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Gerodontology Review Article iMedPub Journals Periodontics and Prosthodontics 2017 http://www.imedpub.com/ Vol.3 No.1:6 ISSN 2471-3082 DOI: 10.21767/2471-3082.100031 Gerodontology: An Interdisciplinary Approach Vikram Jha1, Anuya Hemant Patankar2, Rameshwari Singhal1, Pavitra Rastogi1, Shuchi Tripathi1 and Nandlal1 1Department of Periodontology, Faculty of Dental Sciences, KGMU, Lucknow, India 2Department of Prosthodontics, MA Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India *Corresponding author: Rameshwari Singhal, Associate Professor, Department of Periodontology, Faculty of Dental Sciences, KGMU, Lucknow, India, Tel: 0019134320107; E-mail: [email protected] Received date: May 02, 2017; Accepted date: May 04, 2017; Published date: May 10, 2017 Copyright: © 2017 Jha V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Citation: Jha V, Patankar AH, Singhal R, et al. Gerodontology: An Interdisciplinary Approach. Periodon Prosthodon 2016, 3:1. commonly affecting dental problems in the geriatric patients are caries (both coronal and radicular caries), periodontitis, Abstract tooth mobility, xerostomia (which most commonly occurs as a side effect of the drugs which are taken by the elderly The aim of this review is to throw light on the patients), wear disorders i.e., attrition, abrasion and erosion, interrelationship between periodontics, restorative unreplaced missing teeth, broken or failing older dental dentistry and prosthodontics in geriatric population. restorations, mucosal diseases, oral cancer and alveolar ridge Increased life expectancy along with appropriate dental atrophy [4]. These problems ultimately lead to loss of teeth. treatment in the younger ages leads to retention of more Loss of teeth can be distressing and sometimes devastating as number of teeth in the advanced ages. To maintain these it can lead to serious psychosocial consequences which can teeth disease free and in function in the older individuals affect the person's quality of life [5]. This manifestation is is a multi-faceted challenge. This article describes the more pronounced in the elderly population. various restorative and prosthodontic treatment modalities that are commonly used in the dental Complete dental rehabilitation of geriatric patients involves rehabilitation of geriatric patients and their relationship a multidisciplinary approach. Along with enhancing and with the periodontium and gingival health. maintaining the health of the existing teeth, replacement of missing teeth is of utmost importance. Periodontics, Keywords: Geriatric patients; Inter-relationship; restorative dentistry and prosthodontics are inseparable in this Periodontics; Restorative dentistry; Prosthodontics respect. A prosthesis can be termed as successful only if the abutment teeth and the surrounding periodontium are healthy. An improperly fabricated prosthesis may cause food Introduction entrapment and accumulation of plaque, eventually leading to progression of periodontal disease [6] Periodontal disease will With advances in medical sciences, longevity of age is on an lead to loss of attachment, tooth mobility and ultimately loss increase. Life expectancy is expected to be around 80 years of of tooth [7]. An increased rate of bone loss and periodontal age in India in 2050 as per data [1]. Longer the life span, longer breakdown was observed in patients over 70 years of age in a is the time teeth are retained in the mouth. This coupled with retrospective study by Papapanou et al. [8]. preventive dental care that patients have received in their Prosthetic treatment options for partially dentate patients younger ages will lead to retention of a greater number of include removable prosthesis, fixed prosthesis and currently teeth in the geriatric patients. the most popular, implant prosthodontics. Proper diagnosis Geriatric patients often face a multitude of medical and treatment planning are of paramount importance in ailments. Mostly, these occur in combination with each other. restoring function and esthetics for patients. This is of special Some of the common ailments are diabetes mellitus, significance in older patients, where the aim of the dentist hypertension, myocardial infarction and stroke, osteoporosis, should be restoration of dentition keeping in mind the various neurodegenerative disorders like Alzheimer’s disease, biologic, esthetic and functional parameters [9]. Parkinsonism and dementia, respiratory ailments, osteoporosis A smile is said to be esthetic only when both the pink and and rheumatoid arthritis [2]. Often the physical and mental the white esthetics are in harmony. These two factors are dexterity of the older individual is compromised, necessitating inter-dependent on each other. It is critical that restorations supportive care from care givers. In a report by Griffin et al, are well contoured and well-polished, self-cleansing as well as they have stated that there is a strong correlation between esthetic in appearance. This will prevent food lodgement and general and oral health in the elderly population [3]. The accumulation of plaque. Not only will restorations fail in an © Copyright iMedPub | This article is available from: http://periodontics-prosthodontics.imedpub.com/ 1 Periodontics and Prosthodontics 2017 ISSN 2471-3082 Vol.3 No.1:6 unhealthy mouth but also improper restorations will lead to an treatments [16]. This along with increased calcification of the unhealthy mouth. Andreana in his review article has rightly root canal system requires sound clinical judgement and skills stated that it is essential for the clinician to understand the on the part of the endodontist for a successful endodontic biologic foundation principles prior to restorative treatment. If all the principles of endodontics are followed reconstructions of periodontally compromised teeth [10]. along with good isolation and good technique, there is no reason for loss of the tooth in the aged patient. The aim of the review is to explain in detail the interdisciplinary relationship between periodontal therapy and prosthetic rehabilitation and between periodontal therapy and Periodontal Therapy and restorative dentistry in geriatric patients. Prosthodontics Periodontal Therapy and Restorative This can be further subdivided into three categories Procedures Periodontal therapy and Fixed Prosthodontics Periodontal therapy and Removable Prosthodontics The primary goal of restorative dentistry is restoration of form, function and esthetics while maintaining the biological, Periodontal therapy and Implant Prosthodontics mechanical and esthetic principles. Advances in dental and material sciences have led to the availability of a variety of Periodontal Therapy and Fixed restorative materials which, in a restoration form, cannot be distinguished from a natural tooth. However, to fabricate such Prosthodontics restorations which are in harmony with the gingiva and periodontal health is the primary challenge for most clinicians. The chief compliant of patients of the older age group is inability to eat satisfactorily due to missing teeth. They desire In older adults, dental caries especially root caries is replacement using fixed prosthesis which includes implant rampant because of xerostomia. Root caries are more difficult supported crowns or crowns and bridges. In most cases, fixed to treat, due to difficulty in isolation. Studies have shown that prosthetic treatment options are preferred by the patient root caries are more difficult to excavate due to their greater bearing in mind the physical health and the finances involved extent as compared to coronal caries [11] Also, accessibility is in rehabilitation using implants. a problem, especially in molars12 and the interproximal areas [13] where the prevalence of root caries is the highest. In tooth supported fixed prosthesis, it is critical to assess the Restoration of the carious lesions is generally by the abutment teeth via a periodontal perspective for long term conventional filling methods. Chalmers has advocated the use and short term treatment planning. Tooth mobility, furcation of Minimal Intervention Dentistry for caries control in older involvement, severity of bone loss, bleeding/exudation from individuals [14]. It focusses on early detection and prevention, the gingival pockets are some of the periodontal factors that remineralization; use of a range of restorations such as dental need to be examined prior to finalizing the prosthetic amalgams, composites or glass ionomer cements and surgical treatment plan [17]. It is essential to achieve periodontal intervention only when required and only after disease has health of the abutment teeth before proceeding with any been controlled. Atraumatic restorative treatment (ART) is also further treatments. Similarly, one must bear in mind that the indicated for older dentate institutionalised adults with a high final restorations/ prosthesis that are to be cemented should caries rate. A study by da Mata et al has revealed that ART is as be carefully planned and should be in harmony with the effective as conventional treatment for caries control [11]. periodontium. The most important factor to be considered is Besides the Glass ionomer cements used act as fluoride the invasion of the biologic width by the margins of the releasing agents to limit
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