Elderly patient Flashcards
remember
There is an increase in elderly population and of these there is a higher percentage with natural teeth
how do u treat elderly pt who are independent?
Forget age, treat as young people
frailty criteria
Cant perform 1 or more activities of daily living 3 days prior to admission
Depression currently
Dementia
History of falls
1 or more unplanned admissions in past 3 months (excluding current admission)
Unable to walk/has a walking aid
Bedbound for 4 days or more
Incontinent - urine or faeces
what is used to assess frailty?
Rockwood frailty score
pt with a rockwood frailty score of 7,8 or 9 are treated by who?
community dental team
what prescribing considerations do u have to make for the elderly 3?
Polypharmacy common - alert GP if think some drugs aren’t appropriate
- BNF
Reduced renal function in elderly
Avoid NSAIDs, antibiotic overuse, smallest dose possible for moderate strength analgesics
Holistically assess frail elderly patients
Establish if comprehension is in tact
Take appropriate measures if not and assess capacity
Establish functional abilities
Establish underlying illness and medication
Careful attention to medications and avoid high risk drugs
Offer realistic, sensible treatments
Give the time and your respect
Treat the patient, not just the teeth
tooth loss tends to occur in what socio-economic area?
deprived areas
threats to oral health in the elderly 6
Poorly designed removable partial dentures
Irregular denture maintenance
Systemic disease - xerostomia
Perio disease - poor plaque control e.g. rheumatoid arthritis
Exposed root surfaces - may be from poorly designed dentures stripping away the gingivae, roots are more susceptible to caries
Personal behaviour e.g. smoking
Remember an older pt will respond to perio tx just as well as a younger pt, perio disease is not part of the aging process but a consequence of disease progression in the susceptible pt over many years
what are the 3 types of tooth wear? (non-carious tooth surface loss)
abrasion
attrition
erosion
define abrasion
physical damage to enamel due to external factors e.g. brushing too hard
define attrition
loss of structure due to tooth to tooth contact e.g. grinding and clenching
define erosion
loss of tooth enamel due to acids in the mouth can be external (juice) or internal (GORD)
name 4 causes of dental erosion excluding dietary
Hiatus hernia
Alcohol abuse
Duodenal ulceration
Certain medications
name two dental influences from medication in the elderly population
xerostomia
gingival overgrowth
what drugs can cause xerostomia?
beta blockers - propanolol
ACE inhibitors - lisinopril
diuretics - frusemide
calcium channel blockers - nifedipine
what medications can cause gingival overgrowth? 3
calcium channel blockers, anti epileptic drugs, cyclosporin
what is the benefit of over dentures?
allow transition for pt to full dentures
Preservation of alveolar bone, aids in stability and retention of the denture and increased psychological wellbeing for pt
criteria for tooth selection for over dentures? 3
Has to have 2 roots for stability - 2 teeth
At least 50% bone support remaining
Tooth needs to be able to be root filled
what is the something the pt needs to be made aware of with over dentures?
high maintenance
name 2 denture induced fungal infections?
denture stomatitis
angular cheilitis
what fungus is associated with denture stomatitis?
candida albicans
what systemically makes a pt more at risk of denture stomatitis?
impaired immune response
