Dr. Sapnil MDS, Reader

1. PERIODONTAL TREATMENT
FOR
OLDER ADULTS
Presented by
Dr. Sapnil, MDS
Reader

2. DEMOGRAPHICS
POPULATION DISTRIBUTIONS
The growth in the older population is the
result of the dramatic increase in life
expectancy during the past century
Average life expectancy was 47 years in 1900
and 75 years by 1990
In 2000, life expectancy [ at birth ] was
projected to be 77 years
People who reached the age of 65 in 1990
had an average of 17 remaining years of
life
expectancy

3. HEALTH STATUS
Visual impairments, cataracts, glaucoma, and
hearing impairments increase in frequency
with advancing age
Nearly half of people aged 65+ years have
arthritis
Approximately 7 in 10 deaths among older
adults were caused by heart disease, cancer,
or stroke

4. SOCIAL AND PSYCHOLOGIC ISSUES
The education level of older adults is
increasing
Higher educated tend to be better off
financially than those with low education
Higher educational achievement suggests an
increase in demand for oral health care
among older adults

5. PERIODONTAL STATUS
Older adults who retain teeth are likely
to be less susceptible to periodontitis
Advanced periodontal disease among
older adults is not as common as
once thought

6. DENTAL VISITS
Dental visits by older adults are correlated
with having teeth and not age
Older adults have a higher cost per visit
than younger persons and are willing to
make significant investment in dental care

7. XEROSTOMIA
Saliva plays an essential role in maintaining
oral health
The medications associated with xerostomia
-- tricyclic anti - depressants
-- anti - histamines
-- anti - hypertensives
-- diuretics

8. Medical diseases associated with xerostomia
-- radiation treatment for oral, head , neck
-- thyroid cancers
-- sjogrens syndrome
-- poorly controlled diabetes
-- bone marrow transplantation
-- thyroid disorders
-- depression

9. CANDIDIASIS
Over proliferation of candida albicans and
its infiltration into the oral mucosal layers
results in “candidiasis”
Any condition compromising a patients
immune system can be considered a risk
factor for candidiasis

10. Oral candidiasis can occur with long-term
use antibiotics and steroids
Diabetes mellitus, head and neck radiation
therapy and HIV are risk factors for
acute pseudo-membranous candida
Pseudo-membranous candida present as
white lesion that can be wiped away with
gauze, leaving an erythematous area

11. DENTAL AND MEDICAL ASSESMENTS
REVIEW OF DENTAL HISTORY
Include :
Past restorative, periodontal treatment
Head and neck cancer
Allergies
Oral hygiene care techniques
Tobacco and alcohol use
Past injuries
Tooth paste used

12. REVIEW OF MEDICAL HISTORY
Systemic diseases
Bleeding disorders
Anticoagulants
Diabetes
Heart valve problems
Cardiovascular conditions
Stroke
Artificial joints
Corticosteroids

13. REVIEW OF MEDICATION
Many medications used by older adults can
have a negative impact on oral health
Ask patients to bring each medication
bottle or package to the dental office
This provides additional information such as
medication, dose and number of physicians
prescribing medications

14. ASSESMENT OF RISK
Risk factors
Smoking
Genetic susceptibility
Diabetes

15. Extra oral examination include
Past dental treatment
Lesions
Enlarged lymph nodes

16. Intra oral examination include
Lips
Cheeks
Tongue
Gingiva
Floor of mouth
Palate
Retro molar region
Oropharynx
Red or white patches
Ulcerations
Swellings

17. PERIODONTAL DISEASES
ETIOLOGY
General health status
Immune status
Diabetes
Smoking
Genetics
Medications
Mental health status
Salivary flow
possibly modify the relationship
between periodontal disease and age

18. RELATIONSHIP TO SYSTEMIC DISEASE
Poor oral health is associated with
Aspiration pneumonia
Cardiovascular disease
Periodontal disease is associated with
Coronary heart disease
Cerebro-vascular accidents

19. TREATMENT PLANNING
GOAL
Preserve function
Eliminate or prevent the progression of
inflammatory disease

20. FACTORS TO CONSIDER
Medical and mental health status
Medications
Functional status
Lifestyle behaviors
Periodontal disease severity
Ability to perform oral hygiene procedures
Ability to tolerate treatment

21. Risks and benefits of surgical and
non-surgical therapy
Amount of remaining periodontal support
Past periodontal destruction
Tooth type
Number of occlusal contacts
For older adults a non-surgical approach
is often the first treatment choice
A common goal for all older adults is to
decrease bacteria through oral hygeine and
mechanical debridement

22. MAINTENANCE
The most important factor determining a
successful outcome of periodontal treatment is
-- plaque control
-- frequency of professional Care

23. CHEMO -THERAPEUTIC AGENTS
ANTI-PLAQUE AGENTS
Chlorhexidine may be particularly useful for
older adults who have difficulty with plaque
removal and those who take phenytoin,
calcium channel blockers, and cyclosporins

24. Listerine antiseptic help prevent and reduce
supra gingival plaque
Listerine may benefit patients who do not
tolerate the taste or staining of chlorhexidine,
is sold over the counter and is less expensive
and easier to obtain than chlorhexidine

25. FLOURIDE
Caries preventive agent
Reduce enamel solubility
Promote remineralization of early carious
lesions
Bactericidally affect metabolic process of
plaque

26. SALIVA SUBSTITUTES
CONTAIN :
salt ions
flavoring agent
paraben [ preservative]
cellulose derivative

27. Patients with dry mouth may also benefit by
stimulating saliva flow with sugarless candies
and sugarless gum
Xylitol chewing gum has been shown to
have anti-cariogenic properties in children
Patients with high root caries prevalence
and xerostomia may benefit chewing
xylitol gum

28. CONCLUSION
Aging dental patients have particular oral
and general health conditions that dentists
should be familiar with detecting , consulting,
and treating
Medical diseases that occur with age
may require modification in planning and
treatment phases of periodontal care