Preventive Dentistry Assis. Prof.
Alhan Ahmed
College of Dentistry \ University of Baghdad
5th Grad Lec. 9
Preventive Measures for Elderly Population
Aging is a normal physiological process that every living organism must go through
and is inevitable in the cycle of life.
Geriatric dentistry, or Geriodontics, is the delivery of dental care to older adults
involving the diagnosis, prevention, and treatment of problems associated with normal
aging and age-related diseases. On average, people above the age of 65 years are
expected to suffer from one or more chronic medical conditions that require
consideration before initiating any dental treatment .
The "elderly" segment of the population is diverse and has been subdivided into
the following categories:
•People aged 65- 74 years are the new or young elderly who tend to be relatively
healthy and active.
•People aged 75 - 84 years are the old or mid-old, who vary from those being healthy
and active to those managing an array of chronic diseases
• People 85 years and older are the oldest-old, who tend to be physically frailer.
• Health Status: The study of aging includes not only diseases that cause morbidity
and mortality but also the conditions that cause disability and decline in independent
functioning.
The aging process give major results:
a) A reduced physiologic reserve of many body functions (i.e., heart, lungs, kidney).
b) An impaired homeostasis mechanism by which bodily activities are adjusted (i.e.,
fluid balance, temperature control and blood pressure control( .
c) an impaired immunologic system, as well as related increased incidence of
neoplastic and age-related autoimmune conditions.
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Oral Assessment: A patient’s teeth can demonstrate the lifestyle of the patient and can
perfectly reflect years of trauma from faulty tooth brushing, use of acidic and chemical
agents or even eating habits. The appearance and structure of the teeth tends to change
with time, and recognizing these patterns is the first step in the oral assessment of the
elderly patient. Often, there are some obvious changes in the thickness of the enamel
and dentin, the presence of gingival recession leading to a higher incidence of root
caries especially in teeth with crowns or bridges, and even reduced sensitivity to cold
or hot .
Changes of tooth Structure
Enamel: superficial increases in fluoride content with age, thickness of the enamel
decreases over time, due to the many chewing cycles and cleaning with abrasive
dentifrices.
Dentin: The volume of dentin increases through the apposition of secondary dentin on
the walls of the pulpal chamber and because of caries or dental excavation. Aged
dentin is more brittle, less soluble, less permeable, and darker than it was earlier in life.
Pulp: The size of the pulp chamber and volume of the pulpal tissue decreases with
reparative and secondary dentin.
Cementum: Calcification of the nerve canals increases with age, the cementum
volume within the alveolus increases gradually over time, notably in the apical and
periapical areas.
Oral Soft tissues: Mucus membrane generally atrophy with age. In mouth the rate at
which this occurs depends on diet, habits, dentures wear and oral hygiene.
Increase keratinization of cheek and lips
palate less keratinization
Thinner oral mucosa is more easily damages and penetrated by some substances
in food, which may give rise to etching or burning.
Root Caries: The nature of the root caries appears to be more severe in males and
most likely to affect the molar regions.
Risk factors:
1 .gingival recession
2. Physical disabilities
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3. Existing restorations or appliances
4. Decreased salivary flow
5. Medication
6 .Cancer therapy
7 .Low socioeconomic status
Other risk factors influencing the higher incidence of root caries among the older
patient include:
1. Abrasion at the cementoenamel junction,
2. fixed bridgework.
3 .removable partial dentures,
4. soft diets consisting of refined sugars and sticky, fermentable carbohydrates.
Root caries prevention and therapy include:
1. Application of topical fluoride,
2 .Dietary counseling,
3. Plaque control, and prevention of gingival recession.
Restorative dental treatment
Shallow root caries
1. Smoothing the compromised root surface,
2. improving access to oral hygiene,
3. applying a topical fluoride
Deeper compromised root caries: Need to be cleaned out and restored with a
restorable dental material. There are four types of materials currently used to restore
carious lesions on the root surfaces:
1. amalgam
2. composite resins
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3. auto-cured and dual-cured glass ionomer cements
Periodontal disease: The rate of periodontal disease progression partly related to the
mass and composition of the oral microbiota and the host's ability to respond to this
microbial population. Earlier identification of periodontal disease and risk factors will
be possible, as well as early treatment to help reduce disease progression and its
subsequent loss of teeth.
Local Anesthesia: Most restorative procedures can be done with no discomfort in the
absence of local anesthetic or with minimal infiltration of anesthetic, with the patient’s
consent.
Fluoride treatment: 0.02% sodium fluoride daily mouth rinse.
0.4% stannous fluoride gel
Oral Cancer: person 65yrs of age and older are 7 times more likely to be diagnosed
with oral cancer than under 65yrs of age. Fellow up every six months to:
1- Intra and extra oral examination
2- 2- Receive a thorough questioning regarding changes in oral conditions and
habits.
3- x- rays should be taken periodically.
4- When redness, irritation, bleeding, soreness, sensitivity to temperature changes
and/or chewing is present to such a degree that it interferes with daily routine or
persists for more than 2 weeks, the problem should be investigated. With early
diagnosis, the prognosis is much improved.
Systemic conditions and oral health
Nutritional Status: affect the periodontal condition.
Immunosuppression: higher risk for fungal infections, viral infections, oral
ulcerations.
Diabetes: accelerate periodontal disease, higher risk for fungal infections, periodontal
disease impacts glycemic control.
Dementia: oral hygiene often neglected, hard to localized oral pain
Arthritis: impaired manual dexterity leads to poor oral hygiene
Osteoporosis: accelerates tooth loss, increases frequency of denture
• Functional Status: functional assessment evaluates one's ability and limitations to
complete basic tasks of daily life
o Functional status is defined in terms of Activities of Daily Living (ADLs) are those
abilities that are fundamental to independent living, such as bathing, dressing,
toileting, transferring from bed or chair, feeding and continence.
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Instrumental Activities of Daily Living (IADLs) are more complex daily activities
such as using the telephone, preparing meals, and managing money.
The individual's ability to complete ADLs and IADLs will affect the person's ability
to access and maintain their oral health care regimen.
