Old Age : Dental perspective

Dr. Reecha Gupta, Dr. Siddhant
Time is in universe: It is in Man. Because we are borne we live, we grow, and we age, finally fulfilling greatest truth of life. We die.
As we are basically a part of all life, we are amenable to all natural laws.
1st October…. celebrated as International Day for Elderly People each year. This was first established on 14 th December in year 1990 by the United Nation General Assembly.
Age changes form an unbroken continuity. Aging is a normal, genetically dictated physiological process. It leads to gradual impairment in performance of various systems, hence of the individual as a whole.
Based on the chronological age, the cohort of people 65 years of age or older are considered as elderly. 3 groups of older people have been identified:-
* Young old (65-74 years)
* Old-old (75-84 years)
* Oldest old (>85 years)
Elders above 65 years (old age) have health problems as a result of aging process, which calls for special consideration.
One or the other problems may be common but impairments are not life threatening, they affect a person’s quality-of-life. Thus, planning treatment for the senior dental patient includes an understanding of the chronic diseases the patient lives with daily, as this play a critical role in the acceptance and success of the dental treatment plans
l Dental status is considered to be an important contributing factor to health and adequate nutrition in elderly. Disorders of the oral cavity, lose painful teeth, missing dentition and ill-fitting dentures cause difficulty in chewing and perception of taste of foods or even reduce desire to eat. Although chewing efficiency and nutritional status improve when inadequate dentition or edentulousness is corrected with partial or complete dentures. The dentists are hence in an ideal position to contribute to the well-being of the elderly.
The attitude should be Graceful acceptance of age changes…
Need for preventive services
Presence of root caries, periodontal disease and xerostomia are oral diseases that are found majorly affecting the older population. Despite these conditions affecting the elderly being treatable or preventable, many of the elderly do not avail the needed treatment because, most of the current older than 60 were not introduced to the concept of preventive dentistry at a young age. Many still hold the opinion that tooth loss is a normal part of the aging process.
Mechanical plaque removal
The preferred method of brushing for most elders is sulcular brushing with soft toothbrush (Bass method). These may include the use of an extra soft toothbrush, use of light pressure, modification of the brushing method and effective rinsing. Older people often face difficulty in mechanical removal of plaque because of reduced manual dexterity or impaired vision.
Use of rotary electric toothbrushes, or manual brushes that have been adapted or customized for each person can be of help.
A therapeutic rinse contains an agent that is beneficial to the tooth surface or oral environment. Therapeutic rinses may contain chlorhexidine, sodium benzoate, sanguinaria, a fluoride, or other remineralizing agents, which halts oral disease and should be recommended to the elderly when appropriate.
Chlorhexidine rinse has numerous applications for treatment of elderly. Fluoridated rinses have also known to prevent the development of caries, so they should also be prescribed to the elderly. Saline rinses are very effective.
Denture care
Many edentulous elderly believe erroneously that once all their teeth have been extracted they no longer need to be concerned about oral health. The elderly who wear dentures should be taught proper home care of both dentures and tissues on which they rest as well as the need for continued professional care. The cleaning and massaging of the tissues under a denture at least once a day increases circulation and thus enhances the health of these tissues. An average life span of a denture is 5 years.
Counseling and education
Preventive dentistry counseling for the geriatric patient includes two components: education and motivation.
Tell-show-do procedure can be followed effectively:
* Tell or explain the procedure
* Show or demonstrate the procedure
* Finally, the learner can do or practice the technique until he has mastered the skills. Know your Dentures more ?
* Dentures are removable prosthesis. Dentures are not embedded in bone like natural teeth, they are placed over the ridge.
* ‘Dentures are life lasting’ is not true. In spite of their durability, denture can lose their natural appearance and chewing ability
* Lower denture retention is compromised compared to maxillary denture because the the surface area of the lower jaw bone is less as compared to the upper jaw
* While drinking water, denture may or may not displace in mouth.
* There is increased salivation during initial period of wearing of denture and this decreases with time.
* The patient has to learn to chew with new dentures, should chew with up and down motion and minimum sideways motion.
* Denture should not be worn at night. This gives adequate rest to the denture bearing mucosa
* Patients who wear dentures should be checked annually by the prosthodontist or dental professional for maintenance of optimum denture fit and function, for evaluation for oral lesions and bone loss, and for assessment of oral health status.
(The authors are faculty Dept.of prosthodontics  IGGDC, Jammu.)