Elderly patients Flashcards
What challenges are there when managing older patients?
- Difficult to know who needs treatment as they often won’t seek treatment unless absolutely necessary
- medical issues might take priority so dental issues ignored
- Can they get to the surgery?
- Do we visit them at home?
- Do we provide an ambulance/taxi to bring to surgery for treatment
- issues affecting treatment of complete dentures - consequences of age and tooth loss
- lack of compliance
What are some common dental pathologies that the elderly face?
Denture stomatitis oral cancer denture granuloma lichen planus oral infections
What problems can the surgery cause for the elderly patient?
- access issues
- toilet
- lighting
- busy environment
- time
- noisy
- postural problems so chair is issue
- intolerant of long procedures
How can we make the dental experience easier for the elderly patient?
Seating – keep upright, or slowly alter position
Noise – low tones, reduce noise and speed
Confusion – reduce speed, less instruction-
- check medical history (GP or family)
Timing of appointment – medication, capability,convenience
How can we adapt the dentures without making massive changes that would be difficult for them to get used to?
Make small changes to existing dentures
-reline
=adapt existing denture
Copy existing dentures, having made alterations
Make new dentures that are similar to some aspects of previous dentures
How can age affect the treatment process?
Assessment and examination
-Rapport with patient
-Getting a clear medical history
-Understanding the patient’s problems
-Deciding on appropriate treatment
-Deciding on where best to treat the patient
AND
Ability to adapt to denture wearing
How can consequences of tooth loss affect the treatment process?
Affects
- impression taking,
- jaw registration,
- retention and stability of the denture
- and ability to wear the denture
What is the alveolar ridge?
After loss of the teeth the remaining alveolar bone forms the alveolar ridge
gives support to a denture
part of the denture-bearing area.
How much more resorption is there of the mandible compared to the maxilla?
4 times
Where is the resorption greater around an individual tooth?
Around an individual tooth, resorption is greater where the cortical plate is thinner
What does loss of teeth in the maxilla lead to?
loss of the teeth leads to:
greater loss of the thinner buccal cortical plate with gradual reduction in the width and length of the residual ridge
What does loss of teeth in the mandible lead to?
- Anteriorly - the buccal plate is slightly thinner so the residual ridge apparently moves slightly lingually
- In the premolar region - the buccal and lingual plates are of equal thickness and the residual ridge maintains its position
- In the molar region - the buccal plate is reinforced by the external oblique ridge, resorption of the thinner lingual plate occurs and there is apparent movement of the residual ridge buccally.
What happens if there is too little resorption?
- bulky alveolar ridges with little space to place dentures
- frequent denture fracture OR excessive face height (as increasing size of denture gives adequate strength)
What happens if there is irregular resorption?
- sharp bone
- tissues traumatised under dentures leading to ulcers/discomfort
- surgical reduction of ridge may be needed
What happens if there is excessive resorption?
- normal relationship of posterior teeth may be changed
- increase in width of mandible posteriorly - posterior crossbite
- anteriorly, buccal resorption of maxilla predominates with edge to edge incisor relationship or prominent mandible may occur
- in the mandible - mental foramen may become superficial
- mylohyoid ridge on lingual aspect of mandible becomes sharp and prominent
- both = pain during denture wear
What are the useful clinical techniques to help prosthetic treatment?
Check record
Windowed trays on a primary impression (window filled with fluid impression material to accommodate the flabby ridge) - anterior flabby ridge
Neutral Zone Impression Technique - anterior section of registration rims replaced by impression material
Retained roots - preserve alveolar bone
Polycarbonate - reduced likelihood of midline fracture
Soft Liners - more comfortable base over irregular ridges, processed onto denture in labs
oral surgery - implants, sulcus deepening, ridge augmentation
What is healthy life expectancy?
Summary measure of population health, estimates
based on question ‘How is your health in general?’ (Very
good, good, fair, bad, very bad)
What is disability-free life expectancy?
Estimates based on those who answer yes to both:
• Do you have any physical or mental health conditions or illnesses
lasting or expected to last 12 months or more?
• Does your condition or illness/do any of your conditions or
illnesses reduce your ability to carry out day-to-day activities?
What is the biggest reason for decline in sound and untreated teeth?
Age
What is ageing?
Ageing as the combination of biological,
psychological and social processes that affect
people as they grow older
– Physical changes to the body
– Shifts in mental processing capacity
– Changes in society and the social context in which
people are ageing
• Age and ageing are therefore multidimensional
and so the study of ageing involves different
constructs aimed at these dimensions
What is age strata?
people who share similar social rights
and duties by virtue of age
What is age cohort?
people born at a particular time who
have experiences in common
What is the disengagement theory?
Functionalist theory (focuses on how elements of society work together) • Growing old as ‘inevitable mutual withdrawal or disengagement, resulting in decreased interaction between an ageing person and others in the social system he belongs to’ (Cumming and Henry, 1961, p.227) • Irreversible process
- backed by the fact that older people choose to visit the dentist less frequently
but when interviewed people want to keep their teeth - not about withdrawal from society
What is the structured dependency theory?
Individuals are not free to act in any way they see
fit
• Structured dependency theory approach focuses
on ways in which social institutions shape
people’s lives (see Walker, 1980; Townsend, 1981)
• Dependency structured by retirement, poverty,
institutionalisation in residential and nursing
homes and the restriction of domestic and
community roles
- backed by access to oral care
What is cultural gerontology?
- focuses on role of culture
- multiple cultures of ageing with different representations of old age
- the third age (Life after responsibilities of paid employment
and child rearing) - the challenge of individualisation
- the fourth age - attributed to ageing bodies, appearance etc - starting at about 80/85, the last years of life (Life after responsibilities of paid employment
and child rearing)
What is critical gerontology?
critiquing and changing society
3 main areas - structural pressures and constraints, meaning, empowerment
- ageing as socially constructed
- Ageing negotiated by the individual, but
considering the role of economic and political
systems in shaping power arrangements and
inequalities
