International Journal of Applied Dental Sciences 2022; 8(4): 207-210

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2022; 8(4): 207-210 Prosthodontic management of geriatric patients
© 2022 IJADS
www.oraljournal.com
Received: 07-11-2022 Dr. Snehal Laxman Shinde, Dr. Manisha Mangesh Kulkarni, Dr. Shivani
Accepted: 12-12-2022
Shivajirao Deshmukh and Dr. Amrita P Bhatia
Dr. Snehal Laxman Shinde
Postgraduate Student,
DOI: https://doi.org/10.22271/oral.2022.v8.i4c.1765
Department of Prosthodontics,
Crown and Bridge, Y.C.M.M. & Abstract
R.D.F.’S. Dental College and Aging is a natural part of becoming older. The need for dental care does not usually increase with age. In
Hospital, Ahmednagar, addition to working to extend people's lives, healthcare workers should focus on improving the quality of
Maharashtra, India life in their golden years. The loss of a tooth may have a devastating effect on your ability to chew, as
well as your self-esteem and oral health. Age, illness, trauma, metabolic problems, and dietary
Dr. Manisha Mangesh Kulkarni inadequacies are only few of the causes of excessive bone resorption. Focal infections in the mouth and
Reader, Department of systemic disorders are the main causes of alveolar bone resorption, particularly in medically impaired
Prosthodontics, Crown and individuals. Dental treatment for elderly patients who are coping with several medical conditions,
Bridge, Y.C.M.M. & R.D.F.’S.
including those that are long-term and severe, and include pharmacological and psychological side
Dental College and Hospital,
Ahmednagar, Maharashtra,
effects, is known as geriatric dentistry. The purpose of this article is to give a summary of the many
India factors that must be considered while providing dental care to an elderly patient, as well as strategies for
cultivating the appropriate mentality toward dental care for this population.
Dr. Shivani Shivajirao Deshmukh
Postgraduate Student, Keywords: Geriatric, prosthodontist, dental treatment
Department of Prosthodontics,
Crown and Bridge, Y.C.M.M. & Introduction
R.D.F.’S. Dental College and
Due to the fact that not everyone ages at the same pace, we may distinguish between a person's
Hospital, Ahmednagar,
Maharashtra, India "biologic age," or the age of his tissues, and his "chronologic age," or the amount of time that
has passed since his birth. Traditionally, those 65 and higher have been considered part of the
Dr. Amrita P Bhatia senior population; however, due to significant individual differences in physical, mental, and
Head of Department, medical health, this chronological age criteria has limited use in the field of dentistry. The key
Department of Prosthodontics,
factors that determine the quality of life for a senior citizen are that person's physical and
Crown and Bridge, Y.C.M.M. &
R.D.F.’S. Dental College and mental health [1]. Chronic sickness in the elderly may wreak havoc on the patient's ability to
Hospital, Ahmednagar, enjoy the finer things in life, such as socializing, getting out and about, and, of course, eating.
Maharashtra, India Therefore, the dentist plays a crucial role in geriatric care by ensuring or enhancing the oral
health of patients.

Terminologies [2]
Geriatric Dentistry: Adults who suffer from a serious mental or physical condition and have
accompanying psychosocial issues are given access to dental treatment. (1989 January
D.C.N.A.)
Geriatrics: The medical or dental specialty concerned with the care of elderly patients,
including the diagnosis and management of age-related conditions including senescence and
senility. (D.C.N.A., January 1989)

Classification
Rowe and khan classified aging into
Corresponding Author:
Dr. Manisha Mangesh Kulkarni 1. Successful aging: Persons appear younger and more vigorous then their stated age.
Reader, Department of 2. Usual aging: Person without clinical disease show physiologic changes approximating the
Prosthodontics, Crown and mean.
Bridge, Y.C.M.M. & R.D.F.’S.
Dental College and Hospital, Etting and Beck divided the elderly into three groups: [3]
Ahmednagar, Maharashtra,
India 1. The new elderly (between 60 and 64 years of age)
2. Transition group (between 65 and 75 years of age)
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3. The older elderly (75 years of age and old) people with craniomandibular disorders of arthrogenous
etiology [15]. Anatomic, metabolic, and mechanical factors are
Ettinger and Beck also classified according to functional hypothesized to all have a role in the development of RRR,
needs [4] making it a multifactorial, biomechanical illness.
1. Functionally independent elderly
2. Frail elderly Pharmacologic considerations in geriatric dentistry
3. Functionally dependent elderly The cautionary axiom, “Go low, go slow” is often quoted in
the management of geriatric health care. Drug administration
Janet Yellowitz and Michele J Saunders classification [5] in the dentist office for elderly patients calls for extra caution.
1. Well elderly Physiological changes with age, as well as pharmacokinetic
2. Frail elderly and pharmacodynamic abnormalities, may drastically reduce
3. Functionally dependent elderly the margin of safety, or therapeutic window, in which the
4. Severely disabled, medically compromised elderly medicine is safely effective. Safe and effective medication
prescription may be achieved by consultation with the
Biological basis of aging patient's physician [16].
Criteria of biological aging: Universality, Time dependence,
Intrinsically, Deleteriousness [6]. The basis of these biological Table 1: Drugs prescribed by dentist and Condition precipitated or
processes are Changes in various macromolecules, The exacerbated
inability to maintain homeostasis as we age is the last and Condition precipitated or
most crucial stage in the cascade of biological changes Drugs prescribed by dentist
exacerbated
associated with aging; this eventually results in the death of Pilocarpine Asthama
the person and cannot be reversed. [7]. Congestive heart failure,
NSAID
Hypertension, Peptic ulcer
Immunology and aging Glucocorticoids
Diabetes mellitus,
Illnesses with a late-life peak incidence, such as neoplasia, Osteoporosis
infectious illnesses, autoimmune disorders, and Benzodiazepines Barbiturates,
Organic brain syndrome
immunological complex diseases, may have a role for age- Anticholinergic agents
related immune activities in their etiology. B cell reactivity to Aspirin Gout, peptic ulcer
activation with certain T cell-dependent antigens dramatically
declines with increasing age. In whole saliva of older adults, Psychological considerations for geriatric patients
there appear to be a tendency for levels of all three antibodies Meet the patient's thoughts before you meet their lips," De
(IgG, IgA, IgM) to decrease gradually. Autoimmunity to type Van said. Therefore, we realize that the patient's perspective
I collagen increases in periodontal disease. The age-related and beliefs might affect the result of the therapy. Both the
imbalance in T cell subsets may contribute to periodontal disengagement theory and the activist theory of aging are
disease in the elderly. [8, 9]. prominent in social gerontology [17]
In 1950, Dr. MM House divided patients' mental states into
Physiology of aging four categories [18].
Gillian Hoad-Reddick detailed the difficulties the elderly
encounter, including mobility issues, anxiety, and health Class I: Philosophical
concerns including deafness, impaired eyesight, blindness,
incontinence, and diabetes. Conditions (such as those Class II: Exacting
involving the heart, which may increase anxiety or extend the
time needed for dental treatments, or both. An understanding Class III: Hysterical
of these changes can help the dental staff to modify patient
management and treatment facilities to create an enhanced Class IV: Indifferent
dental office environment that will more satisfactorily
accommodate the older patient [10]. Sharry classification [19].
1. Tolbuds: Patients who were able to adapt to wearing
Age changes in the masticatory apparatus their prosthesis in any orientation.
The teeth, gums, tongue, and cheeks make up the masticatory 2. Tolad: Patients who, with certain alterations, could be
apparatus. salivary glands, nerves and muscles, jaws, and able to live with a prosthetic.
TMJ. The enamel on your teeth may become more 3. Toln: Chronically ill patients who were able to take
impermeable and brittle as you become older. Secondary absolutely nothing in.
dentin formation: when secondary dentin develops, the pulp's
radial diameter gradually decreases. It may be considered an Nutrition for geriatric denture patients
appropriate host response to prevent pulp reactions or pulp In every era, the reward has been the same: the achievement
exposure in association with caries or heavy tooth wear, of perfect health. Substrates from food are required for the
which may also lead to a reduction in sensitivity [11, 12, 13]. An expression of inherited traits.
inflammatory response often results in pulp necrosis and The revised food pyramid [20]: People aged 70 and above now
infection at the apex and the surrounding bone, and the pulp have access to a revised food pyramid that takes into account
in the elderly has low resistance. An inflammatory response their specific nutritional requirements.
often results in pulp necrosis and infection at the apex and the
surrounding bone, and the pulp in the elderly has low Treatment planning in older adults
resistance [14]. Victor J. Miller found that the vertical condylar The main objective of prosthetic treatment and care is the
asymmetry index decreased with patient age in a group of maintenance of existing natural functional tooth contacts for

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life. In treatment planning for frail and dependent residents, it 3. Create uniform emergence profiles for your teeth and
is a challenge to respond to changes in their behavior and gums
decreased cooperation by improving the effectiveness of 4. Reestablish interproximal contact morphology.
collaboration with the health care team. 5. Maintain the status quo of your teeth and bite.
 Treatment with removable partial dentures is one of the 6. Make sure that any repairs blend in with the existing
possible restoration options for partially edentulous building's aesthetic [26].
patients. The essential design principles for removable  Osseointegrated implants can and should be prescribed
partial dentures are proper support, minimal gingival for elderly patients; osseointegration can be maintained
coverage, use of rigid connectors, and simplicity [21]. as patients age despite physical and medical frailty; the
 Overdentures have become more popular as a principles of osseointegration can be reconciled with
replacement for traditional complete dentures in various prosthodontic techniques to help make this
individuals with insufficient tooth structure left to support treatment accessible to older adults [27].
either fixed or removable partial dentures. [22, 23].
There are three major purposes for implant therapy
Principles of overdenture support [24] 1. So that the patient has an easier time chewing.
2. In order to protect the remaining tooth structure or an
Table 2: Principles of overdenture support existing restoration.
Overdenture with support of natural Overdenture supported by 3. The aim is to switch out certain key abutments.
roots implants
Prevent resorption of alveolar bone Preventive measures & maintenance care after treatment
Arrest resorption of bone Maintenance of masticatory system health and function
Maintain sensory feedback
Provide for retention of without excessive therapeutic intervention is the objective of
Provide for stability (and retention)
denture dental and prosthetic care for the elderly. After prosthetic
treatment, a patient recall program with emphasis on oral
Caries and the advancement of periodontal disease next to the hygiene preventive measures must be organized. Recall visits
abutment are the primary hazards associated with treatment should be set up at regular intervals, such as every 6 to 12
with overdentures. Therefore, if treatment with fixed or months [28].
removable partial dentures is available, overdentures should
not be considered.  A maintenance and recall plan should be established
based on:
1. The patient's oral hygiene performance.
2. Gingival recession and the area of exposed root surface.
3. Caries and periodontal disease activity.
4. The rate of residual ridge resorption. The design of the
removable denture.

Conclusion
The global geriatric population is growing as development in
an increase of lifestyle difference.
Given the importance of health and, more specifically, oral
health, patient education is crucial, and dentists should
ordinarily decline to treat complex situations with good
For the prosthetic restoration of the edentulous patient, the
prognoses. Major dental therapy can certainly enhance
clinician has a wide range of treatment modalities available,
function, esthetics, and comfort as well as eradicate signif-
ranging from relining or reparation of existing dentures, to
icant pathology and increases quality of life. But case
copying or transforming existing dentures, to constructing
selection is very important in order to minimize dental
conventional complete dentures, implant-supported complete
treatment failures and the tendency to blame the patient or
dentures, or metal-ceramic fixed prostheses. Patients'
others for negative outcomes.
demands for treatment are often based on their previous
experience, self-esteem, and socioeconomic situation.
Conflict of Interest
Not available
Stanley Fellman classified geriatric complete denture
patients according to treatment needs [25]
Financial Support
1. Patients who should not receive prosthodontic treatment.
Not available
2. Patients who should receive minimal treatment.
3. Patients who should receive intermediate care.
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