Elderly People And The Dentist

Question 1

Why is life expectancy increasing?

Answer 1

Increasing prosperity 
Education 
Public hygiene 
Improved housing 
Social welfare policy 
Advances in healthcare

Question 2

What are the most common systemic disease in the elderly?

Answer 2

Arthritis
Cancer 
COPD
Diabetes 
Cardiovascular disease 
Hypertension 
Mental health conditions 
Osteoporosis 
Parkinson’s disease 
However many elderly patient present with a combination of these diseases (multi-morbidity)

Question 3

What is arthritis?

Answer 3

A common condition that causes pain and inflammation in the joints causing restricted movement

Question 4

What is xerostomia?

Answer 4

Dry mouth
Can be caused by a variety of reasons in older patients:
-radiation therapy (head ad neck cancer)
-systemic diseases (Sjogrens syndrome, diabetes, Alzheimer’s)
-medications (up to 80% of prescription medications can cause xerostomia e.g. anti cholinergics, tricyclic antidepressants, sedatives, antihistamines, antihypertensives

Question 5

What are some things to remember when treating elderly patients with adult onset type II diabetes mellitus?

Answer 5

Main hazard during treatment- hypoglycaemia
Appointment scheduling- ensure patient has eating, taken medications
Dentist prescribed medications can impact on glycaemia control- antibiotics
Well controlled diabetics- little modifications required
Poorly controlled diabetics- poor wound healing, periodontal disease, implants
Medications- insulin, metformin hydorchloride (lowers blood glucose)

Question 6

What are some common medications people with cardiovascular disease may be taking?

Answer 6

ACE inhibitors
Angiotensin receptor blockers
Beta blockers
Diuretics
GTN spray
Patients often take a combination of drugs
Patients with heart failure may also have- pacemakers, implantable defibrillators
Patients may also being taking anticoagulants such as warfarin

Question 7

What are anticoagulants?

Answer 7

Blood thinners
Most common drug- warfarin
Prescribed to prevent blood clotting- heart disease, DVT, pulmonary embolism, artificial heart valves

Question 8

What needs to be checked prior to treatment with patients who are taking anticoagulants?

Answer 8

Check clotting time using the international normalised ratio (INR)

Question 9

What are antiplatelets?

Answer 9

They decrease platelet aggregation and therefore clotting
Most common drug- aspirin
Used prophylactically to prevent cardiovascular disease- stroke, DVT (deep vein thrombosis)
Also used for patients with atrial fibrillation and following coronary bypass surgery

Question 10

What is hypertension?

Answer 10

High BP- the long term force of the blood against your artery walls is high enough that it may eventually cause health problems such as heart disease

Question 11

What medications are used to control blood pressure?

Answer 11

ACE inhibitors
Angiotensin receptor blockers
Calcium channel blockers
Diuretics

Question 12

What are some common mental health conditions in elderly patients?

Answer 12

Cognitive decline

Dementia

Question 13

What are some problems with treating patients with mental health conditions like dementia?

Answer 13

Patients can be forgetful
Difficult to explain treatment concepts
Issues around informed consent

Question 14

What is osteoporosis?

Answer 14

A health condition that weakens bones, making them fragile and more likely to break

Question 15

How is osteoporosis diagnosed?

Answer 15

A bone density scan (DEXA)

Question 16

How is osteoporosis treated?

Answer 16

Bisphosphonates (oral or IV administration)

They reduce the risk of fracture in patients with osteoporosis by slowing down bone turnover

Question 17

What are the dental implications with the treatment of osteoporosis using bisphosphonates?

Answer 17

After extractions patients are susceptible to bisphosphonae-related osteonecrosis of the jaw (BRONJ/MRONJ) where the bone does not heal properly after extraction

Question 18

What is Parkinson’s disease?

Answer 18

Degenerative disorder of the CNS which can causes involuntary movements that can make oral health provision challenging

Question 19

What is a common medication used to treat Parkinson’s disease?

Answer 19

Levodopa

Question 20

What challenges can dentists face with managing older teeth?

Answer 20

Increased incidences of chronic dental disease- caries, periodontal disease, toothwear
High prevalence of root caries
Fermentable carbohydrates fuel cariogenic bacteria
Tooth brushing and cleaning is compromised by reduced manual dexterity
Removable dentures used to replace missing teeth can further complicate cleaning

Question 21

What are some common factors associated with root caries?

Answer 21

Disease almost unique to older patients 
Associated with gingival recession 
Carbohydrate rich die 
Reduced mechanical cleaning
Partial dentures 
Xerostomia 
Huge restorative challenge