Geriatric Dentistry (Elder Care)
People are living longer. However, with age comes various pathological conditions and disabilities, and therefore more care is needed to preserve a person’s dentition.
What are the dental complications associated with the aging process?
The physiological changes that are associated with growing older can affect every aspect of the body. The cardiovascular system doesn’t adapt as well to the stresses imposed on it, and the arteries can thicken causing an increase in blood pressure. As a result, the cardiovascular system of an older individual is more likely to develop cardia ischemia (a restriction in blood supply), arrhythmias (abnormal heart rhythms_ and heart failure. Skeletal changes also occur, such as osteoporosis, which is characterized by a decrease in bone mass and an increased susceptibility to fractures. This increase fragility and decrease bone mass can prevent on from being a good candidate for implants (replacements for failing or missing teeth), and the loss of bone mass can make it more difficult for dentures to fit comfortably. Elderly patients can develop a decreased flow of saliva causing a dry mouth (xerostomia), which impacts dental care in numerous ways: alteration or loss of taste, difficulty swallowing, tooth decay, yeast infections, gum disease, bad breath, and burning sensations in the mouth. Often times the medications that they take to combat their illnesses will have an additional drying effect on the mouth, making things that much worse.
Geriatric patients undergo many central nervous system changes such as memory loss (amnesia) and confusion (dementia and Alzheimer’s disease). Depression is also very common as we age due to a host of potential factors including social isolation, loss of loved ones, physiological changes and psychological factors. Additionally, the immune system becomes more compromised, and becomes more susceptible to viral and bacterial diseases.
Another dental concern, as one grows older, is that the nerves within the teeth begin to recede causing diminished sensory levels within the teeth. This may result in the elderly seeking care for their cavities at a much later date, as they are less aware of what was going on. Additionally, their soft tissues are also frailer and heal more slowly, and the incidences of oral cancers increase with age.
What are the difficulties in geriatric home care?
One of the most common difficulties associated with home care among the elderly population is due to the onset of arthritis. An individual with painful arthritic conditions in their hands will have difficulty holding a toothbrush and maneuvering properly. There are special brushes that are sold with better handles that are more comfortable to grip. Additionally, an electric brush may be better suited to remove the plaque and food debris, because they are more effective and require less effort. Flossing will also be very difficult. There are special floss holders with an ergonomically designed handle which are easier to use. Geriatric patients may have to increase the frequency of their recall visits from 6 months to every 3 months.