Elderly patient

Question 1

remember
There is an increase in elderly population and of these there is a higher percentage with natural teeth

Question 2

how do u treat elderly pt who are independent?

Answer 2

Forget age, treat as young people

Question 3

frailty criteria

Answer 3

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

Question 4

what is used to assess frailty?

Answer 4

Rockwood frailty score

Question 5

pt with a rockwood frailty score of 7,8 or 9 are treated by who?

Answer 5

community dental team

Question 6

what prescribing considerations do u have to make for the elderly 3?

Answer 6

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

Question 7

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

Question 8

tooth loss tends to occur in what socio-economic area?

Answer 8

deprived areas

Question 9

threats to oral health in the elderly 6

Answer 9

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

Question 10

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

Question 11

what are the 3 types of tooth wear? (non-carious tooth surface loss)

Answer 11

abrasion
attrition
erosion

Question 12

define abrasion

Answer 12

physical damage to enamel due to external factors e.g. brushing too hard

Question 13

define attrition

Answer 13

loss of structure due to tooth to tooth contact e.g. grinding and clenching

Question 14

define erosion

Answer 14

loss of tooth enamel due to acids in the mouth can be external (juice) or internal (GORD)

Question 15

name 4 causes of dental erosion excluding dietary

Answer 15

Hiatus hernia
Alcohol abuse
Duodenal ulceration
Certain medications

Question 16

name two dental influences from medication in the elderly population

Answer 16

xerostomia
gingival overgrowth

Question 17

what drugs can cause xerostomia?

Answer 17

beta blockers - propanolol
ACE inhibitors - lisinopril
diuretics - frusemide
calcium channel blockers - nifedipine

Question 18

what medications can cause gingival overgrowth? 3

Answer 18

calcium channel blockers, anti epileptic drugs, cyclosporin

Question 19

what is the benefit of over dentures?

Answer 19

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

Question 20

criteria for tooth selection for over dentures? 3

Answer 20

Has to have 2 roots for stability - 2 teeth

At least 50% bone support remaining

Tooth needs to be able to be root filled

Question 21

what is the something the pt needs to be made aware of with over dentures?

Answer 21

high maintenance

Question 22

name 2 denture induced fungal infections?

Answer 22

denture stomatitis
angular cheilitis

Question 23

what fungus is associated with denture stomatitis?

Answer 23

candida albicans

Question 24

what systemically makes a pt more at risk of denture stomatitis?

Answer 24

impaired immune response

Question 25

what fungus is associated with angular cheilitis?

Answer 25

chronic candidate infection

Question 26

what bacteria is associated with angular cheilitis?

Answer 26

staphylococcal infection from the nose

Question 27

angular cheilitis can be a sign of what systemically?

Answer 27

iron deficiency anaemia

Question 28

what is the treatment for angular cheilitis and denture stomatitis? 4

Answer 28

• Adv pt to remove at night
• Scrupulous denture hygiene
• Topical antifungals - miconazole
• New dentures

Question 29

what are the common sited for oral carcinoma?

Answer 29

lateral border of tongue, lips and floor of the mouth

Question 30

90% of oral carcinomas are what?

Answer 30

squamous cell carcinoma

Question 31

Environmental factors to consider with elderly pt
- Changes in saliva
- Exposed root surfaces
- Single standing teeth
- Softer diets
- Reduced oral activity
- Increase in xerostomia
- Dexterity problems - arthritic disease
- Side effects of drugs - phenytoin, cyclosporin, nifedipine (gingival overgrowth)
- Anticoagulants - INR