Considerations for Treating the Advanced Aged Dental Patient

Feb 23, 2022 by Gabrielle Dizon, DDS - DCDS Member
​It was once commonly thought that as a person reaches old age, he or she will become totally edentulous and a denture wearer. Several things have since changed society’s attitude and thought towards dentistry and the elderly. People are now living longer and desire to keep their natural teeth.

The American Dental Association now describes the geriatric population as individuals 65 years or older.1 Advances in dental materials and techniques have widened the range of treatment options for providing restorative care, which allows for greater opportunity to save teeth. Likewise, the field of preventive dental care has evolved and the general public is better educated in oral homecare. 

All things considered, I’ll argue that the old adage, “smile while you still have teeth,” has become antiquated and a thought of the past. The average geriatric patient is maintaining his or her natural dentition and seeking dental care. We, as dentists, must be cognizant of a number of health precautions unique to this senior demographic in order to provide safe care— chronic disease states, polypharmacy, and change to the oral environment.

Chronic disease states are prevalent amongst the senior population. Commonly, an elderly patient may have one or more of the following chronic conditions: hypertension, diabetes mellitus, chronic obstructive pulmonary disorder, arthritis, and congestive heart failure. In treatment of such disease states, an elderly patient may be taking multiple medications simultaneously. Polypharmacy introduces the challenge of safe drug selection for prescription.2 Ultimately, dentists and physicians alike must have an understanding of the drugs his or her patients are taking in order to avoid dangerous drug interactions. The presence of certain disease states may also alter timing of treatment or usage of certain drugs.

Along with the rest of the body, the condition of the oral environment also changes drastically with age. Namely, xerostomia, or dry mouth caused by the lack of adequate saliva production, can cause a host of issues to the oral condition. Saliva acts as a natural buffer to maintain healthy pH levels of the mouth. Without normal saliva production, the total oral environment becomes at risk. As pH changes, the oral biome changes, allowing opportunistic bacteria and organisms to cause infection. Xerostomia presents many negative consequences for the oral environment including increased risk for: decay, periodontal disease, fungal infections and alteration of taste.3 We can prescribe rinses and pastes to artificially mimic the protective effects of saliva. However, the best treatment we can provide as dentists is close monitoring of the patient’s condition through increasing hygiene recall with exams.

In conclusion, the average person is living longer and better equipped to maintain the natural dentition. We, as dentists, are challenged to provide safe care towards an aging population as the public’s priority has shifted towards optimizing oral health. The comorbidities that our elderly patients experience can be challenging to navigate around; however, it is possible with proper planning. Dentistry has evolved towards treating the patient as a whole, beyond simply looking at the teeth. This principle is especially important in treating the elderly. Therefore, it is appropriate and necessary to expand our treatment team to involve not only dental specialists, but also the patient’s medical providers. With these advances in dentistry, we are able to keep our patients smiling longer.

References

  1. “Aging and Dental Health.” American Dental Association, Department of Scientific Information, Evidence Synthesis & Translation Research, ADA Science & Research Institute, LLC., 9 Nov. 2021, https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health.
  2. Sherman JJ, Davis L, Daniels K. 
  3. Sherman JJ, Davis L, Daniels K. Addressing the Polypharmacy Conundrum. US Pharm. 2017; 42(6):HS14-20. Accessed February 20, 2022.
  4. Ouanounou A. Xerostomia in the Geriatric Patient: Causes, Oral Manifestations, and Treatment. Compendium of Continuing Education in Dentistry (Jamesburg, N.J. : 1995). 2016 May;37(5):306-311;quiz312. PMID: 27213776.
  5. Kramarow EA. Dental care among adults aged 65 and over, 2017. NCHS Data Brief, no 337. Hyattsville, MD: National Center for Health Statistics. 2019.