Editorial 

The growing number of elderly people in the population poses a demanding scientific and diagnostic problem in dentistry. With increasing age, the human oral mucosa gradually undergoes discrete, subtle and sometimes indiscernible clinical changes. The problem is that it is difficult to separate age-related changes from the effects of diseases, nutrition, medication, trauma, or infection. The oral mucosa becomes successively thinner, smoother, and dryer with age. The reduced elasticity, blood supply and keratinisation may increase the risk of injuries. However, scientific explanations of the causes of these changes remain sparse. The evidence on the age-related nature of the changes that does exist is contradictory and needs further clarification. While there is evidence concerning the reduction in quality, as well as in quantity of saliva produced by all salivary glands (which is reduced in volume by 30-50% in elderly individuals), many of these changes could equally be related to various diseases and medications.

Malnutrition in a population is more prevalent among its elderly. As such, the elderly would seem to be at greater risk of suffering from atypical or severe oral signs and symptoms because of age-related atrophy of the oral mucosa. Infections caused by molds like Candida albicans are common among the elderly, but when the individual is additionally malnourished or weak, more severe erythematous or pseudomebranous forms will be present. Could it be that the increasing adhesion of mould and bacteria to the oral mucosa, as well as its reduced permeability - perhaps factors associated with ageing - explain the severe appearance observed? People with removable prostheses may suffer from denture stomatitis, hyperplasias, and/or ulcerations, all of which can take on a far more severe form in the elderly than otherwise. This raises the question whether the severity of the condition is a result of aging, or of delaying the request for treatment, either out of fear or perhaps the long-suffering acceptance of fate. Premalignancies, like leukoplakias and lichen planus, are common findings in the elderly population. The risk for malignant transformation and its obvious seriousness, can be influenced by the aging process, for example by weakened immune reaction or infections.

It is often easier to detect signs of aging in the human skin than in the oral mucosa, which raises the question, whether moisture and humidity are protective mechanisms. As long as the ageing individual is healthy, the oral mucosa is kept moist and well lubricated by saliva, making the effects of mucosal atrophy, reduced elasticity and blood supply, keratinising changes, and age-dependant reduction in immune defense, difficult to detect. Or are these changes dependant instead on other factors like decreasing innervation - for example, reduced amount of telomers, factors yet to be studied in the oral mucosa? Or are the undetectable changes in the superficial mucosa a function of growth factors added by the saliva?