Geriatric dentistry
Geriatric dentistry is the delivery of dental care to older adults involving diagnosis, prevention, management and treatment of problems associated with age related diseases. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. In the elderly population poor oral health has been considered a risk factor for general health problems. Older adults are more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical/mental disabilities. Thus, the elderly form a distinct group in terms of provision of care.
Ageing Population
The world's population is currently ageing with the number and proportion of elderly people growing substantially. Between the years of 2000–2005 to 2010-2015 life expectancy at birth rose from 67.2 to 70.8 years. By 2045-2050 it is projected to continue increase to 77 years. This increasing longevity can be majorly attributed to advances in modern medicine and medical technology. As a result, the population of people aged 60 and over is growing faster than any other younger age group and it is expected to more than double by 2050 globally. This will have a profound effect on society's ability to support the needs of this growing crowd including their dental needs.Older people have become a major focus for the oral health industry. Due to the increasing number and proportion of elderly people, age related dental problems have become more common. This is largely due to success in dental treatment and prevention of gum disease and caries at a young age, thereby leading to people retaining more of their own natural teeth. As they get older, the retained teeth are at risk of developing and accumulating oral diseases that are more extensive and severe.
Geriatrics as a Dental Specialty
In Australia geriatric dentistry is falls under the 'Special needs dentistry' specialty which is recognised by the Dental Board of Australia. This is because often age related problems and medication can make oral health disease and conditions much more serious and complicated to treat. As a result, they require specialized and individualized treatment and considerations. It is however, important to recognize that, contrary to popular belief, ageing is not synonymous with disease and should not be considered pathologic, and rather a natural and inevitable physiological process.In the United Kingdom the General Dental Council has as total of thirteen specialties, however, geriatrics is not one of them. Special care dentistry is however recognised as an area of specialty and focuses on the prevention and management of oral health conditions for people who have physical, sensory, intellectual, mental, emotional or social impairment or disability. Mostly for adults and adolescents and therefore older people.
In America, geriatrics is not currently formally recognised by the American Dental Association as an area of specialty. The Harvard Dental School of Medicine however, does offer a further two-year study for a certificate in geriatric dentistry. This program trains dentist in the specialised care for the population group of older people who often experience disparity.
The Royal College of Dentists of Canada does not recognise geriatrics as one of its nine specialties.
The Geriatric Patient
The elderly can be classified into many criteria. Classifying them allows for a more detailed and accurate analysis of the diversity within this age group and makes diagnosis and treatment planning more personalised. The following is a common classification of the elderly according to age group.The dental classification of ageing however is more useful if it is based on the patient's ability to seek dental care independently.
- Frail elderly have chronic, debilitating, physical, medical and emotional problems who are unable to maintain independence without continued assistance from others. As a result, the majority of the frail elderly live in the community with support services.
- Functionally dependent elderly have chronic, debilitating, physical and medical or emotional problems or any combination that compromises their capacity to the extent where they are unable to maintain independence and as a result are homebound or institutionalized
Dental Health of Geriatric Population
In 1979, 60% of Australians over the age of 65 had no natural teeth. In 1989, 44% had no teeth and it is expected by 2019, this figure will drop to 20%. This prediction was exceeded in 2013, with 19% of those over the age of 65 had no natural teeth.
Although there is a decrease in the rate of edentulism, geriatric patients typically have high levels of plaque, calculus and debris, as they are functionally dependent on others or have lost the capacity to complete tasks such as toothbrushing thoroughly. Consequently, this results in an increased caries prevalence. Dental caries is a process in which enamel is dissolved by acid producing bacteria. In 2004–2006, the average DMFT for adults in Australia over the age of 65 was found to be 23.7%. An individual's caries risk is influenced by their sugar intake, frequency of eating, oral hygiene levels, saliva flow and function and recession. Gingival recession is a significant finding in older adults because the exposed root surface is more susceptible to root caries and therefore increases the risk for the patient. In 2015, 95.2% of Australians over the age of 75 had at least one site with gingival recession. Additionally, periodontal disease prevalence was also great as 26.0% of the geriatric population was diagnosed with active periodontal disease.
Medical Conditions affecting Oral Health
A number of physiological changes happen to the geriatric population with age. The gastrointestinal, renal, cardiovascular, respiratory, and immune systems often decrease in efficiency, and this impacts upon the entire body, including oral health.Along with physiological changes, physical ones involve reduced bone and muscle mass Mobility can be decreased due to osteoarthritis, and a variety of audio and visual changes such as cataracts, macular degeneration, and hearing loss can make communication, patient education and oral health care increasingly difficult to maintain.
The majority of elderly people have at least one chronic condition, with many having multiple. The most common of these include hypertension, arthritis, heart disease, cancers and diabetes. Other prevalent conditions include dementia, depression, hearing loss, cataracts, back and neck pain, and chronic obstructive pulmonary disease.
Geriatric patients may demonstrate a spectrum of cognitive acuity, and dementia is categorised by a progressive deterioration in cognition that eventually affects an individual's capability to function independently. More often than not, this is diagnosed in the elderly population. Unfortunately this disease impacts upon the ability to manage their medications, systemic conditions, and oral hygiene. As the severity of the impairment increases, the elderly become much more susceptible to develop dental caries, periodontal disease and oral infection, primarily because of the reduced capability to maintain good oral health at home.
The elderly usually develop a decrease in appetite, leading to a lower intake of vitamins and minerals. However, many nutrients are recommended at the same amounts as younger people. Another reason why inadequate nutrition levels are more prominent with elders is if their dental status is poor, with missing teeth or ill fitting dentures, it can negatively affect their taste and ability to chew on food. Even well-fitted dentures are less efficient than natural teeth in terms of chewing, so changes in diet to softer foods often happen. Such foods often contain more fermentable carbohydrates, which raise individuals' risk to developing dental caries.