Systemic disease in the Elderly

Question 1

What are the effects of ageing on oro-facial tissues?

Answer 1

Atrophy, reduced epithelial thickness, collagen flexibility, innervation, blood supply. which ? predispose to oral discomfort / poor healing ?

Question 2

What does atrophy of salivary glands or increased drug use predispose to?

Answer 2

Xerostomia.

Question 3

What does an increase in skin creases predispose to?

Answer 3

Angular cheilitis.

Question 4

What are the dental aspects of neurological disease in elderly patients?

Answer 4

Pain, sensory loss, facial palsy, drooling, tremor, communication problems, mental/physical impairment, loss of protective reflexes, adverse drug effects

Question 5

What dental aspects need to be considered in patients with cardiovascular disease?

Answer 5

Dental aspects:
- GA and LA risks
- Effects of anxiety
- Positional breathlessness
- Postural hypertension
- Valve defects
- Pain – usually temporal, rarely tongue pain/ ischaemic necrosis.

Question 6

What are some potential dental drug interactions in cardiovascular patients?

Answer 6

Miconazole/fluconazole and warfarin/statins.

Question 7

What are the dental aspects of respiratory disease in elderly patients?

Answer 7

effects of steroid inhalers (candidiasis), systemic steroids (complications, steroid cover needed?), positional breathlessness, GA risks, anxiety

Question 8

Where does candidiasis related to steroid inhaler present

Answer 8

Affects dorsum of tongue, palate (depapillated with creamy white patch)

Question 9

How can candidiasis from steroid inhalers be prevented?

Answer 9

Rinse mouth after use and use a spacer device.

Question 10

What else predisposes pts to candidiasis

Answer 10

smoking

Question 11

What are the dental aspects of musculoskeletal/bone disease?

Answer 11

• Mobility problems (neck/ back pain and chair positioning)
• TMJ pain/ dysfunction (may also be related to denture problems, missing teeth, lack of denture support)
• Effects of medication (analgesics, anti-inflammatories: oral ulcers, lichenoid reactions. Bisphosphonates: impaired bony healing/ MRONJ)
• Jaw lesions, hypercementosis, post-extraction bleeding, osteomyelitis.

Question 12

What oral problems are associated with bisphosphonates in musculoskeletal disease?

Answer 12

Impaired bony healing, MRONJ.

Question 13

What are the dental aspects of genitourinary disease?

Answer 13

• Xerostomia: drugs are the most common cause, pt may also have restricted fluid intake
• Leukoplakia, halitosis/ taste disturbance, bleeding tendency, jaw metastases (prostate cancer), effects of medication (eg bisphosphonates in prostate cancer)

Question 14

What are the dental aspects of hepatic disease?

Answer 14

Lichen planus, salivary gland swelling/ sialosis, xerostomia, secondary Sjogren’s syndrome, bleeding tendency (severe liver disease)

Question 15

What are the dental aspects of diabetes mellitus?

Answer 15

Candidiasis, xerostomia, periodontal disease, sialosis, lichen planus.

Question 16

What oral side effects of medications for diabetes cause orally?

Answer 16

Lichenoid reactions.

Question 17

What are the dental aspects of connective tissue disease?

Answer 17

xerostomia, salivary gland swelling (can be chronic), candidosis, caries, TMJ arthritis, white lesions (lichenoid/desq ging) ulcers, facial sensory loss, reduced mouth opening (limited dental care) telangiectasia, widening of PDL

Question 18

What are the effects of medications used to treat connective tissue disease?

Answer 18

Effects of medications: eg NSAIDS, antirheumatics, immunosuppressants
Lichenoid reactions, ulcers, ciclosporin – gingival hyperplasia.

Question 19

What are the dental aspects of mucocutaneous diseases?

Answer 19

White/red lesions, ulcers, blisters, desquamative gingivitis, risk of malignancy.

Question 20

dental aspects of mucocutaneous diseases?

Answer 20

Solar keratoses, BCC
Solar keratosis/ actinic chelitis
Risk of SCC if recurrent/ persistent and crusting
Bleeding
Swelling
On lip
Lichen planus
Pemphigoid diseases (mainly MMP)
Pemphigus (p. vulgaris, paraneoplastic p.)
Erythema multiforme
Dental aspects: white/ red lesions, ulcers, blisters, desq ging, blood stained crusting of lips (in erythema multiforme), risk of malignancy

Question 21

What mucocutaneous condition presents a risk of squamous cell carcinoma (SCC)?

Answer 21

Solar keratosis/actinic cheilitis.

Question 22

What are common adverse reactions to drugs in elderly patients?

Answer 22

• side effects: undesirable pharmacological effects at the recommended doses
  - GIT with NSAIDs
• Secondary effects: indirect consequences of pharmacological action of the drug
  - Candidosis with use of steroid inhalers
• Intolerance: a low threshold to the normal pharmacological action of the drug
• Interactions: effects of drugs prescribed in dentistry on drugs for medical treatment
  - Aspirin, metronidazole on anticoagulants

Question 23

What are common oral adverse effects of drugs on the oral cavitiy?

Answer 23

• Fixed drug eruption
• Contact stomatitis
• Erythema multiforme
• Oral ulceration
• Lichenoid reactions
• Discolouration of mucosa and teeth
• Gingival hyperplasia
• Xerostomia
• Taste disturbances