The Ageing Dentition Flashcards
what is the life course of a dentition
primary dentition
secondary dentition
partially dentate
edentulous
what are the reasons that teeth can be missing
- congenitally missing
- trauma
- head and neck cancer
- periodontal disease
- dental caries
- endodontic infection
- NCTSL
- exfoliation
what are the risk factors for losing teeth / missing teeth
- socio-cultural
- environmental
- lifestyle
- medical status
- HPV
- alcohol
- smoking / tobacco use
- nutritional deficiency
- genetic
- socioeconomic status
- sugar
- oral hygiene
- access
- impairment / disability
- salivary flow
- health system
what are some of the challenges of the aging population
• Increased number of people with long term conditions
○ An estimated 4 million older people in the UK (36% of people aged 65-74 and 47% of those aged 75+) have a limiting longstanding illness.
• Increasing age with concurrent increase in co-morbidities (55-98%) ○ - Cardiovascular Diseases and Stroke ○ - Cancer ○ - Diabetes ○ - COPD
• Polypharmacy
○ Over 65s currently taking 10 medications or more = 16.4%
○ An older patient on multiple medications (many of which will have mouth dryness as a side effect) means the effect is compounded so dry mouth can be quite profound
§ A dry mouth can cause riot for your oral health and your quality of life in these situations
in regards to dental care, what impact does the aging population and systemic disease have
- A population at an increased risk of oral disease
- Polypharmacy
- Impaired ability to co-operate
• Access - moving and handling
○ Hoisting
○ Transfer to the dental chair
○ Mobility aids
- Medical conditions complicate the provision of dental treatment
- Medical conditions contraindicate the provision of dental treatment
what problems can the aging dentition experience
- poor oral hygiene
- caries
- periodontal disease
- oral mucosal diseases
- lichen planus
- head and neck cancer
why might an older person have poorer oral hygiene
- Perhaps the patient is relying on someone else to do their oral hygiene for them
○ Caring for Smiles is trying hard to address the training for someone caring for someone else’s oral hygiene - Perhaps the patient is caring for themselves but they have reduced co-ordination mobility, they don’t have strength in their arms to carry an electric toothbrush
○ Lots of barriers here
why can caries be a problem in the aging population?
what sort of caries causes the biggest problems
- Root caries is a real enemy in the older population
○ Root caries becomes circumferential which can then cause the crown to snap off
○ Especially if someone is wearing a partial denture the risk of root caries increases because there is extra plaque retention factors in the mouth where the gingival clasps are meeting
how does periodontal disease present problems in the aging population
- When patients have significant deep pockets it is a harbour for all the bacteria and periodontal pathogens
○ These pathogens have a potential link to both systemic and inflammatory disease
how can oral mucosal diseases impact elderly patients
- If the patients are not examined regularly then it is really easy to miss these fungal infections like denture induced stomatitis or ulcerative lichen planus
○ Things that can contribute to a poorer quality of life for the individual - You can also really commonly get traumatic ulcers
how can lichen planus cause problems to the elderly
- discomfort when eating
- Difficulty in performing oral hygiene
- Risk of malignant transformation
what can contraindicate certain therapies / treatments
• Systemic disease and polypharmacy may contraindicate certain therapies
○ Can be difficult to treat if they are already on multiple medications or have multiple other conditions which means they might not be able to tolerate our treatment for lichen planus (or other diseases)
○ Or that our treatment for this is actually contraindicated because of their other medical status as well
○ Can be complex
what is essential when treating a patient with head and neck cancer
Early Assessment, Diagnosis and Management are essential
but this doesnt happen often
why might patients not present with head and neck cancer until the disease is more advanced
○ Delay in diagnosis
○ Symptoms unable to be communicated
○ Lack of attention paid
○ Misdiagnosis
Or maybe they were treated inappropriately for their symptoms eg maybe they thought it was a fungal infection or something
what is the most common cause of death in patients with dysphagia associated with neurological impairment
aspiration pneumonia
in what patients does aspiration pneumonia usually occur
usually occur in older adults who are dependent
○ Often receiving their nutrition through a NG Tube or they might be peg fed so they are not necessarily eating orally
○ They are commonly mouth breathing
○ They can be dehydrated
○ Sometimes not receiving any regular oral hygiene
§ this is because some people believe if you are not eating then why would you need to clean the teeth
§ But can still get this build up of plaque and a kind of crusting is seen around the oral mucosa
is aspiration pneumonia preventable
This condition is entirely preventable
○ It is as simple as ensuring good oral hygiene measures on a regular basis
○ Unfair as an older person should expect to eb pain free and comfortable
○ A dirty mouth from a carer’s point of view can lead to a life threatening spread of infection and the patient’s quality of life being seriously compromised by this but it is so easy to fix
what does good oral hygiene mean for older people
- 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 to retain one’s independence and control over life
what are teeth important to older people
“Frail older people are positively influenced by natural teeth and this effect seems to increase with increasing frailty”
“Preservation of teeth contributes to a positive body image and self worth”
Important for nutrition as well
what is important in treatment planning for a patient in the early stages of dementia
- Should oral assessment be part of multi-disciplinary care of the person with dementia following diagnosis?
- Planning for the future as we consider the progressive nature of dementia
- Assessment
- Identify and attempt to retain “Key Teeth”
- Focus on high quality restorations
• Are complex restorative treatments able to be cared for in the long term?
○ Want to try and avoid complex treatment
○ You might not want to start crown and bridgework and implants ~ not saying don’t do it but do think about the future
○ Will this patient be able to care for this complex restorative work in the future, will the oral hygiene be there?
- Establish a preventative regime
- Good idea if the patient wears dentures is to consider taking replica impressions of these dentures because the chances are if this patient is going to go into a care home or hospital in the future they are very likely to get lost
why is it a good idea to take replica impressions of the denture
○ If a patient has dementia and loses their dentures then it can be tricky for them to get used to new dentures
○ Or can even be tricky for the dentist to construct the dentures
○ Good idea to have the replica dentures so you have them should these problems arise
○ There is an economic issue and a storage issue but with 3D scanning and imaging becoming more popular it might be possible to store on a computer
what are the key teeth to retain for quality of life
• Occluding pairs of teeth
○ Aid in mastication so this will improve nutrition
- Number of teeth
- Attempt to retain anterior teeth
why is keeping natural teeth through prevention better than complex treatments (ie the cure)
- Natural teeth have a significant impact on QoL
- Chewing and eating
- Nutrition
- Independence / pride and achievement
- Social aspects of life
what is important in treatment planning for a patient in the mid stages of dementia
- Maintenance and prevention are essential
- Ability to co-operate may deteriorate limiting the ability to provide care intervention
- Consideration must be given to medical status and its implications upon provision of care
- Access becomes increasingly more challenging
• Always go back to basics: teeth must be kept clean and healthy
○ Every day prevention
• Consider seeing the patient in a domiciliary setting such as going to their home or their care home
○ More settled and familiar environments