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Prevention > Geriatric Dentistry > Flashcards

Geriatric Dentistry Flashcards

1
Q

Geriatric Dentistry

Is the delivery of __ ___ to older adults involving the ___, ___ and ___ of problems associated with normal___ and age-related diseases as part of an____ team with other health care professionals

A

Is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals

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2
Q

Older Adult Population

One of the fastest growing segments of the American population

  • Current accepted age to define an older adult is __ years*
  • In 2009, 39.6 million seniors were U.S. residents
  • 2030 this aging cohort is expected to reach 72.1 million – an increase of ___%
  • 1 in _ Americans will be aged 65+ years in 2050
A

One of the fastest growing segments

of the American population

•Current accepted age to define an older

adult is 65 years*

  • In 2009, 39.6 million seniors were U.S. residents
  • 2030 this aging cohort is expected to reach 72.1 million – an increase of 82%
  • 1 in 5 Americans will be aged 65+ years in 2050
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3
Q

Older Adult Population in U.S.

Close to ___ percent of older Americans do not have dental insurance

A

Older Adult Population in U.S.

Close to 70 percent of older Americans do not have dental insurance

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4
Q

Oral and Dental Diseases in Older Adults

___ ___ – (root and/or recurrent)

___ disease

___ missing teeth

___ ___
____ __

A
  • Dental caries – (root and/or recurrent)
  • Periodontal disease
  • Edentulism/ missing teeth
  • Oral cancer
  • Dry mouth
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5
Q

Epidemiology of Xerostomia

Approximately __% of adults are ___ - 44 million in the US

>__% of adults ___ from xerostomia

A

Approximately 20% of adults are affected - 44 million in the US >10% of adults suffer from xerostomia

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6
Q

Dry Mouth / Xerostomia in Older Adults

Indicators

  • Feeling of ___of oral mucosal surfaces
  • S___mucosa
  • Dry __
  • __ ___

Causes difficulty in:

  • __
  • __
  • __
  • ___ food components
A

Dry Mouth / Xerostomia in Older Adults

Indicators

  • Feeling of dryness of oral mucosal surfaces
  • Sensitive mucosa
  • Dry lips
  • Bad breath

Causes difficulty in:

  • Mastication
  • Swallowing
  • Speaking
  • Solubilizing food components
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7
Q

Saliva

  • Lubrication & protection
  • Buffering action & clearance
  • Maintenance of tooth integrity
  • Antibacterial activity
  • Taste and digestion
A

Saliva

  • Lubrication & protection
  • Buffering action & clearance
  • Maintenance of tooth integrity
  • Antibacterial activity
  • Taste and digestion
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8
Q

Xerostomia Causes

  • __ __
  • Head & Neck ___n therapy
  • ___disease or conditions
  • __ __ __
A

Xerostomia Causes

  • Prescription drugs
  • Head & Neck Radiation therapy
  • Systemic disease or conditions
  • Illicit drug use
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9
Q

Systemic disease or conditions

___ changes such as pregnancy or menopause

__ ___

__ __

___d disorders

__ __

___
___ __

A

Systemic disease or conditions

  • Hormonal changes such as pregnancy or menopause
  • Diabetes mellitus
  • Sjögren’s syndrome
  • Thyroid disorders
  • Cystic fibrosis
  • HIV
  • Hepititis C
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10
Q

Dental Caries in Older Adults

•Prevalence of ___ caries & ___ caries is ___

Caries risk factors

  • Reduced __ __
  • Reduced ___ and ___s of oral self-care (mechanical plaque removal)
  • Heavy plaque deposits as result of __ ___
  • Presence of __ __ __
  • Increased consumption of ___ & simple carbohydrates
A

Dental Caries in Older Adults

  • Prevalence of root caries & recurrent caries is higher
  • Caries risk factors
  • Reduced salivary flow
  • Reduced frequency & effectiveness of

oral self-care (mechanical plaque removal)

  • Heavy plaque deposits as result of poor cleaning
  • Presence of removable partial dentures
  • Increased consumption of sugars & simple carbohydrates
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11
Q

Base treatment plan & management by utilizing ___ __ ___

Risk of Caries classified as

Low

Moderate

High

A

Base treatment plan & management by utilizing caries risk assessment

Risk of Caries classified as

Low

Moderate

High

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12
Q

Colgate PreviDent® 5000

__ ___ dispersion than ___e-form Rx dentifrice1

A
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13
Q

Sodium Fluoride Mouthrinses

__ ___s - most widely used for rinses

Clear reduction in___ increments in permanent dentition of children (26% in pooled DMFS prevented fraction)*

 Advantages

___ and ___ of ___

A

Sodium Fluoride Mouthrinses

Na formulations - most widely used for rinses

Clear reduction in caries increments in permanent dentition of children (26% in pooled DMFS prevented fraction)*

 Advantages

– effectiveness

– simplicity of use

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14
Q

Colgate® PreviDent® Varnish

Active Ingredients

5% __ ___22,600 ppm F-)

Indication

____: post ___/ __ ___, post ___ surgery, ___exposure

A
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15
Q

Protective Factors Saliva Plays an important role in protection

___ s the salivary pH

Provides___s & facilitates delivery of ___

Xerostomia places patient at a higher risk for __ __ loss

A

Protective Factors Saliva Plays an important role in protection

Buffers the salivary pH

Provides minerals & facilitates delivery of fluoride

Xerostomia places patient at a higher risk for hard tissue loss

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16
Q

Commonly a combination of factors:

___ ___
____

__ ___
improper__ ___habits

A

Commonly a combination of factors:

acidic diet bruxism

gastric acids improper oral hygiene habits

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17
Q

Attrition – wear produced by ___ __ __ __ ___

A

Attrition – wear produced by direct tooth-tooth contact

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18
Q

Erosion + Attrition 27

Cupping is caused by ___ not ____

Erosion will ___e attrition

A

Erosion + Attrition 27

Cupping is caused by erosion not attrition Erosion will accelerate attrition

19
Q

Abrasion – ___l wear produced by an ___ ___

A

Abrasion – mechanical wear produced by an external source

20
Q

Erosion + Abrasion 29

__ __ + __

A

Erosion + Abrasion 29 Acidic diet and poor OH

21
Q

Diagnosis

In-depth assessment of __ __ and medical/dental ___y

__ ___

A

Diagnosis

In-depth assessment of risk factors and medical/dental history photographs: Ren 2010

Clinical evaluation

22
Q

Erosion may lead to

A

May lead to Dentin Hypersensitivity

23
Q

Mechanism of Hypersensitivity

Stimulus: t__ ___ __ ___

___ Dentin; open tubles

Change in __ of dentin __ __

Generation of __ in i___ ___

AP pass to ___ to cause pain

A

Mechanism of Hypersensitivity

Stimulus: thermal, mechanical, evaporative, chemical

Exposed Dentin; open tubles

Change in rate of dentin fluid flow

Generation of AP in intradental nerves

AP pass to brain to cause pain

24
Q

Dentin Hypersensitivity Affects Patients‘ Quality of Life

Normal, everyday activities can become troublesome

  • Ingesting___ food, drinks or sweets
  • Scraping of a ___ utensil
  • ___ in air
  • Routine __ __e practices

Panagakos et al. Am J Dent. 2009

A

Dentin Hypersensitivity Affects Patients‘ Quality of Life

Normal, everyday activities can become troublesome

  • Ingesting cold food, drinks or sweets
  • Scraping of a metal utensil
  • Breathing in air
  • Routine oral hygiene practices

Panagakos et al. Am J Dent. 2009

25
Q

Deposits Covering Dentin Tubules

–Smear Layer; ___ and ___ ebris

–___

A

Deposits Covering Dentin Tubules

–Smear Layer; organic & inorganic debris

–Calculus

26
Q

Dentin Hypersensitivity - Treatment Options

___ the __ __

___ the ___s: Depolarizing the nerves with ___ ___

A

Dentin Hypersensitivity - Treatment Options

Occluding the dentin tubules

Desensitizing the nerves: Depolarizing the nerves with Potassium salts

27
Q

Treatment options: Nerve Depolarization

5% __ ___e (2% potassium ion)

Compatible with __

•___ and ___ sodium fluoride concentrations

Measurable sensitivity reduction

  • minimum of ___o weeks
  • ___ daily use

Significant level of pain relief after ~___ weeks

A

5% Potassium Nitrate (2% potassium ion)

Compatible with fluoride

•OTC & Rx sodium fluoride concentrations

Measurable sensitivity reduction

  • minimum of two weeks
  • twice daily use

Significant level of pain relief after ~4-8 weeks

28
Q

Occlusion of Tubules

8% ___/___ is effective at occluding dentin tubules

A

8% Arginine/CaCO3 is effective at occluding dentin tubules

29
Q

Colgate offer ___ tubule occluding therapies

___ and __ __

A

Colgate offers two tubule occluding therapies In-office At home

30
Q

Periodontitis affects almost ___% of US Adults

A

Periodontitis affects almost 50% of US Adults

31
Q

Conditions & Diseases Affected by Inflammation

DORA CPR

A

Diabetes

Osteoporosis

Atherosclerosis

Rheumatoid Arthritis

Respiratory Diseases

Cardiovascular Disease

Pregnancy Complications

32
Q

Periodontal Disease in Older Adults

  • Prevalence of periodontal disease___ over time
  • Loss of ____ continues
  • Attachment loss appears/begins in ___ sites
  • Key risk factors for periodontal disease

−___

−Systemic conditions such as__ __

−Physical ___

−Presence of specific __ ___

A

Periodontal Disease in Older Adults

  • Prevalence of periodontal disease increases over time
  • Loss of attachment continues
  • Attachment loss appears/begins in new sites
  • Key risk factors for periodontal disease

−Smoking

−Systemic conditions such as Diabetes Mellitus

−Physical impairment

−Presence of specific periodontal pathogens

33
Q

Systemic Inflammatory Response

Locally produced__ ___ mediators spill into circulation and activat___

Liver responds by producin__ phase proteins such as___, ___, ___

These are “biomarkers” of systemic inflammatory response driven by___ic infection and inflammation associated with ___

A

Systemic Inflammatory Response

Locally produced pro-inflammatory mediators spill into circulation and activate hepatocytes

Liver responds by producing acute-phase proteins such as CRP, fibrinogen and haptoglobin

These are “biomarkers” of systemic inflammatory response driven by chronic infection and inflammation associated with periodontitis

34
Q

Periodontal Disease and Chronic Disease - Diabetes Mellitus

  • The most important systemic risk factor for periodontal disease is ___ (Smoking is an ___risk factor)
  • A bi-directional relationship between 2 conditions with emphasis towards diabetes modulating the periodontal disease
  • Evidence suggests that the presence of periodontitis can adversely affect metabolic (___ ) control in patients with Diabetes Mellitus
  • Prevalence of Diabetes Mellitus increases with___
A

Periodontal Disease and Chronic Disease - Diabetes Mellitus

  • The most important systemic risk factor for periodontal disease is diabetes. (Smoking is an environmental risk factor)
  • A bi-directional relationship between 2 conditions with emphasis towards diabetes modulating the periodontal disease
  • Evidence suggests that the presence of periodontitis can adversely affect metabolic (glycemic) control in patients with Diabetes Mellitus
  • Prevalence of Diabetes Mellitus increases with age
35
Q

Prevalence People with diabetes are ___ times more likely to suffer from Periodontal disease

Diabetes Mellitus increases with age

Mealey BL,

A

Prevalence People with diabetes are 2-3 times more likely to suffer from Periodontal disease Diabetes Mellitus increases with age

Mealey BL,

36
Q

Risk Factors in the Development of Diabetes

  • ____and physic ___
  • High-risk ethnic populations-___ ___ ___ ____
  • Hypertension >___
  • HDL levels <__mg/dL or triglyceride levels>___mg/dL
  • __ ___relative with diabetes
  • History of ___ diabetes or delivery of a baby weighing over __ pounds
  • History of ___ disease or __ ___disease
  • ___ years of age or older

©

A

Risk Factors in the Development of Diabetes

  • Obesity and physical inactivity
  • High-risk ethnic populations-Hispanic, African Americans, American Indians, Pacific Islanders.
  • Hypertension >140/90
  • HDL levels <35mg/dL or triglyceride levels>250mg/dL
  • First-degree relative with diabetes
  • History of gestational diabetes or delivery of a baby weighing over 9 pounds
  • History of vascular disease or polycystic ovarian disease
  • 45 years of age or older

©

37
Q

Signs and Symptoms of Uncontrolled Diabetes Mellitus

  • Polydipsia (extreme thirst)
  • Frequent urination due to polyuria (excessive volume of urine)
  • Polyphagia (excessive hunger)
  • Extreme ___
  • Unintentional __ ___
  • S__ ___sores

__ __ skin

•Peripheral ___y (tingling or ___s of feeling in the hands & feet)

___ eyesight

©

A

Signs and Symptoms of Uncontrolled Diabetes Mellitus

  • Polydipsia (extreme thirst)
  • Frequent urination due to polyuria (excessive volume of urine)
  • Polyphagia (excessive hunger)
  • Extreme fatigue
  • Unintentional weight loss
  • Slow-healing sores
  • Dry, itchy skin
  • Peripheral neuropathy (tingling or loss of feeling in the hands & feet)
  • Blurry eyesight

©

38
Q

Biofilm Removal – Mechanical Cleaning

Chemical removal / dislodgement of bioflim – ___

  • Mechanical removal of plaque: t____
  • Supplemented by__ ___
  • For cleaning the interdental spaces: ___l toothbrush /__ __
A

Biofilm Removal – Mechanical Cleaning

Chemical removal / dislodgement of bioflim – Toothpaste

  • Mechanical removal of plaque: toothbrushing
  • Supplemented by Mouth rinse
  • For cleaning the interdental spaces: Interdental toothbrush /DentalFloss
39
Q

Antiseptic / Antimicrobial Therapies

  • Active Ingredients:
  • Agents with____ /anti gingivitis efficacy marketed in the U.S.

-0.12% __ ____te mouth rinse

(Colgate® PerioGard ®) (Rx Only)

-0.3% ___n Colpolymer toothpaste

(Colgate ® Total)

-Essential oil __ ___ (Listerine ®)

  • Other data-supported agents
  • Cetylpyridinium Chloride (CPC) mouth rinse

(Colgate ® Total ® Advanced Pro Shield mouth rinse

A

Antiseptic / Antimicrobial Therapies

  • Active Ingredients:
  • Agents with antimicrobial/anti gingivitis efficacy marketed in the U.S.

-0.12% Chlorhexidine Gluconate mouth rinse

(Colgate® PerioGard ®) (Rx Only)

-0.3% Triclosan Colpolymer toothpaste

(Colgate ® Total)

-Essential oil mouth rinse (Listerine ®)

  • Other data-supported agents
  • Cetylpyridinium Chloride (CPC) mouth rinse

(Colgate ® Total ® Advanced Pro Shield mouth rinse

40
Q

Colgate Total® Toothpaste

  • Two active ingredients: 0.243% sodium fluoride, 0.3% triclosan
  • ADA accepted and FDA approved to fight plaque and gingivitis
A

Colgate Total® Toothpaste

  • Two active ingredients: 0.243% sodium fluoride, 0.3% triclosan
  • ADA accepted and FDA approved to fight plaque and gingivitis
41
Q

Clinical Benefits of Triclosan/Copolymer Toothpaste

The most clinically researched toothpaste

–>90 published clinical studies with >20,000 participants

–>20 long-term clinical trials

•Major systematic reviews/meta-analyses

–Davies RM et al. J Clin Periodontol 2004

–Gunsolley JC. J Am Dent Assoc 2006

•Comprehensive reviews on the efficacy and safety

–Panagakos FS et al. J Clin Dent 2005

–Blinkhorn A et al. Br Dent J 2009

A

The most clinically researched toothpaste

–>90 published clinical studies with >20,000 participants

–>20 long-term clinical trials

•Major systematic reviews/meta-analyses

–Davies RM et al. J Clin Periodontol 2004

–Gunsolley JC. J Am Dent Assoc 2006

•Comprehensive reviews on the efficacy and safety

–Panagakos FS et al. J Clin Dent 2005

–Blinkhorn A et al. Br Dent J 2009

42
Q

Background and Aims of the Cochrane Collaboration

Cochrane Reviews are now the “gold standard” for systematic reviews

A

Background and Aims of the Cochrane Collaboration

Cochrane Reviews are now the “gold standard” for systematic reviews

43
Q
A

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