Geriatric dentistry

Geriatric dentistry is the branch of dentistry dealing specifically with the oral health needs, treatments and concerns of senior citizens. As our population ages this important aspect of dentistry becomes more and more relevant to a larger and larger number of patients. Once the first baby boomers reach retirement in 2011 the number of citizens in the United States at or above the age of 65 will increase almost exponentially until 2030 when the end of the baby boomers reach 65 years old. This means that tremendous number of patients being treated over the next 50 years will be 65 years old or older and will need doctors who are well trained in diagnosing and treating the oral health needs of senior citizens.

One of the most significant aspects of treating senior citizens is getting an accurate list of all the medications they are taking, both prescription and over the counter medications and being aware of any potential adverse interactions with the medications that the dentist may need to place the patient on. As the number of medications a patient is taking increases the chance of an adverse interaction increases geometrically. This leads to a significant concern to all treating physicians not just dentists.
Today the average senior citizen takes 5 prescription medications and two over the counter medications on a daily basis, and it is not unusual for a senior citizen to be taking 10 or more prescription medications and 5 or more over the counter medications. It is quite obvious that medically managing a senior citizen is extremely complex requiring extensive pharmaceutical knowledge.

Another aspect of geriatric dentistry is accounting for the physical changes that occur as we age. One of the most significant changes that we go through as we age is that our lean muscle mass is replaced by adipose tissue (fat). This means someone who is the same weight at 65 to 80 years old as they were when they were 30 years old has more of their mass as fat and less of their mass as lean muscle. Also as people age and because of the amount of drug use that occurs over a lifetime, their bodies metabolize drugs differently than when the patient was younger. All this has profound implications on the way medications act, their potency, their half-life (the time they remain in the body), their complications and their interactions with one another. In geriatric dentistry, a dentist will have to take into consideration the drug regimen that a patient is on and plan their use of anesthesia and follow up care accordingly.

Loss of dexterity especially in the hands due to age related maladies can cause many patients difficulty with their daily oral hygiene. This can make it difficult to grasp a toothbrush and nearly impossible to set and manipulate dental floss with their fingers. Some solutions would be to recommend large handled toothbrushes that are easier to grasp and the use of pre-strung dental floss in a Y-shaped holder. Failing eyesight can also hinder proper hygiene. Patients can’t clean what they can’t see. Fortunately corrective eyeglasses, vision enhancement surgeries and cataract surgery all help improve patients’ vision.

Physical accessibility to a health care provider and their facility can often effect whether senior citizens receive health care. Limited personal mobility, difficulty walking, difficulty climbing stairs and difficulty attaining transportation to and from a health care facility can all limit and actually preclude senior citizens from receiving the health care they need. Handicap parking, handicap accessible facilities and handicap and senior public transportation can all help alleviate these obstacles to health care for the physically limited and handicapped patient.
As with all health care a proper comprehensive health history, through examination, through diagnostic tests and developing a rapport with each individual patient lead to the best possible and most appropriate oral health treatment. Having a team oriented approach in which the patient’s other health care providers are consulted with, help develop and are aware of the proposed dental treatment plan will also help to improve the patient’s oral care treatment. This multifaceted team type of approach to health care becomes even more important for geriatric patients and medically compromised patients than for healthy younger adults.
Certain conditions can occur in seniors that would not normally be found in younger individuals and that can affect the health of their teeth, as well as their overall physical well being.

The following conditions that may be of concern and which should be evaluated by a dentist are:

- Dry Mouth (Xerostomia)
- Tooth Wear and Excessive Staining
- Dental Decay (Root Surface)
- Gum Disease (Periodontal Disease)
- Loss or Alteration in Taste
- Issues Related to Aging Tooth Pulp: Vascular Changes and Excessive Plaque Buildup                                                                                                                           

Dry Mouth (Xerostomia)
A condition common to the elderly whereby saliva flow is decreased. The causes can include certain medical conditions, certain medications such as antihistamines, pain relievers and decongestants, among others. Other causes can be ill fitting dental appliances such as full or partial dentures.

If a person allows this continued dry mouth condition to persist, there is an increase in the level of dental decay due to the increased level of bacterial colonies and plaque accumulations. The reason for this is that saliva has a natural bathing effect on teeth that helps decrease the level of bacteria from forming.

There is also a greater risk for periodontal disease due to the decreased level of saliva. Patients are urged to see their dentist and/or physician to evaluate this condition. Certain products are available that can help correct this condition such as artificial saliva replacement drops, oral rinses such as Biotene mouthrinse and Oral Balance a moisturizing oral rinse. Sugarless lemon drops have also been found to be an excellent saliva stimulant that can help increase saliva flow.

Tooth Wear and Excessive Staining
With the increased wear of teeth over the years, many seniors may notice an unaesthetic appearance. Teeth can become unsightly and can make one appear older than they really are. Teeth can also stain, especially since these areas of enamel wear are excellent places for debris and plaque to accumulate and stain over the years. Also, as the protective enamel wear occurs, the yellowish dentin is more apparent causing teeth to appear darker.

Hypersensitivity of teeth is also common causing unnecessary discomfort in patients.

Dental Decay (Root Surface)
As one ages, the incidence for decay can increase, especially root surface decay. The exposure of the tooth's root surface occurs in seniors primarily from gum tissue receding as one ages. Root surfaces do not have a protective enamel layer and are primarily composed of softer cementum, which easily decays. Plaque and bacterial accumulation can collect on these surfaces increasing the risk for this type of decay. Since the root surface lacks enamel, decay can more easily penetrate the tooth's pulp (nerve), which can cause endodontic (root canal) problems and in worst scenarios, tooth loss. Older fillings may also wear and fracture as one ages causing weakening or loss of teeth.

Gum Disease (Periodontal Disease)
The most common cause of tooth loss in adults is gum disease. Bacteria create toxins which inflame and irritate gum tissue. Over the years, a slow progressive detachment occurs that affects the supporting bone, which dissolves. Tooth loss eventually results, especially if left untreated. The elderly are more prone to this condition as a result of smoking, poor diets, poor oral hygiene habits and certain medical conditions. It is imperative that one have regular dental checkups to determine if they have this condition.

Loss or Alteration in Taste
Many seniors experience the loss of their taste sensation as they age. This can occur as a normal result of aging. However, certain diseases and medications can increase the incidence of taste loss. Ill fitting dentures or other removable dental appliances can increase the alteration of taste.
Patients should always notify their dentist and/or physician if they have any type of alteration or loss in their taste sensation.
Many new and exciting treatment alternatives have been developed in dentistry over the years that can help seniors restore their teeth to a much more functional, healthy and youthful look.

Issues Related to Aging Tooth Pulp: Vascular Changes and Excessive Plaque Buildup
A geriatric dentist will have more experience in dealing with issues related to aging tooth pulp, vascular changes and excessive plaque buildup. As people age, the pulp in their teeth becomes more fibrous and show signs of more frequent scaring. Athrisclerotic plaque can appear in pulp vessels and calcification is often found in the blood vessels surrounding the tooth as well.

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Treating Elderly Patients-Our Approach
Geriatric (Elderly) Patients-Changes in Teeth And Supporting Tissue
Elderly Patient-Improving Dental Hygiene
Xerostomia (Dry Mouth)
Burning Mouth Syndrome
Senior Dental Care-Frequently Asked Questions