Geriatric Dentistry New

8/8/2019 Geriatric Dentistry New

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Age related changes in oral health---Priyanka Sihag

Common oral conditions in old age---Rahul Singh Dahiya

Treatment of geriatric conditions---Punnet Khari andRajender Gilhotra

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ACKNOWLEDGEMENTACKNOWLEDGEMENT

We the students of B.D.S. III YEAR wish toexpress our gratitude to my teachers Dr.

Aparna and Dr. Manish as without their

cooperation, I would not have been able to

complete this seminar. I sincerely thankthem for their valuable guidance, continued

encouragement, constant inspiration and

sincere devotion for the seminar.

I also extend my Cordial and earnest thanksto Dr. Niel Kamal (Head of department) for

her valuable suggestion and help done in

conducting the seminar.


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DENTISTRY IN GERIATRICS

Introduction

The geriatric population is t he most rapidly growing

segment of the general population.

With the increase in life expectancy, their will be an

increase in chronic conditions and illness that will

influence both oral and systemichealth.

The conditions like arthritis, hypertension, heart disease,

diabetes mellitus, sinus diseases have potential oral

sequelae, par ticularly in an older and more medically

compromised adult.

The t reatment of these diseases with medication,

chemotherapy a nd radiotherapy has implications for

maintenance of oral health.


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AGE RELATED CHANGES IN ORAL

HEALTH

ORAL MUCOSA Clinicallythe appearanceoforal mucosais samein

younger people andhealthyolder persons buta life longhistoryoforal mucosal trauma ,mucosal diseases altertheclinical appearanceofmucosain anolder adult.

Clinically thereis drythin smoothmucosal surfacewithloss ofelasticity and stippling.

Histologically -thereis epithelial thinning, less prominent

rate pegs, decreased cellular proliferation, loss ofsubmucosal elastin andfat, increasedfibrotic connectivetissues withdegenerative alterationin collagen.

The age per sehas no clinically significantadverseeffect

onthe appearance andfunctionoforal mucosa.


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DENTITION

Changes indentitioninclude:-

(a)discolorationoftooth

(b)loss ofenamel dueto attrition, abrasion and

erosion.

theenamel wearwill exposedentitionwhichwill

produce sclerotic and secondarydentinin responseto

trauma, caries andmasticatoryforces.


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Withincreasingagedentinundergoes a reductionin

thermal, osmotic andelectrical sensitivity and pain

perception.

With age, thereis decreasein cementumthickness and

pulp dimensions.Dueto poororal hygieneinolderindividuals theyform

plaquemore rapidlywhichincreases the prevalenceof

coronal and rootsurface caries


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PERIODONTIUM

Withincreased agegingival recession and loss ofPDL

and alveolar boneoccurs.

Gingival recessionexposingrootsurface cementum


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Various factors influence the progressionofPDLdiseases inelderly people.Thefactors are:-

(a)Deep periodontal pocketing

(b)Irregulardental visits

(c)Smoking(d)Psychological stress

(e)Poor socio economic status


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Osteoporosis(severe) reduces the bonemineral content

ofthe jaws and can be associatedwithgreater PDL loss

andtooth loss.Diabetes mellitus is also a riskfactorfor PDLdiseases.

Several medications like calcium channel blockers, the

anti seizuredrug(phenytoin) andimmunosuppressant

cyclosporine causes gingival hyperplasia.


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SALIVARY GLANDS

Salivais critical formaintenanceoforal health as its

diminishedoutputcan cause:-(a)Dental caries

(b)Oral mucosal infections

(c)sensorydisturbances

(d)Speechdysfunction(e)Decreasednutritional intake

(f)Difficultyin chewing, swallowinganddenture retention.

Histologically -there are age-related alterations inthe

cellularmakeup ofsalivaryglands with anincreaseinconnectivetissue and adiposedeposition and adecreaseinacinar cells.

Howeverinthe absenceofmedical problems andtheirtreatmentanolder adult, thesemorphological changes

does nothave a considerableimpacton salivary secretion.


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TASTE AND SMELL

Manyolder adults complainofdiminishedfood

recognition andenjoymentas well as altered smellandtastefunction.

Inhealthyolder adults, thegustatoryfunction

remainintactbuttheolfactoryfunctionundergoesage-related changes.Theolfactory bulb and

peripheral receptors are sensitiveto a varietyof

environmental toxins, trauma, medications and

respiratoryinfections.Overthe courseofa lifetime,

these common conditions causes adiminished

sensitivitytoolfactory cues andimpair smell

identification


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Medications, chemotherapy, radiotherapy, trauma, surgery

andneurologicevents can causetemporaryor permanent

taste change.Thus any affecton smell andtastefunction could place an

older adultatriskfordevelopingnutritional deficits and

could adversely affecthis orherqualityoflife.


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MASTICATION AND SWALLOWING

Alteredmasticatory ability can beexacerbatedinolder

individuals who are partiallyorfullyedentulous, have

painful ormobileteethdueto caries or periodontaldiseases orhave adecreased salivaryoutput.

Advanced age alonedoes notappearto cause any

clinical dysfunction.


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Systematic andoral disorders have adverseeffecton

swallowingwhich predisposes the person atriskofchokingor aspiration.

Cerebrovascular andneurologicdiseases( eg- Parkinson's,

Alzheimer's, multiple sclerosis),head andneckcancer and

its treatmentandother systematicdisorders (arthritis,

diabetes) ,diseases andmedications thatdecrease salivary

outputwill adversely affectswallowing.


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ORO FACIAL PAIN

Altered pain sensationinelderly persons may be

relatedtothediminishedfunctional capabilityof

neurophysiologic components associatedwith painortothe alterations inneural pathways thatareinvolved

innociception.

Themostprevalentpainintheoro-facial complex

involves theteeth and periodontium


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Intra-oral paindisorders affect:-

(a)teeth(eg- caries, rootsensitivity)

(b)periodontium(eg-periodontal abscess)(c)Oral mucosa(eg- neoplasia, mucosal infection)

(d)bone(eg-trauma, infection)

Extraoral paindisorders include:-(a)Disorders oftemporomandibular joint

(b)Disorders ofmuscles ofmastication (eg-masticatory

myalgia, internal jointdisorder)

(c)Neuralgias (eg-trigeminal orglossopharyngeal neuralgia

(d)Atypical facial pain


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COMMON ORAL CONDITIONS IN OLD AGE

CLASSIFICATION

ORALMUCOSALDISEASES.

INFECT

IO

US

DISEASES

.DENTALDISORDERS.

PERIODONTALDISEASES.

SALIVARYGLAND DISORDERS.EDENTULOUSNESS.


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ORAL MUCOSAL DISEASES

1. PIGMENTATIONS.

Many older adults have pigmentatedlesions such as melanotic macules,varices andlingual varicosities.Pigmaentations can be

physiological or may be pathological.Dentist

should be able to differentiate the both.

Melanotic macule Lingual varicosity


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2.TONGUE

Tongue conditions include geographic

tongue ,hairy tongue,lingual varicosities.

Also theatrophy of filliform and the fungiform papillae is acommon finding.In edentulous patients fissured orenlarged tongue is seen.Nutritional deficiency can

also cause smooth or shiny tongue.3. BENIGN SOFT TISSUE LESIONS

Tori and extoses are also acommon finding in adult persons.They can cause

hurdles in the prosthodontic rehabilitation thepatient.Other lesions like benign fibromas are alsofound in the old patients.


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Hairy tongue Geographic tongue

Tori Fibroma


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4. VESICLOBULLOUS/ULCERATIVE CONDITIONS

Ulcerative conditions such as lichen planus,pemphigusvulgaris and cicatrical pemphigoid are also found inadults.Lichen planus is the most commonly foundcondition in adults.Other ulceratie disordes such as

apthous are also common in adult patients.

Another verycommon condition is denture induced stomatitis.Rarelyerythema multiforme is also noticed.

Pemphigus vulgaris Lichen planus


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Apthous ulcer Papillary hyperplasia

Cicatrical pemphigoid


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5. ORAL CANCER

Oral cancer is the most significant oralmucosal disease in older adults.Incidence increase withage, over 95% of all oral cancers occurs after the age of45.The most common premalignant lesion seen isleukoplakia.The5 year survival rate in older patients is50%.The most common risk factors are tobacco andalcohol abuse.Most common cancer is squamous cellcarcinoma.

Squamous cell carcinoma


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INFECTIOUS DISEASES

1.VIRAL INFECTIONS

Herpes simplex and varicella-zosterare the two most common viral infection in older

persons.Initial infection occurs during childhood andin the older age reactivation of the dormant virustakes place due to various factors such asstress,trauma,git disorder etc.The clinical feature are

same as in a young patient but last longer and aremore severe because of immunosuppression.A veryimportant sequelae of these viral infections is

postherpetic neuralgia .


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Herpes simplex Vericella zooster


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2. FUNGAL INFECTION

The most common fungal infection seen

in older persons is candidiasis.It is caused by Candidaalbicans.It is secoundry to various underlying systemicconditions such as immunosuppression,salivary glandhypofunction and medication.Other common infection

is actinomycosis.


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3. BACTERIAL INFECTIONS

Bacterial infections in the older

patients include dental caries,periodontitis and salivarygland infections


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DENTAL DISORDERS

1. DENTAL CARIESMostly root surface caries are

seen in older patients.generally cementum isexposed due to gingival recession which leads to

root surface caries.Coronal caries observed aremainly secondary caries in the previousrestorations.


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2. WASTING CONDITIONSErosin,attrition and abrasion

EROSIN ATTRITION ABRASION


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PERIODONTAL DISEASES

A wide variety of periodontal diseases are associated

with the old age.Poor oral hygienee,poor nutrition andimmunosuppression all addup to cause periodontaldisease.Generalised gingivitis with recession andbleeding is observed.In certain individuals severe

periodontitis with furcation involment,bone loss andmobility is seen.


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SALIVARY GLAND DYSFUNCTION

Xerostomia is a common finding in older

patients.Reduced salivary flow can be due to variousconditions such as chemotherapy,radiationtherapy,salivary gland atrophy/infection,sjogrenssyndrome etc.Xerostomia leads to dry mouth

,difficulty in mastication and swallowing also there is aincrease in the incident in dental caries.the musosa ofthe patient appears smooth and shiny.


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EDENTULOUSNESS

Dental caries and periodontaal diseases ultimatelyleads to edentulousness.It is a very common conditionseen in the older persons,Prosthodontic rehabilitationsis a must for these patients.


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ORAL CANCER

Prevention

Eliminateestablishedrisk factors.

Ensureearlydetectionandrecognition.

Treatment

Surgery.

Chemotherapy.

Radiationtherapy


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TRAUMATIC LESION

TREATMENT

TOPICAL SYSTEMIC

Oralrinse

Viscouslidocainehcl 2%Dycloninehcl 1%

Sucralfate

Diphenhydramineelixir

12.5 mg/5 ml

Penicillinvtab 5oo

mg qidAmoxicillintab 5oo

mg qid

Erythromycintab 250

mg qid


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ORAL VESICULOBULLOUS AND

EROSIVE DISEASES

PREVENTIONAvoiddrughypersensitivityTraumaAllergies

TREATMENT

Topical Systemic

Fluocinonidegel 0.05%

Triamcinoloneacetonide

gel 0.01%

Clobetasolpropinategel

0.05%

Oralrinse-

dexamethasoneelixir

0.5%/5 ml

Prednisolone 5 mg

Azathioprin 5omg

Nutritionalsupplements


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INFECTIOUS DISEASE1. Preventionofthespreadofviralinfectioninelderly

patientscanbeaccomplisedbyavoidingpersons withactiveinfection.

2. Herpessimplexandzoosterareusuallyselflimiting.

3. Supportivemeasurearenecessarytomaintain

adequatenutritionaland fluidintake.4. Earlydiagnosiscandiminishmorbidityinolder

individuals.

5. Aggressiveanti-viraltreatmentisrequiredinimmuno-

compromisedpatients.6. Patients withhepaticorrenalinsufficiencyshould

receiveadjustedanti-viraldoses.

7. Patients withpostherpeticneuralgiarequires

analgesics,antidepressantsandsteriods.


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CANDIDIASIS

PREVENTION

Meticulousoralhygiene.Judicioususeofantibiotics,immunomodulators.

Eliminationofunderlyingsystemicetiologies.

TREATMENTRx: Nystatinoralsuspension 100,000 units/ml.

Disp: 60 ml.Sig:Swishandswallow 5 ml qid for 5 min.

Rx: Nystatinointment.

Disp: 15 gmtube.Sig:Applythincoattoaffectedareasaftereachmeal.

Rx: Clotrimazoletrouches 10 mg.Disp: 70 trouchesSig. Let 1 trouchdissolveinmouth 5 timesdaily.


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DENTURE SORE MOUTH

Improveoralhygieneofappliance.Keepdentureoutofmouth forextendedperiodsandwhilesleeping.Soak for 30 mininsolutionscontainingbenzoicacid,0.12% chlorhexidine,or 1% sodiumhypochloriteandthoroughlyrinse.


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DENTAL CARIES

1. Rigorousmaintenanceoforalhygiene.

2. Useof fluoridecontainingdentrifices.

3. Periodicdentalvisits.

4. Monitoringthe frequencyofmealsamdconsumptionofsugarcontainingbeveragesshould

bereduced.

5. Conservativeandestheticrestorations.

6.Earlyrecognitionofxerostomia.


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PERIODONTAL DISEASE

1. Properoralhygiene

2. Regulardentalvisits.

3. Scalingandrootplaning.

4. Surgicalintervention.

5. Antimicrobialtherapy.

Metronidazole

Tetracycline

clindamycine


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Salivary Gland Disorders

DIAGNOSIS

Diagnosticculture.Sensitivitytest.

Radiographs.

Sialography.

TREATMENTAugmentin canbeprescribedimmediatelyandmonitoreduntilcultureandsensitivityreportisreceived.

Sjogrenssyndromeshouldbetreatedimmediately.

Medicationassociatedxerostomiarequireseliminationorreductionof

thecausativedrug Patientsrequiringheadandneckradiationtherapy fororopharyngeal

cancers,contralateralparotidglandpreservationtechniquesare

effectiveandcanhelpdiminishpostirradiationxerostomia

prosthesishygiene.


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Smell And Taste DysfunctionETIOLOGY

Medications.Chemotheraphy.

Chemosensoryalterations.

TREATMENTPrimarystepintreatingsmellandtastedysfunctionis

identificationoftheetiology.

Flavourenhancerscancounteracttasteandsmelldeficits

andalsohelpinmaintenanceofnutritionalhealth.Patients withchemosensorydeficitsshouldbe

encouragedtouseherbsandspicesthat willaugmentflavourperception withoutaddingunnecessarycalories,

fats,sugarsandsalts


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Edentulousness

PREVENTION

Maintenanceoforalhygiene.

Earlytreatmentofdentalcaries.

Earlymanagementofperiodontaldisease.TREATMENT

Treatmentofosteoporosis withestrogensupplements.

Fabricationofremovableprosthesis.

Regularassessmentofdentures,denturebearingareasandallmucosalsurfacesisrequired


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REFERENCES

BURKETS ORAL MEDICINE

IMAGES-GOOGLE IMAGE


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