“Wrinkles should merely indicate where smiles have been.” – Mark Twain
Wrinkles are one of the common qualms that come with age, but the quote above takes a more positive approach. If you do have wrinkles, let them be evidence of lots of smiles over the years rather than worries. The need to have a healthy smile becomes significantly more important as the older population continues to grow. Many prospective statistics around the globe have shown growth in the demographic of older adults because of predicted improvements in the health care sector. Higher birth rates in the baby boomer era (1946-1964), improvements in sanitation and nutrition, as well as astounding advancements in medical care technology in the United States of America are all expected to lead to a phenomenal increase in the number of older adults. These projections are quickly becoming a reality, with a notable increase in the population of the oldest old (>85).
The maintenance of dentition in this population is important not only for their quality of life but also for the maintenance of their general health. Oral health is the gatekeeper to overall systemic health and has an intimate connection with the rest of the body. This makes it very important for us to be mindful of dental care for older adults, which involves the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases. The aging of the population combined with the increased retention of teeth are expected to raise the demand for dental care for older adults in the coming years. The oral health surveillance report in 2019 showed that the complete loss of teeth among adults above 65 years old in the years 1999-2004 has decreased from 27.2% to 17.3% in 2009-2016 & 1.8% increase in retained teeth among older adults from 1999-2004 to 2009-2016.
The management of older patients not only requires an understanding of the medical and dental aspects of aging, but also of other factors such as living conditions (independent, assisted or institutionalized), ability to walk, socialization, and sensory function. The present structure of medical/dental education has a crowded curriculum and pays little attention to the special needs of older patients. The relative insignificance of geriatric education has thus become a barrier in serving this population. Although most dental schools teach geriatric dentistry, only a few provide a didactic course on the topic along with clinical experience training. Education in geriatric dentistry requires that practitioners adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of older adults. The population of older adults often presents with heightened dental complexity, multiple medical conditions, diminished functional status, uninformed attitudes about oral care, and limited finances. To overcome these issues, it is very important to have a solid foundation of geriatric dental education with clinical programs and a research agenda.
A plethora of evidence-based research suggests a relationship between oral diseases and systemic diseases such as diabetes, cardiovascular disease, stroke, respiratory infection, Alzheimer’s disease, and other medical conditions. The dental clinician should receive training to identify the earlier signs of the oral manifestation of these systemic diseases. Early intervention strategies must be formulated to reduce the risk of oral diseases in this population.
The use of several prescriptions and over the counter medications makes older adults vulnerable to medication errors and adverse drug reactions. In geriatric dentistry, it is important to take into account the drug regimen of the patient when planning for the treatment and follow up care. Most of medications are significantly associated with dry mouth condition or xerostomia in older adults. This compromised oral environment can cause difficulty in speech, chewing and swallowing. It can also increase the risk of dental caries (cavities) & decreased denture retention.
Approximately 50% of persons older than 75 years of age have root caries (cavities) affecting at least one tooth and this is likely related to the prevalence of restorations in the older population. Older adults are at an increased risk for root caries because of increased gingival recession as well as poor periodontal status, that exposes root surfaces. Cementum, which has a lower mineral content in comparison to enamel, is more susceptible to cavities, which in turn leads to an increased risk of root caries (cavities).
The magnitude of services that dental professionals must be able to provide to older adults can be realized with the help of a properly structured geriatric dentistry education. This knowledge will help to determine the medical, mental, and physical status of older adults and provide risk assessment and risk reduction protocols with respect to their medication, diet, oral hygiene behavior and other oral diseases secondary to systemic medical conditions and aging.
Increased life expectancy and improved quality of life in old age will necessitate a demand for tooth retention, and consequently the need for preventive and restorative care. To meet the multifaceted challenges related to the aging, clinicians should adopt an individualized approach along with systematic geriatric dental education. The dental profession should endeavor to be conscious of the needs of older adults. This includes developing the patience necessary to comprehend the psychological needs , offering them empathetic care that augments graceful dignity with satisfaction. The curriculum of undergraduate and post-graduate programs should inculcate the physiological, psychological, social, and special needs of older adults so that we may provide safe, effective, and appropriate care to this population.
“While wrinkles and graying are inevitable with age, tooth loss is not.”
About the Author
Vinaya Kundapur, B.D.S. M.D.S is a first year student in the M.S. in Clinical Investigation and Translational Science program (MSCI-TS). She completed her bachelor’s degree in Dentistry and her master’s in Prosthodontics. After working as a faculty member at a dental college in India for about 7 years, she moved to the United States in 2019 and completed a graduate certificate training program in Geriatrics and Special Needs Dentistry at University of Iowa College of Dentistry. She joined the MSCI-TS program in the Fall of 2021 to stay motivated in her field and learn to conduct responsible research.
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