Older adults, which comprise 20% of the population, are those age 65 years and older. They are estimated to reach up to 72 million in the U.S. alone by the year 2030. Due to increased awareness in dental health, more older adults have retained their natural teeth compared to previous generations of aging adults. However, the retained natural teeth most likely have untreated dental caries, periodontitis, and other dental problems.
Physiologic changes in aging
As people age, there is a correlated decrease in organ mass, body fluid, and functional reserves. This leads to changes in overall body balance or homeostasis. There are changes in sensitivity to temperature, blood flow, adaptability to illnesses, and the capacity to recuperate.
Physically, aging people are noted to have decreased muscle and bone mass. They are also prone to osteoarthritis which is joint degeneration due to overuse as one grows older. There are age-related visual and hearing changes as well. Aging adults are prone to falls due to decreasing balance. They will experience cognitive changes such as dementia or increased forgetfulness.
These physiologic changes affect the body's response to illnesses or even to daily care that can lead to more complications if not addressed early on. Due to poor cognitive health, one may find it hard to take medications on time and properly. One may forget or neglect daily hygiene activities including teeth and gum care. Poor muscle and bone health and joint pains limit movements, and this may cause difficulty even in brushing one's teeth.
Comorbidities and dental health
Although older adults may still have very satisfactory overall health and be functional and independent, some will have at least one chronic condition, and some may be frail or impaired despite being at a "younger" elderly age. The comorbidities may have a direct or indirect effect on dental health.
If one takes multiple prescription medications, decreased organ function may easily cause side effects. Some medications may cause changes in salivary glands, which excrete substances that keep the mouth moist, and have bacteria-fighting properties. Some medications may cause thinning of the blood that may lead to bleeding with minimal injury. Uncontrolled diabetes can cause poor healing such that unmanaged gum infection and teeth problems may experience complications (e.g. abscesses or even blood infection).
What could be done
* It is recommended that older adults especially those with dry mouths regular take water throughout the day.
* Limit intake of alcoholic beverages, and those high in sugar and caffeine.
* Continue providing topical fluoride even to older adults.
* Ensure good oral hygiene is maintained at home. Using rotating toothbrushes may be helpful for those with limitation of movement. Having regular dental appointments is a good practice to prevent complicated dental problems.
* Due to cardiovascular disease risks, an epinephrine dose for anesthesia must be used sparingly and cautiously. Excess use of this drug may cause heart problems.
* The patient and possible caregivers must be educated regarding oral health care especially for those at risk of cognitive impairment.
* For dental health practitioners, always remember that the cognitive impairments of older adults may cause problems with communications and self-care. Be understanding when providing instructions, and explaining the procedure. Ensure that sutures are well-placed, and that the patient is stable before discharging him/her.
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