**5. The relationship between oral health and general health**

Caries and periodontal disease are thus more common than other chronic health conditions and increase in older age. Good oral health is an important aspect of general health and wellbeing contributing to self-esteem, dignity, social integration and nutrition.

#### **5.1 Oral health and nutrition**

Aging is a physiological process that affects in unique ways to each person. It is influenced by different factors such as social, economic, environmental conditions and lifestyle of the individual developed through the course of life. It represents a challenge for the professional due to the oral cavity is the first place of the body where the signs of the nutritional deficiencies are manifested clinically [50].

According to the WHO [51] malnutrition refers to "deficiencies, excesses or imbalances in a person's intake of energy and/or nutrients". Who enlists some of the causes that lead to malnutrition in older adults. See **Figure 2**.

It is important to highlight the fact that polypharmacy, chronic diseases and aspects associated to mental health also affect the nutritional status, circumstances that are frequently present in older adults. Poor oral health conditions in this group are associated with discomfort, pain and a reduced appetite, which lead to an inappropriate selection of aliment, with a low or none nutritional content. There is a reduced intake of harder foods, fruits, proteins, vegetables, fiber, vitamins and minerals and a high intake of cholesterol and saturated fat, which alters the nutritional status [52].

Dental loss is related to the reduction of masticatory ability, affecting the maximal biting force and leading to problems in bolus formation. As the number of teeth present in mouth diminishes, the bolus size increases, generating a swallowing dysfunction. This decline can impact seriously in older adult's health, resulting in of chronic disease like cardiovascular problems, diabetes, frailty, sarcopenia and an increased risk of malnutrition [53]. This last condition increases the risk of oral infections.

**Figure 2.** *Oral health and nutrition risk factors enlisted by the WHO [51].*
