Geriatric Dentistry

Dental changes in Elder patients Geriatric patients are prone to wasting diseases of teeth such as attrition, abrasion, abfraction, and erosion. This is because of the fact that the teeth are functional for a long period of time. Periodontal inflammation, loss of attachment, missing teeth, edentulism, ill-fitting dentures, oral ulcerations, xerostomias, and oral carcinomas are some of the age-related changes. Further, root caries is other most common caries found in elderly patients. Habits and Oral implications Elderly patients have habits such as smoking, tobacco pan, and beetle nut chewing which leads to the formation of precancerous or cancerous lesions. Thus, combining both systemic and oral problems the immunity declines in elderly people. Elderly people in rural areas have a habit of tobacco and betel nut chewing as compared to the urban population necessitating the need of integrating primary health care with oral care in the rural population. Further, financial constraints and lack of family support or of transportation facilities affect access to dental services in later life. Thus the untreated oral cavity has its deleterious effects on comfort, esthetics, speech, mastication, and consequently, on quality of life in old age.

The goal of Geriatric dentistry

  • To maintain the oral health of individuals.
  • To maintain the ideal health and function of the masticatory system by establishing adequate preventive measures.
  • In diseased patients maintaining oral and general health. Objectives of Geriatric dentistry
  • To recognize and relieve difficulties of elderly people.
  • Restoration and preservation of function for maintaining normal life in elderly patients.

Preventive measures for dental diseases Oral health care providers should educate patients regarding oral diseases and their prevention.

The five golden rules for preventive dental diseases in geriatric patients are given below:

  1. A well-balanced diet is the key to oral health and a body that is strong and free from diseases because nutrients available systemically will impact overall development, growth and maintenance of tooth structure, connective tissue, alveolar bone and oral mucosa.


  2. Don't eat sweet or sticky foods between meals because high sugar diet have often been associated with caries so such intake should be restricted.


  3. Regular brushing after every meal or at least every meal at night which helps to keep teeth free of plaque and fight decay.


  4. Choose the right toothbrush that fits comfortably in hand and is easy to control. Massage your gums with your fingers after brushing and gently brush your tongue too.


  5. Visit your dentist regularly. Conclusion General and oral health is a fundamental right of a human being. The oral health of a patient determines the general health, and general health determines happiness in life that brings a smile. Good health is achieved by assimilation of a healthy diet and this further helps in maintaining the health of oral hard (teeth) and soft tissues.

Anti Aging Dentistry

Aging is a dynamic process which involves the aging of soft tissue and bony structures. Facial aging shows changes in the shape, size, and volume of the soft tissues and bones of the face. Anti-Age dentistry focuses on soft tissue changes, particularly changes in the muscles, skin, and loss of fat volume, the bony components of the face, the teeth, and intra-oral soft tissues, which form the balance between the overall facial contour. As an anti-age dental practitioner, it is paramount to have succinct knowledge with concerns regarding supervision, guidance, and correction of aging orofacial structures with dental rehabilitation.

Introduction

Aging is a natural inevitable process, every individual dream to freeze this process and try and escape this phenomenon as much as possible. Recent development in anti-age dentistry has ensured that we can prolong the aging process or reduce the intensity of aging appearance.

Anti-Aging Dentistry consultation begins right from the time the patient walks into your practice, the consultant must analyze every aspect orofacial structure, not simply occlusion or the shade of the dentition. Simple prosthodontic correction procedures such as – Changing the size, Changing the shape, or Changing the intrearch distance of worn out dentition with crowns, veneers, and implants can easily smoothen wrinkles around the mouth, fill out the jawline, or balance the appearance of smile without undergoing temporary or permanent surgical procedures.

Anti-aging dentistry is often utilized as a way to cosmetically enhance the individual's appearance and is rarely performed due to health concerns. Altering the appearance can be achieved by means of occlusal changes and or procedures such as whitening, full mouth rehabilitation with or without implants and prosthetic rehabilitation.

As a clinician, we are well aware of the chronological aging and the factors involved in aging process. Individual's age is a primary risk factor for chronic diseases, mortality, and any impairments to systemic, functional, or parafunction activities, sleep disorders as well as the neurological status. Thorough consideration and an understanding of patients nutritional, physical, and psychological conditions along with systemic abnormalities and recognizing the oralimplication and pharmacology of drug‐induced dental disease, contribute towards differentiating normal aging and pathological aging. OSCAR – Criteria for dental assessment

When all pertinent clinical data is gathered, the clinician needs to work with the patient to establish the plan of care that best addresses the dental needs and the medical and functional limitations, given fiscal realities. Shay suggested a systematic approach to planning oral care for aging adults, which he called OSCAR and which he used to determine the needs of a specific patient.

The OSCAR scale is:

  • O = ORAL, which evaluates the teeth, the prostheses, the periodontium, the status of the pulp, the oral mucosa, the occlusion, and saliva.
  • S = SYSTEMIC, which evaluates normative age changes, medical diagnosis, pharmacological agents, and interdisciplinary communications.
  • C = CAPABILITY, which evaluates functional ability such as self-care, oral hygiene, caregivers, and the need for transportation and mobility.
  • A = AUTONOMY, which evaluates the ability to give informed consent or dependence on others.
  • R = REALITY, which evaluates prioritization of oral health care, financial limitations, and anticipated life span.


A clinician must consider the following four important criteria during treatment planning and execution

  1. FUNCTION – Relates to the ability to chew and eat an adequate diet.
  2. SYMPTOMATOLOGY – Relates to comfort while chewing and being free of pain by having an adequate amount of saliva to speak, taste, swallow, etc.
  3. PATHOLOGY – Relates to not having any oraldiscomfort or lesions in the mouth. AESTHETIC – Relates to perceived needs to improve their appearance or smile


Clinicians must have succinct knowledge of understanding and management of orofacial pain conditions which can limit the individuals facial activity or change facial expressions or symmetry giving a fatigued or aged look. Some examples of this are

  • Temporo -Mandibular Disorders (TMD)
  • Oral Motor Disorders
  • Myogenous Pain
  • Vascular Pain
  • Headaches
  • Trigeminal Neuralgia
  • Trigeminal Neuropathic Disease
  • Postherpetic Neuralgia
  • Burning Mouth Syndrome
  • Occlusal Dysesthesia
  • Obstructive Sleep Apnea (OSA).


Balanced nutrition, weight management, facial physiotherapy, cognitive behavioral therapy, and psychological wellbeing can add as adjunct to dental procedures to provide the individual a young look.

Limitations of Anti-Aging Dentistry

The main limitations of anti-aging dentistry are:

  • The amount of change that can be made to the appearance of the patient in regards to soft tissue is limited. However, it will not provide the same results as fillers. Dermal fillers are also the option to use when patient needs structural contouring.
  • Anti-aging dentistry is irreversible when it comes prosthetic rehabilitation
  • Patient compliance and cooperation is the key factor in long term prognosis of the treatment plan.


Conclusion

A variety of oral changes may be observed in patients as they age. These changes can be attributed to a variety of physiological and pathological processes which have developed over a lifetime. Anti-age dentistry requires the dentist to clinically recognize these changes and to develop planning strategies which take account of them. Emphasis must be placed on preventive regimes and treatment delivery which is sympathetic to the changing needs of our existing elders.

If you have additional questions about any of these types of Geriatric & Anti-Aging Dentistry, talk to us.

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