The Aging Mouth Flashcards
what percent of people age 75+ are edentulous?
25.8%
what percept of people age 65+ have experienced dental caries?
96%
what percent of people age 65+ have untreated dental caries?
18-19%
what is the incidence of new coronal caries in older adults?
43.3%
what is the average number (increment) of tooth surfaces per person (in older adults) developing caries?
1.22
what is the attack rate (proportion) of at-risk surfaces developing caries in older adults?
1.4/100 (one new caries lesion per person per year)
T or F:
findings suggest that new decay among older adults is similar to or higher than that in children
true
T or F:
caries among the elderly is less likely to remain untreated than caries in children
false
it is more likely to remain untreated
what is the root caries prevalence among older adults aged 65-74? what about >75?
65-74 = 12% >75 = 17%
what is the reported distribution of root caries in the mandible? maxilla?
- mandible: molars > premolars > anterior (not Dr. E’s personal observation)
- maxilla: more evenly distributed
dentin demineralizes at a pH of ___. enamel demineralizes at a pH of ___.
dentin = 6 enamel = 5.4
what are the 7 main root caries risk factors?
- dentin demineralization
- previous caries experience
- clinical attachment loss
- plaque
- quality and quantity of saliva
- lack of fluoride
- diet
what are the pros and cons of using amalgam to restore root caries?
- pro: greater longevity than composite
- con: more secondary caries compared to GI
what are the pros to using GI/RMGI to restore root caries?
- fluoride release
- high caries risk patients
- 80% greater caries reduction than composite
what are 3 restorative materials for root caries?
amalgam, composite, and GI/RMGI
other than the 7 main root caries risk factors, what are some other risk factors?
newly exposed roots, number of exposed roots, active periodontal therapy, smoking, onset of systemic illness, lack of social integration and support, number of periodontal pockets >3mm, less than 9 remaining teeth
what restorative material is anti-cariogenic, reasonably esthetic, chemically bonds to dentin, and acceptable for minimally invasive preparations and ART (atraumatic restorative treatment)?
glass ionomer
as the periodontium ages, there is a(n) ___ in collagen synthesis in the gingiva, resulting in ___
- decrease
- dekeratinization and thin irregular epithelium
as the periodontium ages, there is a(n) ___ in cellular components of the periodontal ligament with a(n) ___ in irregularity
- decrease
- increase
as the periodontium ages, there is a(n) ___ in alveolar bone density
decrease
T or F:
there is an increase in the prevalence of periodontal disease in older adults than younger
true
T or F:
periodontal attachment loss increases with age and the percentage with advanced periodontal disease (pockets >5mm) increases as well
false
although periodontal attachment loss does increase with age, the percentage with advanced periodontal disease decreases in the oldest
in older adults, severe attachment loss is more often associated with ___ than ___
recession than pocketing
T or F:
age is a predictor of progressing periodontal disease, not new disease
true
T or F:
in older adults, there is a higher prevalence of advanced periodontal disease and a somewhat lower prevalence of mild to moderate
false
there is a higher prevalence of mild to moderate periodontal disease, and a somewhat lower prevalence of advanced disease
what are the 3 main affects that aging has on the pulp?
- secondary dentin = diminished pulp volume
- decreased cellularity, vascularity, and innervation with increased fibrosis
- increase in pulp stones
what affects does diminished pulp volume have?
- decreased risk of pulpal exposure
- decreased pulpal sensitivity
- increased difficulty with pulpal diagnosis
- increased difficulty with canal access if endo is required
what affects does decreased cellularity, vascularity, and innervation with increased fibrosis have on the pulp?
- reduced reparative capacity
- reduced response to EPT, cold (may need dry ice)
late pulp breakdown often results in apical periodontitis in the aging population. what is a complication of this? what % of people >60 have one or more teeth with apical periodontitis of pulpal origin?
- may be slow and asymptomatic (difficult to diagnose)
- 62%
what are 5 types of pulpal therapies?
- direct pulp capping (not predictable)
- pulpotomy (no evidence base, experimental)
- cell activity promotion (cements containing MTA)
- pulpal regeneration (research being done)
- root canal therapy (legitimate and predictable in older teeth)
what are some endo challenges in older teeth?
- access orientation, existing restorations, tooth alignment/rotations, small chambers (calcification)
- negotiating and enlarging canals
what are some things to keep in mind when performing endodontics on older teeth?
- light and magnification
- lubricants
- small files (1/2 sizes may be needed for dense peritubular dentin)
- develop a smooth glide path
- verify orientation
before you get to the teeth, you should always ___
assess the patient first
what is included in the general physical and functional patient assessment?
medical history, social history, cognitive function, physical dexterity, affect/motivation
how is functional status evaluated?
activities of daily living [ADL] (bathing, dressing, transferring, continence, feeding
what are 6 instrumental ADL’s?
obtaining food, cooking, managing finances, phone usage, housekeeping, and taking medications appropriately
how should you obtain a complete medical and functional history?
readable forms, oral review, determine and use caregiver if appropriate, medical consultation
how should you obtain a complete drug history?
have patient’s bring bottles, and ask specifically about OTC products
what are some important considerations with obtaining a complete drug history?
- multiple diseases may lead to polypharmacy
- metabolic changes lead to differences in drug absorption, distribution, metabolism, and excretion
___% of older adults have one or more chronic diseases and are often taking ___ medications at once
80%, 3-12
what are some pain management risks with older adults?
- use NSAIDS with care (renal toxicity) - many older patients have impaired renal function
- use narcotics with care - older patients may be at risk for fall
