Preventive dentistry
5th stage (College of Dentistry/University of Baghdad)
2021-2022
Lecture (27)
Assist. Prof. Shahbaa Munther. B.D.S., M.Sc. College of Dentistry/ University of Baghdad.
Geriatric dentistry
Aging is a normal physiological process that every living organism has to go through and
is considered to be 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 frail.
The aging process gives 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).
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c) An impaired immunologic system, as well as related increased incidence of neoplastic and
age-related autoimmune conditions.
Functional Status: functional assessment evaluates one's ability and limitations to complete
basic tasks of daily life.
• 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.
• Activities of Daily Living (ADLs): it defined the functional status. Activities of daily
living are those abilities that are fundamental to independent living, such as bathing,
dressing, toileting, transferring from bed or chair, feeding and continence.
• 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.
Common oral manifestation
Oral manifestations are classified into physiological changes and pathological conditions.
Physiological changes: include changes in teeth structure and changes in soft tissues.
Changes in teeth structure:
Enamel: increase the fluoride content in the superficial enamel. The thickness of the
enamel decrease over time, due to the many chewing cycles and cleaning with abrasive
dentifrices.
Dentin: The volume of dentin increases due to 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.
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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.
Changes in oral soft tissues:
Mucus membrane generally atrophies with age; the rate of atrophy depends on diet,
habits, dentures wear and oral hygiene
Increase keratinization of cheek and lips.
Decrease keratinization of palate.
Thinning in oral mucosa make it more easily damages and penetrated by some
substances in food, which may give rise to etching or burning.
Pathological condition: the most common oral diseases and disorders associated with
aging are: root caries, periodontal diseases, oral mucosal lesions, Xerostomia and Oral
cancer.
Root Caries
Root caries differs from coronal caries (enamel and dentin) in several aspects
(mineralization and bacterial invasion).
It appears to be more severe in males than females.
Most likely to affect the molar regions.
Risk factors:
1. Gingival recession.
2. Physical disabilities.
3. Existing restorations or appliances.
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4. Decreased salivary flow.
6 Medication.
7 Cancer therapy.
8 Low socioeconomic status.
9 Abrasion at the cementoenamel junction.
10 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.
3. Auto-cured and dual-cured glass ionomer cements.
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Periodontal disease:
• Reduction in vascularity, elasticity, and reparative capacity are some of the most common
underlying causes of periodontal diseases among old people.
• Increased number of gram-negative bacteria associated with gingivitis and periodontitis
including P. gingivalis and Fusobacterium nucleatum.
• Diabetic mellitus, tobacco smoking, dementia/Alzheimer’s disease, arthritis, Parkinson’s
disease, and coronary artery disease have all been linked to periodontal disease and should
be noted in the health history.
Oral Mucosal Lesions: as burning mouth syndrome, candidiasis, Geographic tongue
(benign migratory glossitis), Epulis fissuratum, Hairy tongue, Herpes simplex, Herpes zoster
(shingles), Leukoplakia, Lichen planus, aphthous and others are the most common oral
mucosal lesions among geriatric patients. However, any mucosal lesion that does not respond
as expected within an appropriate period of time or that persists despite all attempts to resolve
any underlying etiology should be biopsied to determine the diagnosis.
Xerostomia: is a subjective sensation of oral dryness and it may be associated with
salivary gland hypofunction and changes in salivary composition. It may result in avoidance
of certain foods that may lead to social avoidance and compromise nutritional status. There is
no cure or single treatment approach that is effective for all patients with symptoms of dry
mouth and/or salivary hypofunction. The management for the majority of these patients is
primarily symptomatic with goals to:
1. Prevent deleterious consequences of decreased or insufficient amount of saliva.
2. Attempt to stimulate salivary flow.
3. Alleviate symptoms in order to improve the patient’s quality of life
4. Saliva substitutes can be used.
Oral Cancer: person 65yrs of age and older are 7 times more likely to be diagnosed
with oral cancer than those less than 65years of age. They require follow up every six months to:
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1- Intra and extra oral examination.
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.
Preventive measures:
1. Dietary modifications that limit sugar intake only to meals.
2. Elimination or decrease of between meal snacking.
3. Maintenance of meticulous oral hygiene.
4. Use of patient- and professionally-applied topical fluorides (rinses, gels, and varnishes).
0.02% sodium fluoride daily mouth rinse and 0.4% stannous fluoride gel. For patient
with Xerostomia, it is recommended to rinse twice daily with a nonprescription 0.05%
sodium fluoride mouth rinse.
5. Frequent dental visits.
6. Patients with salivary gland hypofunction (SGH) are more susceptible to Candidiasis, so
antifungal drugs should be prescribed. It should be noted that many oral antifungal
medications contain high amounts of sucrose and are cariogenic. Therefore, high caries-
risk patients should use nystatin tablets, which contain lactose instead of sucrose.
7. Patients who wear complete or partial dentures and have oral candidiasis should
instructed to wear their prosthesis only in the daytime, clean them with a denture
toothbrush and disinfect them by soaking overnight in a nystatin suspension or
0.12%chlorhexidine gluconate.
