Geroscience: Aging and Oral Health Research

Abstract

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

Keywords: cognitive dysfunction; delivery of health care; loneliness; nutritional status; periodontal diseases; tooth loss.

Figure 1.

Aging is the greatest risk factor for most diseases. Forty years of biological aging has a much greater impact on risk of death from cancer (all types), heart disease, COVID-19, or Alzheimer’s disease compared to other common risk factors. Risk values for alcohol, smoking, obesity, hypertension, and APOE (e4/e4) are an approximation from surveying published studies. Risk resulting from 40 y of aging between ages 45 and 85 is shown and was obtained as the ratio of the risk of death for each condition at age 85 divided by the risk of death at age 45 as listed in the US Centers for Disease Control Wonder Database for 2020. In 2020, heart disease, cancer, and COVID-19 were the 3 most common causes of death in the United States.

Figure 2.

Interconnected hallmarks of aging. The hallmarks of aging represent several interacting processes that are shared features of biological aging across the animal kingdom. These hallmarks represent potentially useful targets for therapeutic intervention to increase health span and prevent age-related disease. The hallmarks of aging should not be considered a comprehensive explanation of biological aging but instead serves as a conceptual framework for our current understanding of the aging process.

Figure 3.

Slowing aging is more effective than curing disease. The impact of curing disease on life expectancy for a typical 50-y-old woman in the United States can be estimated from data collected by the Centers for Disease Control and Prevention. Curing either of the 2 largest killers (cancer and heart disease) increases life expectancy by 3 to 5 y and curing them both by less than 10 y. In contrast, delaying aging to an extent comparable to the effects of rapamycin or caloric restriction on life span in rodents has a proportionally much larger effect on life expectancy, with the added benefit that most of those years are spent in good health, free from chronic disease and disability. Figure generated from data presented in Lombard et al. (2016). Coloring illustrates hypothetical impact on health expectancy in each case, where green represents absence of comorbidity and red represents severe comorbidity.

Figure 4.

Multilevel influences of aging and adult oral health (modified from Fisher-Owens et al. 2007). This model is a depiction of many of the “Aging and Oral Health” topics covered during the 2023 AADOCR Meeting within a Meeting. It is not meant to include all aspects of aging.

Figure 5.

Translational science spectrum (NIH, NCATS 2021).