Aging is a natural process. Old age should be regarded as a normal, inevitable biological phenomenon. The life-stage of older adulthood has considerable variation depending on age and underlying genetic and medical conditions. Frailty, both physical and neurological, in older people represents the move from independence to dependence which can have an impact on oral health and affect the efficacy to perform oral hygiene on a daily basis. Oral health status in the elderly reflects the cumulative outcomes of oral health behavior, diseases and their treatments during a lifespan. Nowadays, it is increasingly common for the elderly to retain most of their teeth, presenting a challenge for oral self-and professional care to maintain the dentition for a whole lifetime. The management of older patients requires not only an understanding of the medical and dental aspects of ageing, but also many other factors such as ambulation,independent living, socialization, and sensory function. These problems can be overcome by proper diagnosis and treatment planning for the elderly that must include considerations of the biological, psychological, social and economic status of the patient in addition to the obvious dental issues.          

AGING PRESENTS NEW ORAL CHALLENGES         

As an individual gets older, certain oral conditions not present at a younger age might develop such as:         Nutrition and its implications on oral health: Disorders of the oral cavity have contributed to poor eating habits in the elderly. Missing or loose/ painful teeth or ill-fitting dentures may result in a reduced desire or ability to eat. A compromised nutritional status, in turn can further undermine the integrity of the oral cavity.

Changes in teeth: With aging, the appearance and structure of teeth tend to change. Geriatric patients are prone wasting diseases of teeth such as attrition, abrasion, abfraction and erosion. Older people are more vulnerable to tooth decay, possibly due to a preference for sweeter foods, less care with their oral hygiene and inability or reticence to access dental treatment. 

Changes in salivary secretion(Dry Mouth):  Xerostomia,the subjective sensation of dry mouth caused by decreased saliva production. Although salivary flow does not decrease with age alone, certain medications and illnesses increase the risk of xerostomia in older persons. This would affect the ability to speak, and chew, and would increase the rate of caries,periodontal disease, traumatic ulcers, fungal infections and reduces denture retention in the edentulous patient. 

Systemic diseases and its dental relation: Almost all systemic diseases have oral manifestations, the first sign of which may be seen by the dental clinician. Recent research suggests a relationship between oral disease and systemic diseases such as diabetes, cardiovascular disease,stroke, respiratory infections, Alzheimer’s disease and other medical conditions. 

Periodontal Changes: Gum diseases have been associated with general health problems such as, diabetes and increased risk of cardiovascular disease. The major local cause of gum disease is dental plaque (sticky, colourless film containing bacteria, food debris and salivary products that build up on all surfaces of the teeth,dentures, gums and tongue) leading to periodontitis (pyorrhea). 

DENTAL TREATMENT CONSIDERATIONS FOR THE ELDERLY

With the rapid progress in dentistry over recent years, geriatric dentistry has been able to help people who have dental problems that are age-related.  The treatment modality can be broadly divided into: 

1. Preventive measures and 

2. Restorative measures 

Preventive measures: 

Active preventive measures include oral health-maintaining behavior.

  •  A well balanced diet is the key to oral health because nutrients have an impact on overall development, growth and maintenance of teeth and its supporting structures.
  • Sweet or sticky foods should be avoided in between meals.
  • Regular brushing after every meals or at least every meal at night which helps to keep teeth free of plaque and fight decay. 
  • Choose the right toothbrush that fits comfortably in hand and is easy to control. Massage the gums after brushing and gently brush the tongue too. 
  •  Regardless of dentate status, it is recommended that the elderly make dental visits at least every 6 months for clinical re-evaluation, depending upon their ability to perform oral hygiene.
  • Cognitive Limitations Affecting Dental Care and Self-Care: Patients with severe cognitive impairment, including dementia, are at increased risk for caries, periodontal disease, and oral infection because of decreased ability to engage in self-care. Education of the caregiver, as well as the patient, is an important part of the prevention and disease management phase of dental care. Dentate patients with cognitive limitations should be encouraged to brush their teeth two or more times daily; use of an electric or battery-operated toothbrush should be considered. In patients with removable prosthetic devices,the device(s) should be removed, inspected, and cleaned before bed and returned to the mouth in the morning.  

 Restorative measures: 

Geriatric dentistry excels in restoring decayed teeth, gingival margins, discoloured teeth, missing teeth, various types of other cosmetic and health related issues and it also helps people who may be taking excessive medications or may be slow to recover from or have sensitivity to dental surgery.

  •  Dental caries:  Minimal intervention dentistry(MID) as a treatment model can be adopted in elderly patients which includes assessment of risk disease with emphasis of early detection and prevention, selection of material and equipment and surgical intervention only when required.
  • Replacement of Missing teeth in elderly (Prosthetic Rehabilitation):  When teeth are missing,prosthodontics restore oral functions such as masticating (chewing), speaking,appearance and oral comfort. There are numerous types of simplified methods and materials that may be indicated for elderly in specific situations. Examples are dental implants, fixed partial dentures (FPDs)also called bridges, removable partial denture (RPDs) and complete dentures.
  • Advantages of FPD are that they can be accomplished in shorter and fewer appointments compared with conventional methods. RPDs are always contra-indicated, except as temporary restorations, because of convincing documentation that long-term use causes irreversible harm to oral tissues, reduced function and poorer prognosis of the dentition. Also, geriatric patients have more difficulty in adapting to a removable denture resulting in dissatisfaction.
  • Dental implants and implant-retained and/or implant-supported prosthesesare viable treatment options for older patients.
  • Universally, the older population has not experienced much access to dental implants as a treatment option.  While there is a myth that implants are not effective for older people, the truth is that these devices work for the aged just as well as they do for younger patients. Even patients with diabetes, heart disease and other health issues have been able to successfully get dental implants.
  • Another myth is that many people avoid dental implants because they believe they are painful.  This is completely untrue. Dentist performs implant surgery under local anesthesia with no pain to the patient. An experienced surgeon will follow a less complicated procedure,offering a wide range of anesthesia options to suit the needs and preferences of patients. 

Older patients are at risk for oral health problems, resulting from declining physical and/or mental status, medications, and reluctance or failure to seek routine dental care. The elderly population must recognize that tooth loss is preventable. They need to understand the risks associated with untreated dental disease, the signals indicating that dental care is required, the importance and value of thorough daily oral hygiene practice, as well as regular professional cleanings and examinations. Through educational efforts, optimal oral health for the life of the individual may be ultimately attainable. The elderly deserve the best care the dental profession can offer.