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Geriatrics > The Aging Mouth > Flashcards

The Aging Mouth Flashcards

1
Q

what percent of people age 75+ are edentulous?

A

25.8%

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2
Q

what percept of people age 65+ have experienced dental caries?

A

96%

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3
Q

what percent of people age 65+ have untreated dental caries?

A

18-19%

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4
Q

what is the incidence of new coronal caries in older adults?

A

43.3%

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5
Q

what is the average number (increment) of tooth surfaces per person (in older adults) developing caries?

A

1.22

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6
Q

what is the attack rate (proportion) of at-risk surfaces developing caries in older adults?

A

1.4/100 (one new caries lesion per person per year)

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7
Q

T or F:

findings suggest that new decay among older adults is similar to or higher than that in children

A

true

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8
Q

T or F:

caries among the elderly is less likely to remain untreated than caries in children

A

false

it is more likely to remain untreated

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9
Q

what is the root caries prevalence among older adults aged 65-74? what about >75?

A 
65-74 = 12%
>75 = 17%
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10
Q

what is the reported distribution of root caries in the mandible? maxilla?

A
  • mandible: molars > premolars > anterior (not Dr. E’s personal observation)
  • maxilla: more evenly distributed
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11
Q

dentin demineralizes at a pH of ___. enamel demineralizes at a pH of ___.

A 
dentin = 6
enamel = 5.4
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12
Q

what are the 7 main root caries risk factors?

A
  • dentin demineralization
  • previous caries experience
  • clinical attachment loss
  • plaque
  • quality and quantity of saliva
  • lack of fluoride
  • diet
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13
Q

what are the pros and cons of using amalgam to restore root caries?

A
  • pro: greater longevity than composite

- con: more secondary caries compared to GI

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14
Q

what are the pros to using GI/RMGI to restore root caries?

A
  • fluoride release
  • high caries risk patients
  • 80% greater caries reduction than composite
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15
Q

what are 3 restorative materials for root caries?

A

amalgam, composite, and GI/RMGI

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16
Q

other than the 7 main root caries risk factors, what are some other risk factors?

A

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

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17
Q

what restorative material is anti-cariogenic, reasonably esthetic, chemically bonds to dentin, and acceptable for minimally invasive preparations and ART (atraumatic restorative treatment)?

A

glass ionomer

18
Q

as the periodontium ages, there is a(n) ___ in collagen synthesis in the gingiva, resulting in ___

A
  • decrease

- dekeratinization and thin irregular epithelium

19
Q

as the periodontium ages, there is a(n) ___ in cellular components of the periodontal ligament with a(n) ___ in irregularity

A
  • decrease

- increase

20
Q

as the periodontium ages, there is a(n) ___ in alveolar bone density

A

decrease

21
Q

T or F:

there is an increase in the prevalence of periodontal disease in older adults than younger

A

true

22
Q

T or F:
periodontal attachment loss increases with age and the percentage with advanced periodontal disease (pockets >5mm) increases as well

A

false
although periodontal attachment loss does increase with age, the percentage with advanced periodontal disease decreases in the oldest

23
Q

in older adults, severe attachment loss is more often associated with ___ than ___

A

recession than pocketing

24
Q

T or F:

age is a predictor of progressing periodontal disease, not new disease

A

true

25
Q

T or F:
in older adults, there is a higher prevalence of advanced periodontal disease and a somewhat lower prevalence of mild to moderate

A

false
there is a higher prevalence of mild to moderate periodontal disease, and a somewhat lower prevalence of advanced disease

26
Q

what are the 3 main affects that aging has on the pulp?

A
  • secondary dentin = diminished pulp volume
  • decreased cellularity, vascularity, and innervation with increased fibrosis
  • increase in pulp stones
27
Q

what affects does diminished pulp volume have?

A
  • decreased risk of pulpal exposure
  • decreased pulpal sensitivity
  • increased difficulty with pulpal diagnosis
  • increased difficulty with canal access if endo is required
28
Q

what affects does decreased cellularity, vascularity, and innervation with increased fibrosis have on the pulp?

A
  • reduced reparative capacity

- reduced response to EPT, cold (may need dry ice)

29
Q

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?

A
  • may be slow and asymptomatic (difficult to diagnose)

- 62%

30
Q

what are 5 types of pulpal therapies?

A
  • 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)
31
Q

what are some endo challenges in older teeth?

A
  • access orientation, existing restorations, tooth alignment/rotations, small chambers (calcification)
  • negotiating and enlarging canals
32
Q

what are some things to keep in mind when performing endodontics on older teeth?

A
  • light and magnification
  • lubricants
  • small files (1/2 sizes may be needed for dense peritubular dentin)
  • develop a smooth glide path
  • verify orientation
33
Q

before you get to the teeth, you should always ___

A

assess the patient first

34
Q

what is included in the general physical and functional patient assessment?

A

medical history, social history, cognitive function, physical dexterity, affect/motivation

35
Q

how is functional status evaluated?

A

activities of daily living [ADL] (bathing, dressing, transferring, continence, feeding

36
Q

what are 6 instrumental ADL’s?

A

obtaining food, cooking, managing finances, phone usage, housekeeping, and taking medications appropriately

37
Q

how should you obtain a complete medical and functional history?

A

readable forms, oral review, determine and use caregiver if appropriate, medical consultation

38
Q

how should you obtain a complete drug history?

A

have patient’s bring bottles, and ask specifically about OTC products

39
Q

what are some important considerations with obtaining a complete drug history?

A
  • multiple diseases may lead to polypharmacy

- metabolic changes lead to differences in drug absorption, distribution, metabolism, and excretion

40
Q

___% of older adults have one or more chronic diseases and are often taking ___ medications at once

A

80%, 3-12

41
Q

what are some pain management risks with older adults?

A
  • 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

Geriatrics (4 decks)

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