60+ form a very important segment. Their needs and presentations are different. Given the urbane setting and demographics of our practice - we also see lifestyle diseases and the concurrent polypharmacy. We have hence adopted certain methods and protocols for our geriatric patients
Treatment philosophy for our geriatric patients—the ones who are 60 years old or older
It’s the only time “we play to the gallery” when we write our treatment plans. We give them three options.
Ideal – A comprehensive treatment plan .
Practical – aimed at pain alleviation and restoration of function in the simplest wayÂ
And the third is pain alleviation only.
What the patient wants involves customizing a treatment plan best suited for them. We go to lengths discussing all the ifs and buts, limitations, and merits.
Late-onset cavities
Some individuals have led a cavity-free life, but after 40 or 45, they seem to suddenly develop cavities. This can be due to:
- Gum recession: The enamel is strong and impregnable in these individuals, but with age, the gum margins get exposed. The dentine has porosities like pumice stone (what was used to scrub feet earlier). Dentine has more organic matter, and porosities harbour bacteria and start forming cavities. There are typically enamel-sparing cavities that burrow insidiously into the tooth.
- Chronic acidity, acid reflux, and acidic regurgitation (khatte dakar). The enamel and gum levels may be good, but the change in pH in the oral cavity causes mineral depletion in the enamel. The acidic burps show a shiny, eroded surface on the inner side of the upper teeth.
The acidic pH of saliva and crevicular fluid (the fluid that remains in the gum pockets around the teeth) causes demineralization of the enamel at the gum margins. The enamel is already thin here and disintegrates, causing generalised hypersensitivity.
Dental care of individuals above 60 years of age
There are specific challenges with this age group:
1. Worn down teeth– The routine biting forces can cause wear on the biting surface, leading to sensitivity, cracks, or chipping.
2. General conditions like long-standing blood pressure, diabetes– General conditions and lifestyle diseases leave their effects on the teeth and gums. E.g., diabetics get dry mouth, which causes an increase in cavities. Long-standing thyroid problems cause bone loss around the teeth.
3. Polypharmacy: Taking multiple medicines on a regular basis. Medicines tend to have side effects. Some BP medicines cause gum swelling, and the blood thinners lead to bleeding gums even when mildly inflamed.
4. Decreased salivary flow (Xerostomia): Dry mouth, which can be age-related or medicine-induced.
5. Altered or delayed healing: We may have to give wounds more time to heal and settle.
6. Altered medication: The patients tend to have existing gut issues like hyperacidity or intolerance to antibiotics. We keep that in mind while prescribing.
7. Revision dentistry: There is generally some existing dental problem that needs resolution for the treatment outcome to be favorable.
8. Reduced motor skills for upkeep:Â inability to brush effectively.
9. Scheduling of appointments: Morning or afternoon appointments are better tolerated. Work can be staggered in the same appointment if the patient finds it difficult to keep the mouth open for a long time. Postural problems such as back problems and vertigo are also a concern.
All these factors have an effect on how we plan treatments for our geriatric patients.
UK Calling – Kaku
The Grandma’s Dentures
