INTRODUCTION CLASSIFICATION AGE CHANGES AFFECTING STRUCTURES IN ORAL CAVITY COMMON DISEASE AMONG GERIATRIC PATIENTS MOST COMMON ORAL DISEASE WITH SUGGESTED TREATMENT GOAL OF ORAL PHYSICIAN COMMON SYSTEMIC DISEASE IN OLDER ADULT CONCLUSION REFERENCES

1. GERIATRIC CARE
DENTISTRY
BY DR PRIYANKA
SENIOR LECTURER
DEPT OF ORAL MEDICINE AND RADIOLOGY

2. CONTENTS
 INTRODUCTION
 CLASSIFICATION
 AGE CHANGES AFFECTING STRUCTURES IN ORAL CAVITY
 COMMON DISEASE AMONG GERIATRIC PATIENTS
 MOST COMMON ORAL DISEASE WITH SUGGESTED TREATMENT
 GOAL OF ORAL PHYSICIAN
 COMMON SYSTEMIC DISEASE IN OLDER ADULT
 CONCLUSION
 REFERENCES

3. INTRODUCTION
 Geriatric dentistry is the branch of dentistry that emphasizes dental care for the elderly
population and focuses upon patients with chronic physiological, physical and/or psychological
changes or morbid conditions/diseases.
 The proportion of the elderly in the world population is expected to increase rapidly from 10.0%
in 2000 to 15.0% in 2025 and 21.1% in 2050.
 It has been estimated that 70% of the world’s elderly population are and will be in developing
countries
 The dental management of the elderly population is different from that of the general population
because special considerations for age-related physiological changes, complications of chronic
condition/therapy, increased incidence of physical/mental disabilities, and social concerns are
required.
 It is difficult to delineate where the normal aging process ends and the disease process begins.

4.  A. Gerontologists divide the geriatric population into three age groups
– Young-Old (65-74 years)
– Old (75-84 years)
– Old-Old (85 years and above)
B. Depending on the degree of disability, the aged have also been classified into four categories as (according to
D.C.N.A.)
– Well elderly (One or two minor chronic medical conditions; independent living)
– Frail elderly (Simultaneous minor and major chronic, debilitating medical conditions, with drugs; self-
sufficient living with support, a minority institutionalized)
– Functionally dependent elderly (Same as category II, but patient is incapacitated to the extent that
independence is not possible; homebound or institutionalized)
– Severely disabled, medically compromised elderly (Health status depreciated to the extent of requiring steady
maintenance; sanatorium or skilled nursing facility)
CLASSIFICATION

5. AGE CHANGES AFFECTING
STRUCTURES IN THE ORAL CAVITY
 Dentition
• Diseases of teeth usually increase with advancing age
• Loss of tooth translucency and surface details are common changes during aging
• The dental pulp becomes smaller because of secondary dentin and pulp stone
formation, and sometimes root canals become totally sclerosed.

6.  Periodontium
• Prevalence of periodontal problems is more
• As gingival recession increases, the prevalence of root surface caries increases in the dentate
elderly population.
 Oral Mucosa
• The oral mucosa becomes thin, smooth, dry and susceptible to injury
• Wound healing and regeneration of tissue may be delayed
• Mucosal atrophy results due to dietary deficiencies.

7.  Salivary Glands
• Regressive changes in the salivary glands, result in decrease in salivary flow,
physiochemical changes in the saliva—Saliva becomes more viscous and ropy. Further
when salivary flow is reduced oral mucosa becomes dry and inelastic and cracking of the
lips and fissuring of the tongue
• Oral mucosal sore spots are seen under a denture because of the lack of lubrication by the
saliva. Denture retention is adversely affected. food selection becomes limited to soft or
liquid type.
• Xerostomia also affects oral hygiene as in absence of cleansing action of saliva, food
particles adhere to the tissues. This makes the oral cavity prone to infection.

8.  Age Changes in the Bone Tissue
• Bone loss is about 3% per decade after the age of 40; but increases to 9% per decade in
postmenopausal women
• There is loss of trabecular bone
• With progressing age, the mandible moves forward, producing an edge-to-edge
occlusion of incisors and accelerates their attrition
• Changes in facial profile occur with tooth extractions
• The mandible resorbs and muscles of mastication undergo atrophy
• Arthritic degeneration may occur in temporomandibular joint (TMJ).

9.  Taste and Smell
• The chemosensory functions of smell and taste decrease with age
• Even the oral motor functions that require coordination of intricate neuromuscular activities
are often disturbed in the elderly
• The tongue loses the filiform papillae and appears smooth
• The next most common tongue change is an increase in lingual varicosities on the ventral
surface.

10. Common Diseases Among Geriatric Patients
1. NORMAL VARIATION Linea alba
Fordyce’s granules
Leukoedema
2. TONGUE Fissured tongue
Coated tongue
Geographic tongue
Hairy tongue
Lingual varicosities
3. REACTIVE LESIONS Traumatic fibroma
Traumatic ulcer
Pyogenic granuloma

12. 4. PREMALIGNANT AND MALIGNANT
LESIONS
Leukoplakia
Lichen planus
Nicotine stomatitis
Actinic cheilitis
Oral submucus fibrosis
Squamous cell carcinoma
5. PIGMENTED LESIONS Hemangioma
Melanotic macule
Amalgam tattoo
Nevus
6. INFLAMMATORY LESIONS Atrophic glossitis
Angular cheilitis
Erythematous candidiasis
Papillary hyperplasia

14. 7. INFECTIOUS LESIONS Pseudomembranous candidiasis
Oral squamous papilloma
8. VESICULOBULLOUS LESIONS Recurrent aphthous stomatitis
Recurrent herpes
Pemphigus vulgaris
Cicatricial pemphigoid
9. SALIVARY GLAND DISORDERS Sialadenitis
Sjogren’s syndrome
Mucocele

16. 10. DENTURE ASSOCIATED LESIONS Denture stomatitis
Denture hyperplasia
Suction irritation
11. BONY LESIONS Torus platinus
12. DENTAL AND PERIODONTAL DISEASE Root surface caries
Coronal caries
Gingival recession
Tooth furcation involvement
Mobility
Tooth drifting

19. Goal of Oral Physicians
 Oral physicians can understand the overall oral health and manifestations of systemic
disease
 life expectancy of an average individual can increased
 Medical conditions common in older adults are
 Arthritis
 Hypertension
 Ischemic heart disease / Myocardial infarction
 Infective endocarditis
 Diabetes mallitus
 Osteoporosis
 cancer

20. ARTHRITIS
 About 49% of people older than 65 years in the United States have arthritis and that this
condition limits the activities of 11.6% of people of 65 years and older.
 OROFACIAL MANIFESTATION
1. Flatness of face on affected TMJ area
2. Pain, tenderness
3. Stiffness on opening
4. Crepitus sound
 RADIOLOGICAL FINDING
1. Generalised osteopenia
2. Diminished joint space
3. Bone erosion
4. Sharpened pencil / mouth end piece of flute appearance

21.  BLOOD TEST
1. Rheumatoid factor
2. Erythrocyte sedimentation rate
3. C – Reactive protein test
4. Full blood count
5. Renal function
6. Liver enzyme
 DENTAL MANAGEMENT
1. Short appointments in the late morning or in the early afternoon are recommended
2. Analgesic ,
3. NSAID and
4. Physiotherapy

22. HYPERTENSION
 Medications used for management of hypertension have oral manifestations
1. Diuretics (Thiazides) cause oral dryness
2. Adrenergic inhibitors ( Methyldopa) cause oral dryness, ulcerations and
sialadenosis.
3. Calcium antagonist ( Verapamil) give rise to gingival overgrowth.
4. ACE Inhibitors ( Captopril ) cause loss of taste and lichenoid reaction
 DENTAL MANAGEMENT
1. Hypertensive patients should be treated in a reclined position.
2. The incidence of orthostatic hypotension can be minimized by raising the chair
gradually and allowing the patient to remain in an upright seated position for some
time before attempting to stand

23. ISCHAEMIC HEART DISEASE
 Medication can cause
Anticoagulant or antiplatelet can cause bleeding (haematoma, petechiae or gingival
bleeding)
 DENTAL MANAGEMENT
1. Stress reduction
2. Within the dental office, all staff members must be trained in cardiopulmonary
resuscitation

24. MYOCARDIAL INFARCTION
 Patients who have angina should be assessed to determine the severity of their disease.
 Patients should not undergo elective dental care until at least 6 months after a
myocardial infarction (MI) because of the increased risk for angina, arrhythmias, or another
MI while in the dental chair.
 A patient with a known history of angina that is not relieved by nitroglycerin should be
sent to the emergency department

25. INFECTIVE ENDOCARDITIS
 Prophylaxis for infective endocarditis is essential if the elderly patient has previous
endocarditis, a prosthetic valve or implant or valvular heart disease.
 The standard prophylaxis for dental procedures is to give 2 g amoxycillin 1 hour prior to
the procedure, or if the patient is allergic to penicillin, 600 mg clindamycin may be used.

26. DIABETES MELLITUS
 ORAL MENIFESTATION
1. Dental caries
2. Xerostomia
3. Burning mouth syndrome
4. Altered taste sensation
5. Lichen planus
6. Gingivitis, periodontitis
7. Delayed wound healing

27. OSTEOPOROSIS
 Fractures resulting from minimal trauma can result in significant morbidity and
mortality in older adults who are functionally independent.
 These fragility fractures are related to an underlying osteoporosis.
 It is an extremely common disease affecting most women during their lifetime.
 It reduces bone density, affecting the bone mass and strength without altering the basic
chemical composition.
 Declining estrogen levels during and after menopause lead to increased bone resorption
and increased urinary excretion of calcium.
 Thus, estrogen deficiency plays a primary role in osteoporosis, accounting for up to one
half of the bone lost during a women’s lifetime

28. CANCER
 Any mucosal lesion that persists for 3–4 weeks despite all attempts to remove suspected
etiologies (e.g. ill-fitting denture flange) must be thoroughly investigated to determine a
diagnosis (e.g. biopsy).
 Regularly scheduled periodic head, neck, and oral examinations are required to diagnose
oral mucosal diseases at an early stage and to intervene with appropriate therapy.
 Importantly, even edentulous older adults require at least an annual head, neck, and oral
examination to evaluate for benign and malignant lesions.
 Patients who have been diagnosed with any type of cancer should have a comprehensive
clinical and radiographic dental examination completed as far in advance as possible of
any surgical and/ or chemotherapeutic treatments

29. CONCLUSION
 The geriatric patient may face special health care needs and challenges.
 The major emphasis or goal of the oral health team, when caring for older patients, is to show emotional and
physical support by giving ample time to their hearing.
 The proportion of older adults in our society is higher, meeting these challenges requires a clear understanding
of the health needs of older adults, innovative planning to develop programs, systems and structures which
will support the health and welfare of the aging population, and substantial reforms and policies at global,
national, and local levels.
 Geriatric dental education should be taught both at the predoctoral and postdoctoral levels to oral health
providers, and other health care professionals such as physicians and nurses, and to caregivers and patients.
 Interdisciplinary and coordinated efforts of medical, dental, nursing staff, social workers, occupational
therapist and paramedical staff with use of mobile and portable dental care unit are required for home-bound
and hospitalized patients.

30. REFERENCES
 Rai S, Kaur M, Goel S, Bhatnagar P. Moral and professional responsibility of oral
physician toward geriatric patient with interdisciplinary management - The time to act is
now!. J Mid-life Health 2011;2:18-24
 Teeuw WJ, Kosho MX, Poland DCW, et al. Periodontitis as a possible early sign of
diabetes mellitus. BMJ Open Diabetes Res Care 2017;5(1):e000326.
 Turner MD. Hyposalivation and xerostomia: etiology, complications, and medical
management. Dent Clin North Am 2016;60(2):435–43
 National Cancer Institute Cancer Statistics. 2017. Available at: https://seer.
cancer.gov/statfacts/html/oralcav.html. Accessed April 16, 2017.
 Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and neck cancer
patients, before, during and after radiotherapy: part 1. Br Dent J 2015; 218(2):65–8

31. THANK YOU