The most common chronic and infectious adult disease in Canada (as measured by American data on the prevalence of chronic adult diseases), is dental caries. At age 55, the average Canadian has a 35% chance of having root caries17, a prevalence which exceeds that of hypertension, arthritis, mood disorders, heart disease and diabetes.18 At age 70, half of Canadians have this disease. The risks of root caries, particularly around existing restorations and at teeth where the gums have receded, grows with age, such that the patient's odds of getting this chronic, infectious disease are "his/her age less 20%".19
With the widespread use of fluoride and professional dental care, the distribution of dental caries has become concentrated or "clustered" in an at-risk population. One Canadian study of coronal caries in older adults over three years found that 57% were affected by this disease and 43% had no disease.20 In this Canadian study, 13.6% of older adults accounted for approximately 42.6% of the disease burden over 3 years.
Epidemiological surveys shows that the annual root caries increment and root + coronal caries increment in adults over age 45 exceeds that in children and adolescents.21, 22 Amongst adults aged 40 to 80 years of age in Boston who were taking a known xerogenic medication, the annualized mean root caries increment was 0.47 surfaces.23 The most recent longitudinal research on caries increment between age 55 and 75, moreover, shows that the "older old" are particularly vulnerable to this disease (Figure 1).24 There are also additional factors which promote this disease in an aging Canada (a) multiple medication use has been growing substantially such that (using American data) almost half of Canadian seniors now take 3 or more prescription drugs daily25- a level of poly-pharmacy associated with dry mouth;26 (b) frequency of carbohydrate intake during the day may increase with age.27
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