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 as part of an interdisciplinary team with other health care professionals.
Video Geriatric dentistry
Overview
Last century has witnessed a number of remarkable demographic changes related to health, diseases, longevity and mortality of the population all over the world. By now one third of the world's elderly population is living in the developing countries and one out of twelve persons in the developing countries is over sixty five.
The twentieth century witnessed remarkable population ageing with regard to human longevity worldwide, and the twenty-first century is set to carry forward the gains in longevity further, both in the developing and the developed world. This rise in life expectancy is attributed primarily to the substantial reduction in mortality at different stages of life, which has been brought about by improved health care facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions. As a result of the increasing life expectancy, the proportion of the elderly in the total population is projected to be around 20% in India and 32% in the developed nations by 2050.
Keeping this increased life expectancy in mind, the age of retirement in many sectors in India is increasing and in some it has even gone up to 70 years. In some states, the retirement age has not been raised but this is because of the concerns regarding the resultant job cuts for the younger generation. As per the Government of India's classification, the elderly are those who are 60 years of age and above; these citizens become eligible for varied concessions offered by the government and other agencies. In the developed world, the elderly are those above the age of 65 years.
The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. In the elderly population poor oral health has been considered a risk factor for general health problems. On the other hand, older adults are more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical/mental disabilities. Thus, the elderly form a distinct group in terms of provision of care.
The dental diseases that the elderly are particularly prone to are root caries, attrition, periodontal disease, missing teeth because of earlier neglect, edentulism, poor quality of alveolar ridges, ill-fitting dentures, mucosal lesions, oral ulceration, dry mouth (xerostomia), oral cancers, and rampant caries. Many of these are the sequelae of neglect in the early years of life, for example, consumption of a cariogenic diet, lack of awareness regarding preventive aspects, and habits like smoking and/or tobacco, pan, and betel nut chewing. All these problems may increase in magnitude because of the declining immunity in old age and because of coexisting medical problems. As a result of poor systemic health, the elderly patient often does not pay sufficient attention to oral health. In addition, medications like antihypertensives, antipsychotics, anxiolytics, etc., lead to xerostomia, and the absence of the protective influences of saliva in the oral cavity increases the predisposition to oral disease. Financial constraints and lack of family support or of transportation facilities affect access to dental services in later life. The untreated oral cavity has its deleterious effects on comfort, aesthetics, speech, mastication and, consequently, on quality of life in old age.
Maps Geriatric dentistry
State of Oral Health of the Older Adult
Despite overall improvements in oral health, the senior population specifically still maintains higher rates of oral disease and lower levels of oral health than the general population. This is especially true for those residing in continuing care homes. The decline of oral health with age can be attributed to many factors such as frailty, barriers to maintaining oral health and accessing care, and comorbidities with chronic conditions and treatment. Maintaining oral health is especially important for this population as poor oral health can lead to a number of systemic diseases, facilitate the progression and severity of systemic diseases, and contribute to complications of overall health.
Reasons for Poor Oral Health in Seniors
Seniors experience a high rate of dental decay and root caries , this can be attributed to many factors including poor plaque control due to lack of or ineffective daily oral hygiene and dry mouth from medications or disease. With age and increasing frailty, dexterity may decrease leading to a lack of tooth brushing and interdental cleansing, or decreasing the effectiveness of such tasks.Some patients have decreased ability to engage in self-care due to cognitive impairment, therefore they are more at risk for more serious oral diseases and infections. For many older adults, this decreasing effectiveness in oral home care can go unnoticed and result in unfavorable oral conditions. For seniors suffering from dementia, they may forget to brush on a regular basis or may have troubles completing this task. Seniors also experience fungal infections, such as yeast infections, of the oral cavity related to complications such as dry mouth and improper denture use and care. When salivary flow is slowed and the oral environment is altered, fungal infections of Candida albicans, also referred to as thrush, are more likely to occur. When dentures are not removed overnight or are not cleaned regularly, the tissues they contact are also prone to developing a fungal infection.
Barriers to Oral Health for Seniors
With ageing, many factors arise that serve as barriers in maintaining oral health and accessing oral health treatment. Many seniors have declining dexterity and become frail. This may affect their ability to brush their teeth and clean interdental areas and certainly impacts their effectiveness in these tasks. Dementia is noticeably present among older adults, this disease affects each individual differently and as a result can pose a problem for primary care workers when providing oral care. For seniors suffering from dementia, even if they maintain the skill of tooth brushing and flossing they may forget to do so, or have troubles focusing on completing the task once they have started. Attending dental appointments also becomes more difficult with age if seniors rely on public transit, transportation by friends of family members to get to appointments, or if the senior is wheelchair bound and requires a specific type of transport. Another barrier is cost, most seniors no longer have a source of income and do not receive employer benefits to aid in covering the high cost of dental care. Some seniors may be eligible for federally or provincially funded programs, such as the Alberta Seniors Benefit program in Alberta, Canada. Unfortunately, many of these resources are made available exclusively online, which is a medium that is often unfamiliar to older adults. As a result of being unaware of these services or being unfamiliar with the method for application, many seniors do not access these funds.
Oral Care in Long Term Care Facilities
Maintaining oral care is challenging, especially for those residing in long-term care facilities. For those living in long-term care facilities who require assistance from care staff for daily oral care, nursing staff often are not given enough training or enough time to effectively assist patients with oral hygiene care on a regular basis.
Importance of Salivary Flow in Older Adults
Pneumonia is the fourth leading cause of death among the elderly. The risk of pneumonia related death increases with age, especially after the age of 65. Incidence of aspiration pneumonia increases with increased incidence of dysphagia. Dysphagia can be a result of neuropathology in individuals suffering from dementia. Dysphagia, or difficulty swallowing, is also closely linked to dry mouth. Dry mouth, also known as xerostomia, is multifactorial but a common contributor to xerostomia in older adults is medication and polypharmacy. Dry mouth is often listed as a side effect of pharmaceuticals. The hyposalivation resulting from these drugs is exasperated by combination with other medications. For older adults, especially those living with chronic illnesses, polypharmacy is a common practice. Discussing the possibility of altering medications, to respond to concerns of xerostomia, with a patient's pharmacist or physician can lead to reduced issues relating to hyposalivation. Lack of salivary flow can contribute to the development of cavities. Saliva helps to neutralize the acidity of the mouth which is created in a response to eating. Limited saliva results in limited buffering of this acid, allowing the teeth to be exposed to acid for a longer period of time. This increased exposure time puts these individuals at risk for tooth decay. The teeth and hard tissues of the mouth do not exclusively benefit from adequate salivary flow, the soft tissues like the gums and the tongue also benefit from the buffering effects of saliva. Saliva prevents ulceration and penetration of carcinogens into these tissues. Another benefit of saliva is the antifungal and antiviral properties. This is especially important for older adults who suffer from diminished immune systems.
Dentures and Edentulism
Edentulism among older adults is common, whether it be related to removal as a result of decay, or as a result of periodontal disease. Periodontal disease is the loss of bone levels in the jaw due to infection. The rates of edentulism are decreasing. More and more older adults are maintaining their natural teeth. This is beneficial for these individuals as the contact of the teeth promotes bone health and decreases resorption of bone in the jaw. Another benefit of maintaining natural teeth is the effectiveness of natural teeth in comparison to dentures. The force generated by individuals who wear dentures is not as effective as those with natural teeth. This difficulty producing a sufficient biting force can result in malnutrition. Financially, dentures can also be a burden. The fit of the dentures can change as a result of the care they are given as well as a result of the loss of bone structure, especially in the lower jaw. Those with dementia may also have difficulty with denture fit as a result of the progression of their disease. Many individuals affected by late stage dementia find that their dentures, especially their upper dentures, are ill fitting; resulting in a gag reflex. A temporary solution to ill-fitting dentures is the use of dental adhesive, but ultimately, once the denture is inhibiting oral function they should be relined by a denturist. Broken dentures should be replaced with new dentures if they are inhibiting oral functionality. Another downfall of removable dentures, especially among residents of continuing care facilities who suffer from dementia, is lost or stolen dentures. Labelling dentures is a good practice to aid in minimizing this confusion.
References
Source of the article : Wikipedia
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