Saturday, February 24, 2018 5:38

The Special Needs Of Older Dental Patients

Posted by on Thursday, February 4, 2010, 12:43
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Last century has seen the life expectancy of Americans nearly double, from forty six to about eighty. This increase has brought about a new focus on health problems of the elderly .

Modern dentistry enables people to keep their mouths healthy, comfortable, and functioning. But for a variety of reasons this does not always apply to the elderly.

Many elderly Americans are financially better off than other segments of our society, and dental care is a major source of financial outlay for them. Unfortunately, much of this dentistry may be substandard or leaving the patient with more serious and costly problems.

Dr. Poorwork  is particularly careless with the elderly. possibly calculating that they won’t be around long enough to complain when the dentistry fails. Some older patients who, throughout their lifetimes, have kept their mouths immaculately clean and enjoyed excellent oral health, suddenly begin to have serious problems of decay and periodontal disease.

The cause almost always is a loss of skill and ability in tooth brushing. Although these patients may brush several times a day, because of loss of motor skills the brushing is ineffective. Other elderly patients may suffer depression or lack of motivation, again resulting in a falling down of effective oral hygiene.

Moreover others may suffer from any of the many diseases associated with aging; some of these diseases can affect the mouth directly, while others affect the ability to brush teeth correctly. Poor quality dentistry that is maintained intact by meticulous oral hygiene will start to deteriorate as soon as the level of home care decreases.

Bad dentistry is like a time bomb, waiting to go off when the fuse of incomplete cleaning is lit. Complicating the loss of oral hygiene skills is a decrease in the amount of saliva. Saliva decreases as we get older. This situation can be aggravated by side effects from medications, poor diet, and systemic diseases such as diabetes and anemia.

Saliva in the younger person helps keep the mouth clean and dilutes the harmful acids produced by the oral bacteria from food residue. The older person, now not brushing effectively, has much more food residue in the mouth but less saliva to neutralize it.

This new area of dentistry, concerned with the dental needs of the elderly, has been named “geriatric dentistry.” Although this is not a specialty recognized by the American Dental Association, it is a valid area for those with a special interest and expertise, and there is even an American Society for Geriatric Dentistry.

Topics that are being investigated include the relationship of osteoporosis to oral bone loss, root decay prevention, oral cancer detection, new methods of tooth cleaning, and chemotherapeutic (medicinal) methods of decay control and periodontal disease treatment.

Currently, the best approach is to use electric mechanical toothbrushes, which make it far easier to clean the teeth effectively,  and fluoride mouthwashes, which increase the resistance to decay. A
fluoride containing chewing gum is available.

Although there is no completely satisfactory answer to this problem, the situation demands that the dentist change his normal treatment routine for such a patient. A dentist of conscience will not undertake to do a complex, heroic, and expensive program of treatment for a patient who is unable to brush properly and whose mouth is falling apart.

Rather, the dentist is likely to focus on relieving pain and patching things as best as possible. Instead of a crown, the dentist may try a large filling, perhaps even a filling made of a less durable material that has pain relieving properties. An ethical dentist is much more prone to treat very early cavities and slightly broken fillings, to keep them from rapidly deteriorating.

When senior citizens who relocate to a retirement community go to a new dentist they may be told they need extensive dentistry. Caution is indicated; they should speak to the old dentist and get a second opinion. A nearby dental school is a good place to go for an unbiased exam.

We always tell our patients that going to the dentist is one of life’s great pleasures, but we suspect that as people age this is one pleasure they would prefer to forgo. Although we may be unable to avoid problems with our teeth as we age, we can lower our risks by making sure the dentistry undergone at a younger age is properly done, that we maintain good oral hygiene, and that we avoid unnecessary dental treatment.

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