The journal of

PROSTHETIC
AND IMPLANT
DENTISTRY
Official Publication of Indian Prosthodontic Society
Kerala State Branch

GERIATRIC CARE IN PROSTHODONTICS

*Jithin GN, *Amalorpavam, **T Sreelal, ***Aparna Mohan,
***Giri Chandramohan, ****Allen Jim Hines

* P.G. Student, **Professor and Head, *** Reader, ****Senior Lecturer, Department of Prosthodontics, Sree Mookambika
Institute Of Dental Sciences, Kulesekharam. |Dr. Jithin GN, e-mail: [Link]@[Link]

the thought of impending medical & dental care

Abstract: or experience itself can affect the patient’s mind &
personality. The Prosthetic needs of our geriatric
-Dentists should recognize the oral problems that population are monumental & most probably will
affect the elderly, but treatment should extend
remain that way at least for the next generation1.
beyond replacement of diseased or missing parts.
Elderly persons may have special problems of tissue
deficiencies & mental & emotional disorders. These Classification of Geriatrics
are markedly different from those seen in young I. According to the psychologic reactions to aging
& middle-aged adults. Patient care for the elderly
process
requires special knowledge and special skills in
the same sense that babies and young children A. Realistic group
benefit from special knowledge and special skills.
B. Resentment group
The specialties of pediatrics & pedodontics came
into being to meet the needs of young persons. C. Resigned group
Similarly, a special area of patient care is rapidly
II. According to functional criteria (Ettinger and
arising as geriatric medicine and geriatric dentistry.
Beck 1984)
Keywords: geriatric dentistry, nutrition, A. Functionally independent elderly
treatment care.
B. Frail elderly
C. Functionally dependent elderly
Introduction
III Classification according to Winkler
As we are born, we grow old & as we grow old we
die. Aging is a normal life process. Age itself is not A. The hardy elderly
a contraindication for medical or dental treatment. B. The senile aged syndromes
Degenerative physiologic & biologic changes &
C. In between groups1
associated chronic diseases & disorders directly
or indirectly resulting from this deterioration make Aspects of aging :-
the patient a poor candidate for complete denture.
The geriatric person is one who has reached the It can be classified as:
age when important changes in bodily functions -Physiologic
occur. Their health and well-being pose a major -Psychologic
challenge to society and particularly to the persons -Pathologic
who are responsible for their care. Psychologically

JPID – The journal of Prosthetic and Implant Dentistry / Volume 2 Issue 2 / January–April 2019 / 61
The journal of Jithin GN, Amalorpavam, T Sreelal, Aparna Mohan, Giri Chandramohan, Allen Jim Hines

PROSTHETIC
AND IMPLANT
DENTISTRY
Official Publication of Indian Prosthodontic Society
Kerala State Branch

 Apart from occlusal, insical and interproximal

a) Physiologic changes
wear, there is also wear and loss of the structural
The more prevalent physiologic changes are loss details on the enamel surface.
or greying of the hair and diminution of the senses
 Formation of secondary dentin, which results in
of sight, hearing and taste. Skin becomes thin
gradual narrowing circumference of the pulp. The
wrinkled dry and freckled. The wrinkled skin of the
gradual obturation of dentinal tubules (dentinal
face, particularly around the mouth may be cause
sclerosis) by peritubular dentin changes.
for great mental anguish for some aging persons.
 With increasing age, the pulpal volume
Advanced age brings a loss of muscle strength.
decreases , apparent fibrosis of the pulp tissue
There is a generalised slowing down of normal
and a reduction in vasculature. The denervation
activity. A slowly progressive denervation of
causes impairment in pain.
muscles is a feature of aging process, consistent
with long contraction times and more slowly  Generally, restorative and prosthetic treatment
contracting muscles. The density and muscle mass of worn dentitions is difficult. It is often difficult to
decreases with replacement of muscle fibers by create sufficient vertical space for the prosthesis.
fibrous tissues. The most common systemic bone
condition occurring in both sexes is osteoporosis.  Plaque control becomes difficult due to lack of
It appears more frequently in women than in men. proper oral hygiene & periodontal status becomes
Back pain, loss of body height and face height, poor. It can occur due to systemic illness & various
stooping and some types of deformity are some other ailments.
of the symptoms. In advanced cases spontaneous  Loss of teeth and loss of taste sensations lead
bone fracture can occur. to malnutrition.

b) Psychological changes  Decrease in thickness of both the mucosa and

submucosa. The oral mucosal lining becomes
The reaction to other physiologic changes such as more susceptible to stress, pressure and disease.
senses, hearing, taste, neuromuscular function etc Although denture adaptation may be good the
can also cause personality changes, which can tissue resistance is poor, and inflammation and
be unpredictable. As people age, changes over even ulcerations can occur.
which they have no control take place in their social
lives. In many instances, these changes occur in  Tooth wear increase as the age increase and
a relative short period. is primarily due to the fact that the teeth have
functioned within the oral environment for a long
c) Pathologic changes period of time.

The pathologic disorders or changes most  As age increase the tongue size increases.
frequently encountered are metabolic, skeletal, Depapillation on apex and lateral borders along
muscular, circulatory, neoplastic and psychologic. with fissuring of tongue may be seen, further
To evaluate and treat the total patient, the dentist more there is a decrease in taste buds resulting
must know the basic factors that are involved in in decreased taste sensation.
the process and should discuss this with patients,
 Residual ridge in elderly undergoes resorption
to refer them for consultation to specialist1,2.
after tooth extraction. The resorption is a sequel
of alveolar remodeling due to altered functional
Intraoral Changes:
stimulus of bone tissue.

62 / JPID – The journal of Prosthetic and Implant Dentistry / Volume 2 Issue 2 / January–April 2019
The journal of Geriatric Care in Prosthodontics

PROSTHETIC
AND IMPLANT
DENTISTRY
Official Publication of Indian Prosthodontic Society
Kerala State Branch

 As a result of regressive changes in the salivary - Antibiotics

glands, particularly atrophy of the cell lining of the
- Chemotherapy
intermediate ducts, there is a decrease in salivary
flow in the aged2,3. - Radiation Therapy
Intra Oral Pathological changes - Aids
 Ill-fitting dentures lead to - Physical debilitation2,3.
-Inflammatory hyperplasia
The Geriatric Prosthetic Patient
-Papillary hyperplasia
The longer a patient retains some of his natural
Inflammatory hyperplasia can also be seen in teeth, the shorter time he will be edentulous and
patients with continuous denture wear. better the residual ridges will be. Patient motivation
cannot be underestimated. The patient must realize
 Unilateral swelling in the hard palate, in the
his need for prosthetic treatment, want dentures,
second bicuspid, and for molar area may be an
accept the prosthesis and attempt to learn to use
indicative of neoplasm of maxillary antrum.
it. The dentist, inturn must adapt his technique
 Purple discoloration and atrophy of the to fit the patient perhaps changing his original
superficial papilla of tongue can be indicative of diagnosis as treatment progress and concern
Riboflavin deficiency. himself with construction of a functional and
comfortable prostheses.
 Generalized cyanosis of the oral mucosa of
elderly suggests either heart or lung disease or • An elderly patient with only a few remaining
Polycythemia. bilaterally occluding posterior teeth who is
comfortable, has no difficulty eating and keep his
 Thinning of the mucosa of the geriatric patient teeth reasonably clean is often better left alone.
allows Fordyce’s spots to become more apparent. Perhaps a single partial denture would improve
function considerably.
 Red petechial areas of the buccal mucosa
may indicate a blood abnormality, a thinning or • A patient with advanced degenerative disorders
fragility of the blood vessel walls, or a disturbance or people under mental and physical stresses are
in blood forming organs. not good candidates for complete dentures.
 Macroglossia occurs in disturbances of the
endocrine glands as in hyperpituitarism or it can
Nutrition in Geriatric Patients
be due to relaxation of tongue musculature due Vitamin deficiencies in the elder population
to extraction of mandibular posterior teeth are apt to be sub clinical, but any body stress
may result in an individual having detectable
 Serous glands decrease in activity and saliva
symptoms. Individuals who have low calorie
becomes more mucous and ropy. When the salivary
intakes, ingest multiple drugs, or have disease
glands atrophy, the reduction of salivary flow
states that cause malabsorption are at higher risk
results in a dry mouth (xerostomia)
for hypervitaminosis. Free living older persons often
 Candidiasis can be seen in report low dietary intakes of vitamin D, vitamin E,
folic acid, calcium and magnesium. Oral symptoms
- Denture irritation of malnutrition are usually due to the lack of the
- Xerostomia vitamin B complex, vitamin C, iron or protein.

JPID – The journal of Prosthetic and Implant Dentistry / Volume 2 Issue 2 / January–April 2019 / 63
The journal of Jithin GN, Amalorpavam, T Sreelal, Aparna Mohan, Giri Chandramohan, Allen Jim Hines

PROSTHETIC
AND IMPLANT
DENTISTRY
Official Publication of Indian Prosthodontic Society
Kerala State Branch

With the measurements of serum metabolites of difficult to obtain. The risk of failure comprises poor
vitamin B12, a high prevalence of undiagnosed adaptation to denture wearing, caries, periodontal
vitamin B12 deficiency has been noted among the disease and mechanical failures. The major benefit
elderly population. Such deficiencies may even of treatment is improved masticatory efficiency in
lead to dementia in older adults. Folic acid plays cases of posterior tooth loss.
an important role in cell division and in red blood
cell formation. Anaemia results from deficient  Today the treatment with conventional complete
folate intake. Many drugs and alcohol affect dentures is normally restricted to edentulous
folic acid absorption and metabolism. Because patients who are not apt for treatment with an
of its role in collagen synthesis, ascorbic acid implant supported prosthesis for socioeconomic
(vitamin C) is essential for wound healing. Heavy or anatomic reasons or because of poor
smokers, alcohol abusers or persons with high general health status. The biologic risk factors
aspirin intake have a higher daily requirement for associated with the treatment are considerable
ascorbic acid. The denture wearing patient should and are associated with resorption of the residual
be encouraged to consume foods rich in vitamin ridge, destabilization of the occlusion, diverse
C daily. Vitamin E functions as an anti oxidant in pathologies in the denture contacting mucosa, and
cell membranes by acting as a scavenger of free the emergence of temporomandibular disorders.
radicals and preventing oxidation of unsaturated The modifications of the denture bearing tissues
cell phospholipids. Therefore elderly patients must and the temporomandibular joints are difficult to
have foods rich in vitamin E regularly. Magnesium control with prosthetic therapy and may result in
is a component of the body skeleton and plays an complete invalidation of the masticatory apparatus
important role in neuromuscular transmission. in the aged person.
A detailed history of the family constellation in  Treatment with over dentures supported by
which the patient lives, a history of the daily diet, natural roots is particularly indicated if there are few
a history of the daily activities of the prosthetic remaining teeth, there is severe loss of periodontal
patient are essential to the successful management attachment, or the teeth are unfavorably distributed
of the geriatric patient. On the basis of nutrient in the arch with natural roots as support, some
deficiencies reported in denture wearing patients, dental support for the prostheses is obtained, the
it may be reasonable to prescribe a low dose stability of the abutment teeth can be maintained,
multi vitamin – mineral supplement for certain and the denture can readily be modified if one
patients even though clinical signs of a nutrient or several abutments are lost. Further more
deficiency are lacking. For patients receiving maintaining roots beneath a denture is an efficient
dentures, a generic one –a –day vitamin tablet way to prevent bone resorption, provide better
that includes, vitamin, folic acid and vitamin B12 load distribution, and maintain the sensory feed
may be recommended1,4,5,6. back of periodontal receptors. If the patient’s
socioeconomic status is poor, rehabilitation with
Treatment Planning tooth-supported overdenture is a better alternative
than implant supported complete dentures1,4,5.
 Treatment with removable partial dentures is a
non-invasive and low cost solution for the prosthetic
rehabilitation of missing posterior teeth (Kennedy Conclusion
class I and Class II). A removable partial denture The elderly have both the greatest level of need
is also an excellent treatment modality in large for prosthodontic services and the greatest degree
tooth borne saddles (class III) where sufficient of complicating dental, medical and behavioral
retention and stability for a fixed partial denture is factors. Age alone is not a contraindication to
The journal of Geriatric Care in Prosthodontics

PROSTHETIC
AND IMPLANT
DENTISTRY
Official Publication of Indian Prosthodontic Society
Kerala State Branch

complex prosthodontic treatment; patients of References

advanced age may still have many years of
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life ahead, during which they will appreciate
prosthodontics. 3rd [Link] 580 -599
the aesthetic and functional advantages of a 2) Geriatric dentistry : The Problem, Maury Massler;JPD:
restored dentition. The dental aspects of planning 1976:40(3): 324-325
prosthodontic treatment for the older patient should 3) Geriatrics & Denture Patient, Charles Jamieson ;JPD:
focus on the integrity of individual teeth as well 1957:8(1): 1 – 13
as the potential contribution of each tooth to the 4) Prosthodontic treatment for edentulous patients- Zarb-
masticatory system. In this ways, the clinician Bolender
is best prepared to anticipate the full range of 5) Textbook of complete dentures- Heartwell

restorative occlusal and functional challenge likely 6) Nutrition and oral health- DCNA, April 2003.

to arise in the course of treatment.

JPID – The journal of Prosthetic and Implant Dentistry / Volume 2 Issue 2 / January–April 2019 / 65