Recognition and management of oral health problems in older adults by physicians: a pilot study.

Oral health problems are among the most common chronic health conditions experienced by older adults. Healthy People 2000, an initiative to improve the health of America, has selected oral health as a priority area. l About 11 of 100,000 persons have oral cancer diagnosed every year.2 The average age at which oral cancer is diagnosed is approximately 65 years, with the incidence increasing from middle adulthood through the seventh decade of life. l -3 Even though the mortality rate associated with oral cancer (7700 deaths annually)4 ranks among the lowest compared with other cancers, many deaths from oral cancer might be prevented by improved case finding and referral. Because oral cancers and other important conditions can be detected with a simple oral cavity examination, the US Preventive Services Task Force and the American Cancer Society both recommend oral screening for all adults.2 An important question yet unanswered is how best to implement screening oral examinations. Older adults have one of the lowest utilization rates of dental services for any age group.5 Only 35 percent of patients 75 years or older visit their dentist at least annually, but nearly 90 percent see physicians.6 Physicians, however, are often limited in their awareness of the spectrum and clinical relevance of oral health problems in their older patients.4 Several studies have cited the need to improve and integrate educational standards on oral health care in primary care physicians' training programs. This emphasis is due in part to assessments