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Oral Challenges of the Mature Person
Oral Challenges of the Mature Person
CHAPTER 9
Geriatric Dentistry P
eople are living longer than ever before in the history of mankind. This increased longevity has been related to excellent preventive and therapeutic medical care, public education about health, improved diet, exercise, and a reduction in smoking and alcohol consumption. Many people are living into their eighties and nineties with good health and with the ability to live their lives in a near normal manner (FIG. 9.1). But, just as 60,000 miles on your automobile tires significantly wears them, 80 years of life takes its toll on your mouth. What challenges can you expect in your oral condition as you pass into the mature years of life? This chapter describes and demonstrates numerous oral conditions of
the mature person. You may not have all of these conditions, but you will have some of them.
ORAL HYGIENE DIFFICULTY The most common malady of the mature years is arthritis. How does arthritis influence oral health? A person with painful arthritic hands finds it difficult to clean his or her mouth to the meticulous level that was possible in younger years. What is the significance of inadequate oral hygiene? Dental plaque and tartar accumulations cause increased dental caries (decay) (p. 167) and periodontal disease (p. 129). If you have more difficulty cleaning your mouth than you did when you were younger, it is suggested that you ask your dentist or hygienist to suggest a mechanical toothbrush for you, and that you change your routine visits to the dentist from the standard 6-month intervals to 3-month intervals. More frequent visits will cost you more preventive dollars, but you will have less tooth and supporting structure destruction and less expense for repair (see Chapter 19).
DIET In past generations, people died at much younger ages than they do today. With an average longevity of approximately 80 years of age, it is not uncommon to see people in their eighties who are living normal, productive, and independent lives. However, their oral problems can be challenging.
FIG. 9.1
As persons move into the mature years, become more physically debilitated, and lose a few teeth, they often elect to eat softer foods. These foods are usually sticky,sugar-containing snack foods. The result of frequently eating soft, sticky, sugar-containing snack foods is a significant increase in dental caries (decay). 57
58
Oral Challenges of the Mature Person
Gums and bone have receded about 1⁄4 inch on this patient. Note the heavy tartar and debris on the teeth. The pink color is a removable disclosing solution used to demonstrate the dental plaque accumulation to the patient. Periodontal therapy is needed, followed by replacement of missing teeth. FIG. 9.2
When such foods are consumed, they should be eaten with meals, and the mouth and teeth should be cleaned of all debris immediately after eating. This problem is especially present in nursing homes. It is suggested that when mature persons live in nursing homes, the nursing home staff persons should be instructed by the mature person’s dentist on the special oral hygiene needs of their client. Currently, dental problems are one of the most significant health challenges in nursing homes, and it is related to both poor diet and inadequate oral hygiene.
GUM RECESSION (FIG. 9.2) Gum tissues shrink (recede) as we age. This situation is unavoidable. As the gums move down the roots of the teeth, the roots are exposed. Root structure is darker in color than the enamel present on the tops of the teeth. Often, an unsightly appearance of brownyellow roots occurs, and discriminating patients become concerned about the esthetic result. A more critical and threatening problem is root caries (decay).
TOOTH ROOT DECAY As we move into the mature years, the gums around our teeth shrink back from the teeth,
Root canal therapy (endodontics) is needed for this patient’s darkened tooth.
FIG. 9.3
exposing the softer, more decay-prone dentin surfaces of the teeth. This dentin is the major constituent of the tooth root. Dentin decays far faster and easier than enamel (the hard substance on the top portions of teeth). In mature persons, the combination of poor diet, gum shrinkage, and dentin exposure cause rapidly progressing, aggressive decay that often will destroy teeth within only months. Root caries (decay) is one of the most serious oral challenges facing mature adults.
ENDODONTIC THERAPY NEED (FIG. 9.3)
Root surfaces are closer to the dental pulp (nerve) than the top surfaces of the teeth. If decay begins to destroy the root surfaces of teeth, root canal therapy can be needed within only a few months. Root canal therapy (p. 40) is expensive and destructive of tooth structure. It is to be avoided if possible by adequate oral hygiene and routine dental recare (see Chapter 19).
WEAR ON TOOTH SURFACES (FIG. 9.4) About one third of any population has destructive habits called bruxism or clenching (p. 76). People with this condition grind their teeth, especially while sleeping. They may cause up to 100 days of wear on their teeth in only one night of grinding. Bruxism was not a
59
Geriatric Dentistry
Geriatric Dentistry
This person has a clenching habit. He has destroyed a significant amount of tooth structure with this destructive habit. He needs major rehabilitative therapy.
Periodontal disease is present in most mature adults. This person has severe, ongoing periodontal disease and needs immediate treatment.
FIG. 9.4
FIG. 9.6
Crowns (caps) and fillings placed many years ago have worn out in this patient. She requires major dental therapy to retain her teeth.
tooth structure and the restoration, partial clasps break, porcelain breaks from crowns (caps), and the restorative therapy degenerates. Decay starts, the bite relationship collapses, and myriad oral problems start. Mature people need to make sure they are receiving very thorough dental care even more so than they did earlier in life. Many new restorative materials containing decay-preventive chemicals are now available and they are especially indicated for mature people.
FIG. 9.5
major problem when people died at age 45 or 50, but now they live beyond age 80. Often, teeth subjected to bruxism are destroyed by middle age unless occlusal bite guards are used, beginning at an early age (p. 79). If you have bruxism, you probably are well aware of this malady. Your teeth are short, worn, and potentially sensitive. If you are a bruxer, you cannot avoid tooth wear without professional help. It is imperative that this preventive, professional help be started as early in life as possible. Bruxism carried on into the mature years is catastrophic for the dentition.
OLD TOOTH RESTORATIONS (FIG. 9.5) Restorations (fillings), crowns (caps), and other dental prostheses (partial dentures), wear out after years of service. As they wear out, openings occur between the remaining
PERIODONTAL DISEASE (FIG. 9.6) Periodontal (gum and bone) disease (p. 129) in youth is infrequent. Periodontal disease in mature adulthood is commonplace. Mobile, spaced teeth, and foul breath often indicate that periodontal disease is present. Most mature people have some form of periodontal disease. They need professional help in the form of scaling, rinses, antibiotics, surgery, etc. They need more frequent recall appointments than they needed in their earlier years.
BONE SHRINKAGE UNDERNEATH DENTURES (FIG. 9.7) About 40 million people in the United States have dentures. Each year the bone and gums supporting the denture shrinks. Over the period of a lifetime the bone can shrink more than half an inch, resulting in poorly adapted
60
Oral Challenges of the Mature Person
FIG. 9.7
Note the collapse of the face related to bone and gum recession under dentures. Well-made dentures can regain the facial form.
FIG. 9.8
and loose dentures, poor chewing efficiency, and inadequate nutrition. Despite patients wearing the same set of dentures for decades, the average denture has a functional longevity of only about 10 years. Relines are needed every few years. For optimum health, artificial complete dentures need professional observation at least once per year and relining or remaking on a periodic basis. Your dentist can advise you concerning your own need for professional care.
colored food. The color in mature teeth only has a cosmetic disadvantage, and much of it can be removed with polishing and bleaching (see Chapter 8).
DISCOLORED TEETH (FIG. 9.8) Teeth discolor with age. This discoloration occurs because of ingestion of pigmented substances such as coffee, tea, colas, or any
Note the several colors of teeth and crowns (caps) in this 60-year-old person. Staining of natural teeth is present in every mature person. It can be removed with tooth-whitening techniques.
SUMMARY As with all parts of the human body, age produces a predictable degeneration of the teeth and then the supporting tissues. This chapter has discussed and demonstrated the most significant challenges that occur with your mouth in the mature years. With the help of your dentist, decide which of these challenges you face and immediately begin preventive or therapeutic care.
CHAPTER 9
Geriatric Dentistry P
eople are living longer than ever before in the history of mankind. This increased longevity has been related to excellent preventive and therapeutic medical care, public education about health, improved diet, exercise, and a reduction in smoking and alcohol consumption. Many people are living into their eighties and nineties with good health and with the ability to live their lives in a near normal manner (FIG. 9.1). But, just as 60,000 miles on your automobile tires significantly wears them, 80 years of life takes its toll on your mouth. What challenges can you expect in your oral condition as you pass into the mature years of life? This chapter describes and demonstrates numerous oral conditions of
the mature person. You may not have all of these conditions, but you will have some of them.
ORAL HYGIENE DIFFICULTY The most common malady of the mature years is arthritis. How does arthritis influence oral health? A person with painful arthritic hands finds it difficult to clean his or her mouth to the meticulous level that was possible in younger years. What is the significance of inadequate oral hygiene? Dental plaque and tartar accumulations cause increased dental caries (decay) (p. 167) and periodontal disease (p. 129). If you have more difficulty cleaning your mouth than you did when you were younger, it is suggested that you ask your dentist or hygienist to suggest a mechanical toothbrush for you, and that you change your routine visits to the dentist from the standard 6-month intervals to 3-month intervals. More frequent visits will cost you more preventive dollars, but you will have less tooth and supporting structure destruction and less expense for repair (see Chapter 19).
DIET In past generations, people died at much younger ages than they do today. With an average longevity of approximately 80 years of age, it is not uncommon to see people in their eighties who are living normal, productive, and independent lives. However, their oral problems can be challenging.
FIG. 9.1
As persons move into the mature years, become more physically debilitated, and lose a few teeth, they often elect to eat softer foods. These foods are usually sticky,sugar-containing snack foods. The result of frequently eating soft, sticky, sugar-containing snack foods is a significant increase in dental caries (decay). 57
58
Oral Challenges of the Mature Person
Gums and bone have receded about 1⁄4 inch on this patient. Note the heavy tartar and debris on the teeth. The pink color is a removable disclosing solution used to demonstrate the dental plaque accumulation to the patient. Periodontal therapy is needed, followed by replacement of missing teeth. FIG. 9.2
When such foods are consumed, they should be eaten with meals, and the mouth and teeth should be cleaned of all debris immediately after eating. This problem is especially present in nursing homes. It is suggested that when mature persons live in nursing homes, the nursing home staff persons should be instructed by the mature person’s dentist on the special oral hygiene needs of their client. Currently, dental problems are one of the most significant health challenges in nursing homes, and it is related to both poor diet and inadequate oral hygiene.
GUM RECESSION (FIG. 9.2) Gum tissues shrink (recede) as we age. This situation is unavoidable. As the gums move down the roots of the teeth, the roots are exposed. Root structure is darker in color than the enamel present on the tops of the teeth. Often, an unsightly appearance of brownyellow roots occurs, and discriminating patients become concerned about the esthetic result. A more critical and threatening problem is root caries (decay).
TOOTH ROOT DECAY As we move into the mature years, the gums around our teeth shrink back from the teeth,
Root canal therapy (endodontics) is needed for this patient’s darkened tooth.
FIG. 9.3
exposing the softer, more decay-prone dentin surfaces of the teeth. This dentin is the major constituent of the tooth root. Dentin decays far faster and easier than enamel (the hard substance on the top portions of teeth). In mature persons, the combination of poor diet, gum shrinkage, and dentin exposure cause rapidly progressing, aggressive decay that often will destroy teeth within only months. Root caries (decay) is one of the most serious oral challenges facing mature adults.
ENDODONTIC THERAPY NEED (FIG. 9.3)
Root surfaces are closer to the dental pulp (nerve) than the top surfaces of the teeth. If decay begins to destroy the root surfaces of teeth, root canal therapy can be needed within only a few months. Root canal therapy (p. 40) is expensive and destructive of tooth structure. It is to be avoided if possible by adequate oral hygiene and routine dental recare (see Chapter 19).
WEAR ON TOOTH SURFACES (FIG. 9.4) About one third of any population has destructive habits called bruxism or clenching (p. 76). People with this condition grind their teeth, especially while sleeping. They may cause up to 100 days of wear on their teeth in only one night of grinding. Bruxism was not a
59
Geriatric Dentistry
Geriatric Dentistry
This person has a clenching habit. He has destroyed a significant amount of tooth structure with this destructive habit. He needs major rehabilitative therapy.
Periodontal disease is present in most mature adults. This person has severe, ongoing periodontal disease and needs immediate treatment.
FIG. 9.4
FIG. 9.6
Crowns (caps) and fillings placed many years ago have worn out in this patient. She requires major dental therapy to retain her teeth.
tooth structure and the restoration, partial clasps break, porcelain breaks from crowns (caps), and the restorative therapy degenerates. Decay starts, the bite relationship collapses, and myriad oral problems start. Mature people need to make sure they are receiving very thorough dental care even more so than they did earlier in life. Many new restorative materials containing decay-preventive chemicals are now available and they are especially indicated for mature people.
FIG. 9.5
major problem when people died at age 45 or 50, but now they live beyond age 80. Often, teeth subjected to bruxism are destroyed by middle age unless occlusal bite guards are used, beginning at an early age (p. 79). If you have bruxism, you probably are well aware of this malady. Your teeth are short, worn, and potentially sensitive. If you are a bruxer, you cannot avoid tooth wear without professional help. It is imperative that this preventive, professional help be started as early in life as possible. Bruxism carried on into the mature years is catastrophic for the dentition.
OLD TOOTH RESTORATIONS (FIG. 9.5) Restorations (fillings), crowns (caps), and other dental prostheses (partial dentures), wear out after years of service. As they wear out, openings occur between the remaining
PERIODONTAL DISEASE (FIG. 9.6) Periodontal (gum and bone) disease (p. 129) in youth is infrequent. Periodontal disease in mature adulthood is commonplace. Mobile, spaced teeth, and foul breath often indicate that periodontal disease is present. Most mature people have some form of periodontal disease. They need professional help in the form of scaling, rinses, antibiotics, surgery, etc. They need more frequent recall appointments than they needed in their earlier years.
BONE SHRINKAGE UNDERNEATH DENTURES (FIG. 9.7) About 40 million people in the United States have dentures. Each year the bone and gums supporting the denture shrinks. Over the period of a lifetime the bone can shrink more than half an inch, resulting in poorly adapted
60
Oral Challenges of the Mature Person
FIG. 9.7
Note the collapse of the face related to bone and gum recession under dentures. Well-made dentures can regain the facial form.
FIG. 9.8
and loose dentures, poor chewing efficiency, and inadequate nutrition. Despite patients wearing the same set of dentures for decades, the average denture has a functional longevity of only about 10 years. Relines are needed every few years. For optimum health, artificial complete dentures need professional observation at least once per year and relining or remaking on a periodic basis. Your dentist can advise you concerning your own need for professional care.
colored food. The color in mature teeth only has a cosmetic disadvantage, and much of it can be removed with polishing and bleaching (see Chapter 8).
DISCOLORED TEETH (FIG. 9.8) Teeth discolor with age. This discoloration occurs because of ingestion of pigmented substances such as coffee, tea, colas, or any
Note the several colors of teeth and crowns (caps) in this 60-year-old person. Staining of natural teeth is present in every mature person. It can be removed with tooth-whitening techniques.
SUMMARY As with all parts of the human body, age produces a predictable degeneration of the teeth and then the supporting tissues. This chapter has discussed and demonstrated the most significant challenges that occur with your mouth in the mature years. With the help of your dentist, decide which of these challenges you face and immediately begin preventive or therapeutic care.