians (36.5%) was lower than their birth cohort (46%) when they were ages 65-74 years in 1971-1974 (per National Center of Health Statistics). Adjusting for confounding factors, in comparison to the centenarian offspring, the referent cohort was more likely to be edentulous (AOR=2.78, 95%, CI=1.17-6.56), less likely to have all or more than half of their own teeth (AOR=0.48, 95%, CI=0.3-0.76), and less likely to report excellent/very good oral health (AOR=0.65, 95%, CI=0.45-0.94). CONCLUSION These findings support the hypothesis that centenarians and their offspring exhibit better oral health than their respective birth cohorts. Oral health may prove to be a helpful marker for systemic health and healthy aging.