Oral Health Conditions in the Older Adult A. ENRIQUE VARELA D.D.S. Disclaimer
All images belong to their respective owners No financial conflict of interests to report Overview
Specific oral conditions seen in the Geriatric Clinic Xerostomia Radiation caries Osteoradionecrosis Medication-related osteonecrosis of the jaw Periodontal disease Medications and polypharmacy
6 Xerostomia
Adequate Salivary Flow Poor Salivary Flow
6 4 6 3 Xerostomia Radiation Caries
Radiation induced xerostomia Salivary gland damage/destruction 3 First 6 weeks of treatment Serous glands have increased sensitivity Mucous glands can recover
2 1 Radiation Caries
Recommendations: Dental Consult Prior to Radiation
Address existing problems
Get the patient in good oral health
Make fluoride trays to help maintain good dental health 8 Help keep the oral cavity clean
6 Osteoradionecrosis of the Jaw
Osteoradionecrosis of the Jaw: High dose radiation Hypocellularity
Hypovascularity 9 Ischemia in the jaws
Microtrauma
Soft tissue separation
Exposed bone (necrotic)
10 Osteoradionecrosis
Dental Management CC: “My teeth are getting loose” Findings: Loose teeth Exposed bone Management Referral to Oncologist HBO Denture patients should avoid wearing dentures during first 6 months after 2 therapy Osteoradionecrosis
Dental Management 25-30 Dives (Pre-surgical) 7-10 Day working time 10-15 Dives (Post-surgical) Adjunct Therapy Chlorhexidine Amoxicillin
6 Osteoradionecrosis
Dental Management Barriers to treatment Treatment coordination Patient finances Lack of understanding No Intervention Jaw fracture Osteoradionecrosis
Prevention Dental clearance prior to radiation therapy Resolve existing infections Anticipate potential sources of infection and eliminate them
11 Medication Related Osteonecrosis of the Jaw (MRONJ)
Medications Antiangiogenics (angiogenesis inhibitors) Anti-resorptives
Bisphosphonates
Ibandronate (Boniva)
Alendronate (Fosamax) RANKL inhibitors
2 Medication Related Osteonecrosis of the Jaw (MRONJ)
Clinical Manifestation Exposed bone Soft tissue dehiscence Mucositis Suppuration Symptoms Pain 1 3 Paresthesia Medication Related Osteonecrosis of the Jaw (MRONJ)
Staging of MRONJ At Risk Stage 0 Stage 1 Stage 2 Stage 3
1 Medication Related Osteonecrosis of the Jaw (MRONJ)
3 2 Periodontitis
Gingivitis Inflammation of gums 1 Periodontitis Progressive Inflammation
Destroys bone and soft tissue Needs to be removed mechanically Requires maintenance
1 Periodontitis Periodontal Disease
1 1 How to recognize oral health problems
Things to look at: Salivation Color Self-report 1
1 1 How to recognize oral health problems
Things to look at: Salivation Color Self-report 1
1 1 How to recognize oral health problems
Things to look at: Salivation Color Signs and Symptoms
Self-report
Clinically evident
Caregiver reported
Less obvious clues
3 Works Cited
Eke PI, Dye BA, Wei L, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J of Periodontology. 2015;86(5):611-622. National Institute of Dental and Craniofacial Research. National Institutes of Health. Fact Sheet: Dry Mouth (Xerostomia) website. http://www.nidcr.nih.gov/OralHealth/Topics/DryMouth/external icon. Accessed July 5, 2016. Sparks Stein, Pamela, Michelle J Steffen, Charles Smith, Gregory Jicha, Jeffrey L Ebersole, Erin Abner, and Dolph Dawson. "Serum Antibodies to Periodontal Pathogens Are a Risk Factor for Alzheimer’s Disease." Alzheimer's & Dementia: The Journal of the Alzheimer's Association 8.3 (2012): 196-203. Web. Kamer, Angela R, Ronald G Craig, Elizabeth Pirraglia, Ananda P Dasanayake, Robert G Norman, Robert J Boylan, Andrea Nehorayoff, Lidia Glodzik, Miroslaw Brys, and Mony J De Leon. "TNF-α and Antibodies to Periodontal Bacteria Discriminate between Alzheimer's Disease Patients and Normal Subjects." Journal of Neuroimmunology 216.1-2 (2009): 92-97. Web. Jeffcoat, Marjorie K, Jeffcoat, Robert L, Gladowski, Patricia A, Bramson, James B, and Blum, Jerome J. "Impact of Periodontal Therapy on General Health." American Journal of Preventive Medicine 47.2 (2014): 166-74. Web. Kamer, Angela R, Ronald G Craig, Ananda P Dasanayake, Miroslaw Brys, Lidia Glodzik-Sobanska, and Mony J De Leon. "Inflammation and Alzheimer's Disease: Possible Role of Periodontal Diseases." Alzheimer's & Dementia: The Journal of the Alzheimer's Association 4.4 (2008): 242- 50. Web. Jimenez, Monik, Frank B Hu, Miguel Marino, Yi Li, and Kaumudi J Joshipura. "Type 2 Diabetes Mellitus and 20 Year Incidence of Periodontitis and Tooth Loss." Diabetes Research and Clinical Practice 98.3 (2012): 494-500. Web. Kamer, Angela R, Elizabeth Pirraglia, Wai Tsui, Henry Rusinek, Shankar Vallabhajosula, Lisa Mosconi, Li Yi, Pauline Mchugh, Ronald G Craig, Spencer Svetcov, Ross Linker, Chen Shi, Lidia Glodzik, Schantel Williams, Patricia Corby, Deepak Saxena, and Mony J De Leon. "Periodontal Disease Associates with Higher Brain Amyloid Load in Normal Elderly." Neurobiology of Aging 36.2 (2015): 627-33. Web. Image Sources
1. Neville, Brad W, Allen, Carl M, and Damm, Douglas D. Oral and Maxillofacial Pathology. Fourth ed. 2016. Web. 2. Little, James W., Miller, Craig S., and Rhodus, Nelson L. Little and Falace's Dental Management of the Medically Compromised Patient. Ninth ed. 2018. Web. 3. Trump, Brian, 2019 4. Keddington, James 2019 5. Okano, David 2019 6. Wikipedia 7. Eastondentists.com 8. Pixabay.com 9. Oralcancerfoundation.org 10. Sciencedirect.com 11. Bestpractices.bmj.com Special Thanks
Dr. Rory Hume, D.D.S., Ph.D.- Dean, University of Utah School of Dentistry Dr. Glen Hanson, D.D.S., Ph.D.- Vice Dean, University of Utah School of Dentistry Dr. Lea Erickson, D.D.S., M.S.PH, Associate Dean, University of Utah School of Dentistry Dr. Bryan G. Trump, D.D.S., M.S.- Oral Pathology Dr. David Okano, D.D.S., M.S.- Periodontology Dr. R. James Keddington, D.D.S.- Restorative Dentistry