live life / dental implant courses

 Presented by :
 INDIAN DENTAL ACADEMY
 Leader in continuing Dental Education
www.indiandentalacademy.com

“You can’t help getting older, but
you don’t have to get old”.

 India - An AGEING nation - With 7.7% of its population being
more than 60 years old
 By year 2050, the number of elderly people in India would
rise to about 324 million.
 Average life expectancy at birth -Females - 64.1 years
Males - 61.8 years
 In population over 70 years of age, more than 50% suffer
from one or more chronic conditions
( Talwar M, Chawla HS. Geriatric dentistry: Is rethinking still required to begin
undergraduate education?. Indian J Dent Res 2008;19:175-7 )

 Decreased visual acuity and hearing impairment
 Arthritis
 Dental complaints
 Cardiovascular disorders
 Mental disorders – Dementia
 Respiratory disorders
 Diabetes
 Urinary disorders

 Geriatric dentistry is a science which
deals with the diagnosis, management,
and prevention of all types of oral
diseases in the elderly population
(Talwar M, Chawla HS. Geriatric dentistry: Is rethinking still required to
begin undergraduate education?. Indian J Dent Res 2008;19:175-7)

 Oral mucosa
 Peridontium
 Dentition
 Bone
 Salivary glands

Physiologic age changes
 Dry thin smooth mucosal surfaces, with loss of
elasticity and stippling.
 Oral mucosal immunity – Reduced
 Wound healing and regeneration of tissue
-delayed

 Predisposed to trauma
 Epulis fissuratum,Denture
Stomatitis/ papillary
hyperplasia
 Lingual varicosities
 Tongue - fissured,
coated, ,enlarged ,smooth,
bald, or shiny tongue
 Infections

 Vesiculobullous and
Ulcerative mucosal
conditions –
Lichen planus, pemphigus
vulgaris, and cicatricial
pemphigoid
 Lichenoid lesions
 Premalignant oral lesion -
Leukoplakia , Erythroplakia
 Oral cancer

 Elimination of risk factors
 Repair of ill fitting dentures
 Denture Hygiene -10- to 15-minute 1% sodium
hypochlorite soak
 Palliative topical medications ( Antifungal, analgesics)
 Antibiotic coverage
 Vesiculobulllous lesions - Topical corticosteroid, Oral
rinses, Systemic corticosteroid
 Oral cancer – Surgery, chemotherapy, radiation
therapy

 Only 30% of adults aged ≥ 65
years are completely edentulous
 Discoloration, loss of enamel,
abrasion, and erosion.
 Sclerotic and secondary dentin
deposition
 External root resorption

 Pulpal calcifications
 Cementum thickness and pulp
dimensions – Reduced
 Diminished tooth sensitivity and pain
perception
 Reduce responsiveness to pulp
testing
 Decreased need for local anesthesia
for dental procedures.
 Coronal , cervical and root surface
caries increases with age

 Rigorous maintenance of oral hygiene,
including brushing and flossing after
each meal
 Consumption of sugar-containing
beverages should be reduced
 Fluoride-containing dentifrices and
rinses
 Electric toothbrushes
 Cosmetic enhancement of teeth and
smiles

 Gingival recession
 Loss of periodontal
attachment
 Alveolar bone loss
 Osteoporosis in post
menopausal women -
Increased bone loss .

 Scaling and root planing and
meticulous daily oral
hygiene
 Electric toothbrushes and
floss holders
 Pulsed-jet water irrigators
 0.12% chlorhexidine rinses
 Systemic antimicrobial
therapy

Physiological age changes
 Minor reduction in quantitative
salivary production
 Diseases -Alzheimer’s disease,
diabetes, radiation therapy and
dehydration, Sjogren’s syndrome
 Medications –
Antidepressants,
Antihypertensives,
Antiparkinsonian drugs,
Antipsychotics, and
Antihistamines

 Burning mouth syndrome
 Xerostomia – may predispose to
Dental caries
Oral mucosal infections,
Speech dysfunction
Decreased nutritional intake
Difficulty in chewing, swallowing, and
denture retention

 Eat and swallow carefully and to avoid large ingestions of
foods and fluids.
 Additional time spent sipping fluids between bites of
food
 Elimination of drug causing Xerostomia
 Salivary stimulants – Sugarless candies and beverages,
mints and gums

 Medications - Pilocarpine – 5-7.5 mg tid
Cevemiline – 30 mg tid given
30 minutes before meal time
 For patient recieving head and neck radiation therapy –
Contralateral parotid gland preservation
 Intubation and artificial nutrition - Institutionalized
older adults

 Rapid alveolar bone
resorption -especially in
the mandible - problems
in denture fabrication and
retention
 Poorly fitting prostheses
- accelerate the loss of
alveolar bone.
 Osteoarthritic changes of
condyle
 Osteoporosis

 Prevention and early treatment of dental
caries and periodontal diseases
 Occlusal rehabilitation
 Regular assessment of dentures, denture-
bearing ridges, and all mucosal surfaces
 Medical treatment of osteoporosis with
estrogen supplements
 Denture adjustments and/or reliners
 Endosseous dentoalveolar implants

 Altered mastication and swallowing
 Most serious sequela of dysphagia is
Aspiration, particularly in a neurologically
impaired person - can lead to pneumonia
 Oral motor weakness in the lips, tongue, and
buccal mucosa - predictors of a poor swallow
reflex

 Decrease in sensitivity to painful stimulation
with age .
 Due to the alterations in neural pathways
that are involved in nociception

 Intraoral pain disorders
 Teeth - Caries, root sensitivity
 Oral mucosa - Neoplasia, mucosal infection
 Bone - Trauma, infection
 Extraoral pain disorders
 Disorders of the temporomandibular joint and
of the muscles of mastication - masticatory
myalgia, internal joint disorder
 Neuralgias - Trigeminal or glossopharyngeal
neuralgia
 Atypical facial pain

 Cardiovascular disorders
 Stroke
 Valvular damage
 Heart murmur
 Increased risk for developing Subacute Bacterial
Endocarditis
 Elective dental trestment to be avoided for 6 months
after stroke
 Antibiotic prophylaxis MUST
 Tooth brush adaptations – Hemiplegic patients

 Parkinsonism
 Prone to Xerostomia, burning mouth syndrome, root caries.
 Use of resin modified Glass Ionomer restorations.
 Implant supported Dentures/ Overdentures.
 Toothbrush adaptations.
 Alzheimers disease
 Use of short sentences, avoid complicated words, be clear,
brief.
 Break down tasks into simple, one-step instructions.
 Short appointments.
 Use of mouth props.
 Airway protection – if conscious sedation used.
 Toothbrush adaptations.www.indiandentalacademy.com

Dentist Physician
Counselling Family members

 Rapidly growing segment of the population
 Bulk of the group -medically compromised and
on multiple drug regimen.
 Oral physician must be able to identify, manage,
and prevent the problems in order to enhance
the quality of life of older adults.

THANK
YOU

live life / dental implant courses

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