Geriatric Dental Practice - The Need, The Demand And The Challenges

Improved quality of life at old age will demand tooth retention and consequently need for dental care. It is desirable to have a functional dentition not only for the enjoyment of food but also for proper diet and nutrition. There is also mounting evidence that oral diseases impact cardiovascular, endocrine and pulmonary health particularly in the elderly, which will certainly provide additional stimuli for the elderly to seek dental care¹. In addition, gone are the days when elderly people cared less for their appearance, an edentulous mouth with resultant sagging is most often one of the presenting complaints of the elderly.

The World health organization documents that although the global population is growing at a rate of 17% annually, the aged population is galloping at a rate of 30% which implies that people over 60 years of age are outrunning young children below 15 years of age^2,3. This implies that the need and demand for dental care is expected to upsurge tremendously in the coming years.

A multi-faceted challenge

In the course of one's life, teeth would have been subjected to various physiological wear and tear, as well as pathological disease conditions leading possibly to a compromised dentition. Old age is associated with several risk factors, both general as well as those specific to the oral cavity. Managing compromised dentition amidst multitude of risk factors is indeed a multi-faceted challenge.

The general risk factors include various medical problems, medication induced side effects and psychological problems. Therefore, all health care providers should be familiar with the course and the complications associated with these disease conditions, drug interactions and the prophylactic guidelines provided for various medical, conditions^4,5. Any attempt at treating such patients without proper precaution may prove counter-productive.

Great percentage of elderly patients suffers from endogenous depression and senile dementia. This can cause memory loss, confusion, difficulty in making decisions, comprehension and even alter the patient's ability to learn and concentrate on new tasks associated with the treatment modality^6,7.

Those risk factors related specifically to oral cavity are gingival recession, presence of restorations, removable partial dentures, attrition, abrasion, erosion and other age related odontometric changes⁸. Most elderly patients suffer from dry mouth often associated with use of medications such as anti-depressants, anti –hypertensive, anti - cholinergic & anti-asthmatics etc⁹. In order to overcome this dryness they resort to chewing lozenges containing sugar which further worsens the situation.

All the above risk factors together with dry mouth and reduced physical ability of older individuals poses a challenge as it can hinder the maintenance of oral hygiene, often encouraging the development of diseased conditions such as dental caries, periodontal disease, tooth wear etc.

Treatment planning dilemma-:

“Adding life to years” rather than “years to life”, expresses the state of geriatric care model

Philip.J. Clark

While planning treatment for elderly, it is important to understand each patient's perceived needs, priorities, their expectations and its impact on patient's quality of life in terms of ability to eat, comfort level and esthetics that could affect self image.^[10,11] . when conditions prevent the achievement of an ideal treatment plan, the dentist should focus on each problem and then distinguish between ideal, realistic alternatives and an interim plan. One can combine the discussed systems and provide a modified concept of staged treatment planning. If the practitioner carefully stages provision of dental care, the patient can receive the requisite care in increments that are appropriate to the resolution of the immediate problems. Once a critical dental problem is stabilized the dentist can consider undertaking the next appropriate step, which is providing more and more elaborate and comprehensive care¹².

To summarize, increased life expectancy is causing an explosion of the aging population that will continue now and in the foreseeable future. Due diligence and interdisciplinary co-ordination among the dental and the medical professionals is crucial in providing safe, effective and appropriate care to the elderly. It should be the endeavor of Dental professionals to be conscious of the needs of the elderly dental patient, offer them empathetic care to ensure satisfaction, and inculcate a sense of well being as age advances.

'While wrinkles and greying are inevitable with age, tooth loss is not '.