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Geriatric Dentistry: Before You Call 911

Course Number: 586

Oral Assessment

A patient’s teeth can demonstrate the lifestyle of the patient and can perfectly reflect years of trauma from faulty toothbrushing, use of acidic and chemical agents or even eating habits. The appearance and structure of the teeth tends to change with time, and recognizing these patterns is the first step in the oral assessment of the elderly patient. We cannot predict what the oral symptoms will be as everyone is different. However, some of the more common features will be discussed. Often, there are some obvious changes in the thickness of the enamel and dentin, the presence of gingival recession leading to a higher incidence of root caries especially in teeth with crowns or bridges, and even reduced sensitivity to cold or hot. There may be noticeable signs of reduced keratinization, increased xerostomia or periodontal disease leading to loose teeth and subsequent tooth loss.47 In cases of elderly patients with partial or complete edentulism, the alveolar ridges are most likely to be resorbed or knives edged and often have low success rates with both the fabrication and wearing of dental prostheses.

There are many other factors that can have direct or indirect impact on the oral health of the elderly. Physical and cognitive status, socioeconomic conditions, educational background, personal motivation levels, etc. are some of the aspects that need to be considered before offering extensive treatment options. It’s advisable not to schedule elderly patients for dental appointments with multiple procedures planned during a single session. The ability of elderly patients to handle complicated dental procedures tends to decline with time, particularly with diminishing health status.

The dental team must appreciate these limitations and understand that we still do not possess the ‘Golden Key’ to solve all dental problems. Every elderly patient will present with a unique set of conditions that needs to be respected at all times. It is understandable it’s easier said than done. However, to become a successful practice that includes the care of elderly patients, it is essential to identify areas of improvement, train the staff and search for innovative ways to provide effective and efficient treatment for the elderly.

Even scheduling a routine dental appointment can prove to be stressful for many older adults. Past experiences or stories shared by other people has the potential to leave a lasting negative impact on their memories. It can be a result of a painful procedure or a mild allergic reaction that can make it harder for them to accept the concept of painless dentistry or latest medical achievements. The next section is intended to shed light of some of the most common allergic reactions that take place in a dental clinic along with its preventive measures before the event can turn into a life threating condition.