Periodontitis
Deeper inflammatory process, extending to periodontal ligaments and alveolar bone irreversible destroys hard and soft tissues of the periodontium
Advanced dental care in older adults
Destruction of tooth.
Necrosis of pulp.
Dental abscess formation
Might not be saved
Clinical significance of dental disease in adults
Affects overall health
Social function (people may not smile/open mouth)
Especially important for frail nutritionally at risk adults
Prevalent findings for OA:
- Decayed or missing teeth
• Periodontal disease
• Salivary hypofunction
Importance of preventative and therapeutic dental care
Age related changes are normal.
Patient should seek care (even if no pain) b/c untreated dental issues can lead to metastatic infections.
Beta hemolytic strep
Bacterial endocarditis and complications in hip arthroplasty
Bacteria in mouth and systemic infection
Adv dental decay = necrosis of remaining pulp if untreated = dental abscess
a-hemolytic (viridans) streptococci of the oral cavity implicated in 1/3 of bacterial endocarditis cases in USA
Bacteria associated with dental abscesses have been cultured from aspirates of infected hip arthroplasties
Effect of diminished tooth sensitivity in older adults
Dental care oft asymptomatic
Delayed dental care
Increased risk for advanced decay
Abscess and systemic infection
Gingivitis
Inflammation as a reaction to plaque only on gingiva— reversible treated by scraping off plaque during teeth cleaning
Risk Factors for periodontitis
Aging
Smoking
Poor oral hygiene.
Ethnicity (African-Americans, and Hispanic Americans have higher prevalence than European
Health conditions linked to periodontitis
Peripheral vascular disease exacerbation
Cerebrovascular disease
CAD
CRP
Same pathogens causing periodontitis can be aspirated into lungs (pneumonia)
Joint infections
Management of periodontitis
Debridement down to roots and below gingiva (may require surgical access)
Tx: topical abx (chlorhexidine, oral rinse) sometimes systemic abx (Minocycline/flagyl) used as adjuncts to other periodontal tx
How prevalent is edentulism in Americans over 85 today?
Nearly 50% of Americans over 85 are edentulous.
What happens if older adults lose all teeth and do not have prosthetic replacement?
Loss of facial appearance
Impaired chewing → poor nutrition
Increased risk of aspiration
Speech difficulties
What positive impacts do dentures provide?
Restore facial features
Improve chewing and nutritional intake
Less aspiration risk
Aid in speech
Not covered by Medicare
How should dentures be cared for?
Remove and clean after meals
Soak in commercial disinfectant several times a week or at bedtime
Remove for several hours/day, especially overnight
See a dentist immediately if fractured or broken dentures, loose, or soreness
Why do dentures need periodic adjustments?
Jaw and gum structures change over time, affecting denture fit.
How does aging affect salivary glands?
Fatty replacement of acini occurs
Healthy aging generally preserves saliva production
Extreme old age and other factors (drugs, dehydration) can impair function
Q: What are common causes of dry mouth (xerostomia) in older adults?
Anticholinergic med effects:, TCA, opioids, antihistamines, antiarrhythmics, antihypertensives, antimuscarinics for incontinence
Local disease: salivary gland tumors, blocked ducts
Systemic that Dec flow: Sjogren syndrome, depression, poorly controlled diabetes, hypothyroidism
Therapeutic radiation to head/neck
Q: How is dry mouth managed in older adults?
Modify or discontinue causative (dec saliva) medications if possible
Oral pilocarpine for patients post-radiation for 3 mo
OTC salivary substitutes or oral lubricants for temporary relief
Counsel pt on high risk of oral dz:
Maintain daily oral hygiene, frequent dental exams, Limit sugar, especially at night
What are common oral lesions seen in older adults?
Oral cancers
Exostoses/tori (bone growths in mouth)
Geographic tongue/migratory glossitis (map-like appearance)
Candidiasis (thrush)
Herpes simplex
Hairy tongue
Burning mouth syndrome (often B12 deficiency)
Who is most affected by oral cancers?
Risk increases with age
Men: 4× more likely for intraoral squamous cell carcinoma, 8× for lip SCC
Squamous cell carcinoma accounts for 96% of oral/oropharyngeal malignancies
Q: What is the 5-year survival for oral SCC?
European Americans: 55%
African-Americans: 34%
What factors increase the risk of oral cancer?
Strongly linked to Tobacco use (cigarettes, pipes, cigars)
Alcohol use (exacerbates tobaccos effects)
detection of oral cancer?
erythroplakia/leukoplakia
Through oral CA screening: takes < 2 mins head/neck nodal assessment then oral cavity inspection
prime location to examine is under tongue and assess lymph nodes
Old smokers shud get annual oral eval by qualified professional.
How is oral squamous cell cancer tx
Localized: surgical removal
Large localized tumors: radiation (implants, beam radiation)
extensive dz: beam irradiation to shrink it then surgery
Inoperable: palliative radiation
new technique (adv): surgery + chemo ± radiation depends on tumor aggressiveness
