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

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

Dry Mouth / Xerostomia in Older Adults Indicators Feeling of ___of oral mucosal surfaces S___mucosa Dry __ __ ___ Causes difficulty in: __ __ __ ___ food components

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

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

Xerostomia Causes __ __ Head & Neck ___n therapy ___disease or conditions __ __ __

Xerostomia Causes Prescription drugs Head & Neck Radiation therapy Systemic disease or conditions Illicit drug use

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

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

Geriatric Dentistry Flashcards by Daryl Stein

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

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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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

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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Older Adult Population in U.S.

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

Older Adult Population in U.S.

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

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Oral and Dental Diseases in Older Adults

___ ___ – (root and/or recurrent)

___ disease

___ missing teeth

___ ___
____ __

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

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Epidemiology of Xerostomia

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

>__% of adults ___ from xerostomia

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

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Dry Mouth / Xerostomia in Older Adults

Indicators

Feeling of ___of oral mucosal surfaces
S___mucosa
Dry __
__ ___

Causes difficulty in:

__
__
__
___ food components

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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Saliva

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

Saliva

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

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Xerostomia Causes

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

Xerostomia Causes

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

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Systemic disease or conditions

___ changes such as pregnancy or menopause

__ ___

__ __

___d disorders

__ __

___
___ __

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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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

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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Base treatment plan & management by utilizing ___ __ ___

Risk of Caries classified as

Low

Moderate

High

Base treatment plan & management by utilizing caries risk assessment

Risk of Caries classified as

Low

Moderate

High

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Colgate PreviDent® 5000

__ ___ dispersion than ___e-form Rx dentifrice1

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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 ___

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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Colgate® PreviDent® Varnish

Active Ingredients

5% __ ___22,600 ppm F-)

Indication

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

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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

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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Commonly a combination of factors:

___ ___
____

__ ___
improper__ ___habits

Commonly a combination of factors:

acidic diet bruxism

gastric acids improper oral hygiene habits

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Attrition – wear produced by ___ __ __ __ ___

Attrition – wear produced by direct tooth-tooth contact

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Erosion + Attrition 27

Cupping is caused by ___ not ____

Erosion will ___e attrition

Erosion + Attrition 27

Cupping is caused by erosion not attrition Erosion will accelerate attrition

Abrasion – ___l wear produced by an ___ ___

Abrasion – mechanical wear produced by an external source

Erosion + Abrasion 29

__ __ + __

Erosion + Abrasion 29 Acidic diet and poor OH

Diagnosis

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

__ ___

Diagnosis

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

Clinical evaluation

Erosion may lead to

May lead to Dentin Hypersensitivity

Mechanism of Hypersensitivity

Stimulus: t__ ___ __ ___

___ Dentin; open tubles

Change in __ of dentin __ __

Generation of __ in i___ ___

AP pass to ___ to cause pain

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

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

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

Deposits Covering Dentin Tubules –Smear Layer; ___ and ___ ebris –\_\_\_

Deposits Covering Dentin Tubules –Smear Layer; organic & inorganic debris –Calculus

Dentin Hypersensitivity - Treatment Options \_\_\_ the __ \_\_ \_\_\_ the \_\_\_s: Depolarizing the nerves with ___ \_\_\_

Dentin Hypersensitivity - Treatment Options Occluding the dentin tubules Desensitizing the nerves: Depolarizing the nerves with Potassium salts

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

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

Occlusion of Tubules 8% \_\_\_/\_\_\_ is effective at occluding dentin tubules

8% Arginine/CaCO3 is effective at occluding dentin tubules

Colgate offer ___ tubule occluding therapies \_\_\_ and __ \_\_

Colgate offers two tubule occluding therapies In-office At home

Periodontitis affects almost \_\_\_% of US Adults

Periodontitis affects almost 50% of US Adults

Conditions & Diseases Affected by Inflammation DORA CPR

Diabetes Osteoporosis Atherosclerosis Rheumatoid Arthritis Respiratory Diseases Cardiovascular Disease Pregnancy Complications

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 __ \_\_\_

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

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 \_\_\_

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

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\_\_\_

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

Prevalence People with diabetes are ___ times more likely to suffer from Periodontal disease Diabetes Mellitus increases with age Mealey BL,

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

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 ©

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 ©

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 ©

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 ©

Biofilm Removal – Mechanical Cleaning Chemical removal / dislodgement of bioflim – \_\_\_ * Mechanical removal of plaque: t\_\_\_\_ * Supplemented by\_\_ \_\_\_ * For cleaning the interdental spaces: \_\_\_l toothbrush /\_\_ \_\_

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

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

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

Colgate Total® Toothpaste * Two active ingredients: 0.243% sodium fluoride, 0.3% triclosan * ADA accepted and FDA approved to fight plaque and gingivitis

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

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

Background and Aims of the Cochrane Collaboration Cochrane Reviews are now the “gold standard” for systematic reviews