Gerodontology

Question 1

Why are more older patients retaining their teeth?

Answer 1

• improved preventative programmes
• changing patient attitudes
• desire for treatments to maintain natural teeth

Question 2

What challenges do retained teeth is older people pose?

Answer 2

• chronic dental diseases
  
  • caries
  • periodontitis
  • toothier

Question 3

What are chronic diseases?

Answer 3

conditions of long duration and generally slow progression

• leading cause of mortality worldwide

Question 4

What are the common risk factors between destructive dental diseases and chronic systemic diseases?

Answer 4

• smoking
• diet
• glycemic control

Question 5

Why is becoming edentulous in later life challenging?

Answer 5

• generally less able to adapt to the limitations of complete dentures

Question 6

What can cause pain and suffering in elderly patients and impair oral function?

Answer 6

• diet
• reduced manual dexterity
• xerostomia
  
  • poly pharmacy

Question 7

What are the different sections of oral frailty?

Answer 7

• mastication
  
  • difficulty eating hard or tough foods
  • inability to chew all types of food
• swallowing
  
  • decreased ability to swallow solid foods
  • decreased ability to swallow liquids
  • overall poor swallowing function
• oral motor skill
  
  • impaired tongue movement
  • speech or phonatory disorders
• salivation
  
  • hypo salivation or xerostomia

Question 8

What contributes to quality of life for older people?

Answer 8

• having good social relationships
• maintaining social activities and retaining a role in society
• having a positive psychological outlook
• having good health and mobility
• to enjoy life and retain independence and control

Question 9

What may be an older persons perspective of oral care?

Answer 9

• health declining in the last year of life
• more likely to rate their oral/general health as bad
• twice as likely to report disliking the appearance of their mouth
• more likely to report difficulty with chewing
• more than seven times more likely to report an impaired sense of tase
• increased reporting of oral pain and discomfort
• less likely to utilise oral health services
• oral health behaviours decline towards death due to reduced function

Question 10

What perspective may medical and caring staff have on older care for elderly patients?

Answer 10

• lack of oral health knowledge
• health and caring facilities with no oral health protocols
• importance of protocols not recognised
• range of products used to provide oral care
• oral products used often wrong

Question 11

What perspective may relatives have of end of life care?

Answer 11

• cleanliness
• free of pain
• have family present
• dignity maintained

Question 12

What are the 3 factors important for oral care for elderly patients?

Answer 12

• social wellbeing
  
  • communication
  • comfort
  • halitosis
• pain and infection
  
  • immune status
  • OHRQoL
• function
  
  • nutrition
  • communication

Question 13

How is the decision made to treat or not treat oral disease in elderly patients?

Answer 13

• end of life trajectory tends to be longer
• difficult to predict how long patients will live
• can be more conservative if close to end of life
• risk of over treatment

Question 14

What is ART and what is its role?

Answer 14

• atraumatic restorative technique
  
  • removal of caries with an excavator
  • restored with glass ionomer
  • no need for LA
• useful for uncooperative patients
• good survival rate after 2 years
  
  • average care home stay is 2-3 years
  • risk factors for failure
    
    • reduced frequency of toothbrushing
    • absence of prosthesis
    • posterior location of teeth
    • higher baseline plaque index

Question 15

What is the link between older patients and oral candidiasis and how is it treated?

Answer 15

• disease of the diseased
• significantly prevalence in older people
• anti fungal treatment
  • miconazole gel placed on denture

Question 16

What is the link between older patients and xerostomia?

Answer 16

• altered speech
• reduced nutritional function and intake
• impaired social interaction
• protective features of saliva lost

Question 17

What is frailty?

Answer 17

a biological syndrome of increased vulnerability resulting from ageing associated decline in reverse and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised

Question 18

What are the 5 frailty syndromes

Answer 18

• falls
• immobility
• delirium
• incontinence
• susceptibility to side effects (poly pharmacy)
  • chronic health conditions
  • multiple medications

Question 19

What are the most common medical concerns in older people?

Answer 19

• frailty
• poly pharmacy
• continence
• falls
• bone health
• nutrition and weight loss
• dementia
• Parkinson’s disease
• diabetes
• stroke

Question 20

What can cause falls in elderly patients and what are the dental implications?

Answer 20

• causes
  
  • intrinsic
    
    • postural hypotension (antihypertensives)
  • extrinsic
    
    • trip hazards
• 50% over 80s fall each year
• 33% over 65s fall each year
• dental implications
  
  • dental trauma
  • sitting patients up slowly after treatment
  • manual handling
  • domiciliary visits
    
    • fear of falling

Question 21

How does bony health impact older patients?

Answer 21

• sharp increase in prevalence of osteoporosis
  
  • between 50 and 80 years
• higher incidence in females
  
  • oestrogen withdrawal
    
    • menopause
  • impacts on bone density
• bony fractures
  
  • leads to use of bisphosphonates
• dental implications
  
  • MRONJ risk
  • mandible fracture
    
    • fall
    • extractions

Question 22

How do nutrition and weight loss impact older patients?

Answer 22

• loss of functional teeth or poor fitting dentures
  
  • restriction of food choices
  • high sugar diet lacking essential nutrients
    
    • increased caries risk
• weight loss can contribute to frailty
• dental implications
  
  • delayed healing
  • NCTSL (erosion)
    
    • dependent on diet
  • haematinics
    
    • burning mouth syndrome
    • recurrent aphthous stomatitis
  • higher caries rate

Question 23

How do medications and the immune system impact older patients?

Answer 23

• less agile immune system
• medications impacting immune system function
• oral corticosteroids
  
  • range of inflammatory autoimmune conditions
    
    • prednisolone (asthma/temporal arteritis)
• disease modifying medications
  
  • severe autoimmune diseases
  • rheumatoid arthritis
    
    • methotrexate
  • systemic lupus erythematous
    
    • mycophenolate
• chemotherapy agents
  
  • cancer treatment
• immunomodulatory treatment
  
  • cancer treatment
  • non-Hodgkin lymphoma
    
    • rituximad
• dental risks associated
  
  • dental infections
  • prolonged healing
    
    • invasive procedures

Question 24

What is diabetes?

Answer 24

• condition affecting regulation of blood sugar
  
  • insulin usually produced by the body
    
    • moves sugar from blood into cells
  • sugar excreted unto urine
    
    • blood sugar level is high
    • water pulled by sugar
  • polyuria and polydipsia
    
    • hallmark symptoms

Question 25

What is Type 1 diabetes?

Answer 25

- pancreas does not produce insulin - appears in younger people - treated with insulin

Question 26

What is Type 2 diabetes?

Answer 26

- most common form - develops over time - body becomes less responsive to insulin - treatment with insulin tablets

Question 27

What are the dental implications of diabetes?

Answer 27

- written information in larger font sizes - damage to retinal blood vessels - can lead to visual loss - transfer from wheelchairs - peripheral vascular disease - significant impact on mobility - amputation - wound healing - compromised - rapid infection progression - require aggressive management - general anaesthetic - alteration to insulin regime - fasting - appointment times - scheduled for morning appointments - higher endogenous cortisol levels - increase blood glucose - decreased risk of hypoglycaemia - avoid scheduling at certain times - maximum insulin activity peak - missing a meal time - dental risks - hyperglycaemia - hypoglycaemia - fatigue/reduced tolerance for long treatment - increased risk of infection - poor wound healing - increased risk of periodontal disease - co-morbidities/secondary complications

Question 28

What is a stroke?

Answer 28

- sudden interruption of blood supply to break leading to rapid focal or global neurological disturbance which lasts >24 hours - fatal 7% of the time - haemorrhagic is worse than ischaemic - signs and symptoms - limb weakness - facial weakness - slurred speech - cranial nerve deficits - gait disturbance - confusion - loss of consciousness

Question 29

What are the 4 different types of stroke?

Answer 29

- ischaemic - cerebral infarction - neurological deficits - occluded artery in cerebral circulation - thrombotic stroke - most commonly atherosclerosis - in cerebral artery - flow stagnation and local thrombosis - results in occlusion - embolic stroke - thrombus breaks up and passes through - commonly bifurcation of common carotid - haemorrhagic - cerebral haemorrhage - neurological deficits - collection of blood from rupture - intracerebreal haem stroke - sub arachnoid haem stroke - AV malformations - berry aneurysms - carotid artery dissection - neck trauma - cerebral venous thrombosis - clot in venous sinus in brain

Question 30

What are the signs and symptoms of stroke?

Answer 30

- facial weakness - arm weakness - slurred speech - hair disturbance - urinary incontinence - loss of taste - impaired pain/thermal - headache - confusion - loss of consciousness - face/neck pain - CN deficit - loss of voluntary movement on opposite side

Question 31

What are the risk factors involved in dentistry for stroke patients?

Answer 31

- hypertension - diabetes melitus - hypercholesterolaemia - atrial fibrillation - infective endocarditis - carotid artery disease - atheroma - stenosis - congestive heart failure - congenital/structural heart disease - age - >55 years doubles risk - genetics - family history in first degree relative - gender - more common in males - females - OCP - migraine with area - immediately postpartum - sickle cell disease - microvascular disease - hypercoaguability - antiphospholipid syndrome - CKD - life choices - smoking - alcohol - physical inactivity - poor diet

Question 32

What guidance should be referred to for advice on treating stroke patients?

Answer 32

Guidelines for the Oral Healthcare of Stroke Survivors - British Society of Gerontology 2010

Question 33

What are the dental implications for stroke patients?

Answer 33

- access, mobility and communication impaired - cognitive and visual defects - speech difficulties - confusion and memory loss - capacity - depression - self-neglect - deterioration or oral hygiene - especially on affected side - impaired manual dexterity - recommend electric toothbrush - dysphagia - around 50% of patients - concern when taking impressions/water - defer elective treatment for 3-6 months - communication - don't wear mask - face patient - speak slowly - clear - simple language - short mid-morning appointments - treatment upright - extra care about aspiration - loss of protective reflexes - high volume suction - care with anticoagulants - care with adrenaline containing LA - can cause hypertension - avoid benzodiazepines - respiratory depression