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Geriatric Dental Care : an Emerging New Speciality Dr Geriatric Dental Care : An Emerging New Speciality Dr. Amarnath Shenoy Dr. U.S. Krishna Nayak Dr. Gary Ignatius Dr. Harish K Shetty Asso. Professor Dean-Academics, Sr. Professor & HOD Lecturer Professor & HOD Dept. of Conservative Dept. of Orthodontics Dept. of Conservative Dept. of Conservative Dentistry & Endodontics A.B.Shetty Memorial Institute of Dentistry & Endodontics Dentistry & Endodontics Yenepoya Dental College Dental Sciences Yenepoya Dental College Yenepoya Dental College Mangalore Mangalore Mangalore Mangalore Abstract open up and speak up about their financial hypertensive and anti-asthmatics can cause he dental needs and challenges of options. Most of the time the old people live such conditions. Caries, periodontal disease, senior adults are unique. This is alone so patients should talk about their dysphagia can be consequences of such Tmore challenging when we come family also.7 Earning more money as the only conditions. In such cases if they chew to know that the life expectancy of people is objective of a busy dentist will hinder the lozenges containing sugar to overcome increasing. The number of male population process of interaction with the patient and as a dryness, it further worsens the situation.1 above 70 years and female population above result the patient will be quickly disposed off Maintenance of oral hygiene becomes 72 years is expected to increase by 2025 in in clinics.3,6 difficult and leads to dental disease due to India. At any age a healthy mouth makes a lot Three groups of older subjects are food impaction and plaque accumulation on of difference in life style and health. A healthy identified. They are young old (65-74yrs), the rougher cemental surface. All this is due mouth also makes one feel good, stay healthy older old (75-84yrs) and oldest old (above 85 to the gingival recession which occurs at old and look great throughout life. By 2050 the yrs) 8 age. proportion of elderly in the total population is Careful consideration of all coexisting Increased risk of secondary caries due to projected to be around 20% in India and 32% medical problems before one initiates the faulty restoration margins and poor oral in other developed nations. Geriatric dental treatment is a cardinal rule in geriatric care. 9,1 hygiene along with dry mouth can also be needs at present are not given much The lack of knowledge regarding the seen in elderly. The retention clasps of partial importance in our country. There is a strong psychological management of elderly dentures can also accumulate plaque and this need to focus on research encompassing all patients prevents many from working in this can lead to further decay. aspects of aging, dental and medical field. The exception is those who are Compensatory changes occur in the teeth problems and its appropriate management. naturally interested in the welfare of the as they age and this can be also be due to the Key Words: Dental need, Senior adults, elderly. teeth responding to injury and other insults. Healthy mouth, Geriatric. More than 50% of patients above 60 yrs Tooth tissue and supporting tissue undergo a Introduction are medically compromised and are on lot of changes. Wear, disease and habits lead All individuals would like to lead a medication. Clinical conditions like diabetes, to many changes. Reparative capacity of the quality life even when they are aged. hypertension, cardiovascular diseases, pulp is reduced following injury.12 volume of Retention of teeth can have an impressive arthritis and neuromuscular problems like pulp is reduced and the thickness of dentin is value on the overall dental, physical and Parkinson’s disease and Alzheimer’s can increased. To compensate between loss of emotional health of any elderly individual. trigger emergency situation during dental bone support and excessive from occlusal Teeth help in not only for enjoyment of food treatment if proper considerations and forces imposed on teeth, attrition occurs. but also for proper nutrition and pleasant precautions are not taken. The health care Proximal wear of posterior teeth can cause looks. There is a relation between oral providers should be able to take initiative to anterior edge to edge bite and reduced over diseases and cardiovascular, endocrine and know these conditions through proper history jet. Loss of sluice ways is seen with an pulmonary health particularly in the elderly. and medical reports and thus provide increase in food table.12, 13 This will be one more reason for the elderly to prophylactic guide lines.9,10 Before a clinical treatment is planned the 1,2 seek dental care. Feeling of neglect or loneliness can lead following is to be considered14 Geriatric dentistry is a science which any elderly to endogenous depression. Senile 1. Patients' expectations and desires deals with the diagnosis, management, and dementia can lead to memory loss, confusion, 2. Type and severity of dental problem prevention of all types of oral diseases in the difficulty in making decisions, compre- depending on function, symptom, elderly population. It focuses of delivery of hension and alter ability to learn new tasks pathology and esthetics. dental care to the elderly population. It also associated with treatment modality.11,1 If the 3. Prognosis 3 addresses age related dental ailments. elderly has hearing and vision impairment it 4. Factors that affect personality The term geriatrics stems from a Greek can worsen the situation further. 5. Alternatives word “GERON” that means old man and For ambulatory elderly oral care be 6. Patient's ability to tolerate stress during 4 “IATROS” means healer. provided at Chairside in a hospital setting. treatment In treating elderly the main problem one These hospitals setting should have suitable 7. Motivation faces is the complexity of the treatment that rails, ramps, lifts, wheel chairs and a walker 8. Financial sources gets compounded due to ageing.5 Factors like for transfer to a dental office, all of which 9. Family support muscular fatigue, dementia, mental illness, needs evaluation before the appointment. 10. Life span depression, arthritis, stroke, Parkinson's However in case of non ambulatory it's When an ideal treatment is not possible, disease, neurosis and psychosis which are different. Portable chair side or bed side then individual problem should be focussed common in elderly can affect the locomotor equipments need to be arranged in the places upon and then distinguish between ideal, skills which in affects the ability to seek where the elderly stay. These places can be realistic alternatives and then interim plan.1 treatment. Successful treatment to these geriatric wards, institutions for mentally Staged treatment planning was suggested elderly also depends on the dentists' challenged, old age homes etc.3 by Bannet and Cramer. According to them behaviour and attitude. The time allocated by Dry Mouth & Other Conditions careful staging of the treatment can deliver the dentist for treating the elderly is also During old age there is reduction in saliva the requisite care in increments and resolve crucial for the success of treatment.3,6 which leads to dry mouth. This may be due to the immediate problems and then consider Motivation is also the key to success the hypo functioning salivary glands. providing more elaborate and comprehensive when dealing with geriatric patients. Most of However this is not the only reason for care. Staged treatment plan.1 the time old people are very receptive to reduced saliva in the mouth. Anti- Stage 1: Emergency care. talking, but they should be provided time to depressants, anti-cholinergics, anti- Stage 2: Maintenance and monitoring. Continue on Page No. 38 3612 Heal Talk | November-December 2013 | Volume 06 | Issue 02 Save The Girl Child Chowdhary : Sterilization In Orthodontics An Insight Guidelines for sterilization of alginate required for completion of this procedure as 6. Schneeweiss D. Avoiding cross-contamination of elastomeric ligatures. Journal of Clinical impressions- Prevention of cross infection is a crucial Orthodontics: JCO1993;27(10):538. 1. Rinse thoroughly under running water aspect of dental practice. There is still need 7. Mayhew MJ, Kusy RP. Effects of sterilization on the following removal. for improvement in disinfection and mechanical propertiesand the surface topography of 2. Immersions of impression in disinfectant sterilization in dental practice, especially nickel-titanium arch wires. American Journal of O r t h o d o n t i c s a n d D e n t o f a c i a l for 10 minutes. Spraying aerosols are not including monitoring and documentation of Orthopedics1988;93(3):232-6. recommended for their unevenness and sterilization process, proper use of 8. Powell GL, Whisenant BK. Comparison of three additional inhalation risk. disinfectants and frequent disinfection of lasers for dental instrument sterilization. Lasers in Surgery and Medicine1991;11(1):69-71. 3. Rinse again under running water. surfaces which contact with patients. 9. George OF, Benoit C. Rapin L. Aranda P. Berthod P 4. Ready for model processing. References Steinmetz MP Filleu. Effect of Surgical Sterilization The manufacturer’s prescription 1. Adivce Sheet, infection Control in Dentistry, Procedures on Orthodontic Pliers: A Preliminary recommends immersing the alginate Department of Health, United Kingdom, 2005. report. European Cells and Material 2005. 10(4):13. 2. Kapila S, Haugen JW, Watanabe LG. Load-deflection 10. Benson PE, Douglas CWI. Decontamination of impression for not more than 10 minutes as it characteristics of nickel-titanium alloy wires after orthodontic bands following size determination and may cause alteration in the surface clinical recycling and dry heat sterilization. American cleaning. Journal of Orthodontics 2007; 34 (1): 18- characteristics of the material. Newer Journal of Orthodontics and Dentofacial 24. Orthopedics1992;102(2):120-6. 11. Mayberry DR, Allen J, Close Kinney DA. Effects of alginate impression materials are 3.
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