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The elderly become edentulous (total tooth loss)

Enamel becomes darker due to stain-producing foods and drink

Enamel acquires lamellae on the surface (cracks) and becomes translucent

Dental caries appear brownish- black due to discoloring

Cementum undergoes compositional changes (increased fluoride and magnesium). Abrasion is compensated for by depositing cementum at the apical end.

Vitality of dentin is decreased and aged dentin may become insensitive

Pulpal blood supply and number of cells decrease. The number of fibres increases

Pulp chamber size is reduced

Attrition is common along the incisal and occlusal area

Tooth abrasion in the cervical area and root surfaces is common due to the use of stiff toothbrushes and abrasive toothpaste

Elderly are at a higher risk of developing caries

(Bowen & Pieren, 2020)

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Reduction in salivary flow is not a result of the normal aging process

Typically attributed to systemic disease, radiation therapy, tumours or medications

In the absence of medications, the presence of xerostomia may be caused by an underlying disease

Sjogren's Syndrome: an autoimmune disorder of the salivary glands

Approx. 60% of people with this disorder are older than 50 years

Clinically: oral mucosa is extremely dry and saliva is ropy

Initially tongue shows marks of atrophy on papillae but becomes smooth and lobulated

Instruct pt. to use saliva substitutes and dry mouth products (alcohol- free rinses, sugar- free lozenges, fluoride rinses)

(Bowen & Pieren, 2020)

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Geriatrics is a term used to identify the branch of medicine concerned with the illness of old age and their treatment.

Gerontology is the scientific study of factors that affect the normal aging process and effects of aging.

Categories of study include young-old (65-75yrs), middle-old (75-84yrs), and old-old (85-plus yrs).

Social Theories of Aging

Disengagement theory: aging individuals and society gradually withdraw from one another for mutual benefits

Activity theory: aging individuals should be expected to maintain the norms of middle-aged including employment, activity, and replacement of lost relationships.

Continuity theory: aging depends on individuals' psychologic makeup and methods for coping.

(Bowen & Pieren, 2020)

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Common side effect of many prescription and OTC medications

Saliva is important in proper function of the oral cavity

Lubricates oral mucosa

Assists speech and swallowing

Facilitates retention of oral appliances (dentures)

Provides minerals for enamel remineralization

Diminished salivary glands can:

Alter taste

Contribute to plaque formation

Cause dental caries

Cause a dry/ inflamed oral mucosa

Management: use of saliva substitutes, oral lubricants, mouth rinses and frequent water intake

Pt's should return for frequent recalls and caries status assessment

Stimulate salivary flow with sugar- free, xylitol- containing oral care products (gum, candy, etc.)

Caries- prevention efforts include:

Daily brushing with fluoride dentifrice

Use of salivary substitutes

Nutritional counselling

Chlorhexidine mouth rinses

Frequent debridement

Professional application of topical fluoride

Use of xylitol- containing products

(Bowen & Pieren, 2020)

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A unifying theory does not exist as aging does not appear the same in every individual and is not linear. Yet, there are theories on the aging process.

Biologic Theories

Stochastic: view aging as random events accumulating

Error theory: errors in protein synthesis impair cell function

Free Radical Theory: free electrons alter cell function

Cross-link theory: fibers become rigid so cross-links increase

Nostochastic: view aging as a predetermined sequence throughout life

Programmed aging: biologic clocks trigger cells

Neuroendocrine: efficiency of signals regulating organs and tissues is decreased

Immunologic: alteration of B and T cells causes capacity loss

(Bowen & Pieren, 2020)

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Use a minimal amount of fluoride toothpaste to reduce foaming

Hand over-hand technique when assisting seniors with brushing

Standing behind the senior reduces the risk of being kicked or spit on

For seniors with difficulty swallowing or spitting, use cloth or gauze to clean debris and saliva when brushing

Provide comfort to seniors when assisting with self-care

Remove dentures before going to bed and clean them after each meal

water bath for dentures overnight

(CDHA, 2022)

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Dental hygienist's role with elderly patients include:

Providing care at long-term care homes

Providing in-service education programs for staff/ family

Educating pt. on denture care

Giving fluoride applications

Creating care plans

Modifying oral hygiene aids

Nurses play an important role as well:

Staff should refer the elderly to the dental office and contact the dentist if they detect unusual signs

Use Brief Oral Health Status Examinations to evaluate the oral health of clients at the entrance and routinely

Attend in-service education programs run by dental hygienists to acquire the knowledge/ skills to help their patients with oral hygiene

Home-bound patients:

Prevention programs

Mobile vans (dental cleaning)

DH can collaborate with local agencies/ schools to develop oral screening, referral and preventive programs for these patients

(Bowen & Pieren, 2020)

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Education on differences between normal, physiologic and pathologic changes seen in aging.

Health promotion strategies based on clients' needs.

Encourage compliance with all medications and medical treatments.

Consider the client's functional limitations and oral health conditions when presenting hygiene instructions.

Education on the development and prevention of dental caries and periodontal disease.

Recommend the use of topical and professional fluorides as prevention mechanisms.

Education on drug-induced changes in the oral cavity.

Education to primary caregivers regarding clients oral hygiene care and home care if needed.

(Bowen & Pieren, 2020)

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Healthy People 2020 initiatives; focused on increasing the overall health of the nation, provides a baseline from which to plan programs, set priorities, and evaluate progress in meeting health objectives and increasing health status.

Research indicates that older adults typically take better care of their health than the general population does.

65 years and up are less likely to drink alcohol, be overweight, smoke, less health stress than younger adults.

Older adults are less likely to maintain regular physical activity, this poses a threat to heart disease, obesity, tension, chronic fatigue, premature aging, osteoporosis, and inadequate flexibility.

It is important for the dental hygienist to educate and promote appropriate wellness information while reinforcing positive lifestyle habits.

this will facilitate achieving human needs for the responsibility for oral health, prevention of health risks, and a wholesome facial image.

(Bowen & Pieren, 2020)

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Gingivitis is an inflammation of the gums caused by plaque and it is reversible through oral hygiene care. Periodontitis occurs when gingivitis is left untreated. It is a chronic and irreversible oral disease that is prevalent in the elderly. The gums pull away from the teeth allowing for pockets of plaque to form. This sparks the immune response which leads to inflammation which causes irreversible destruction causing bone loss. It can be maintained with proper oral care but it can not be cured. The likelihood of periodontitis increases in those 65 years of age. This increase is due to many risk factors. Research suggests a correlation between perio. and other systemic conditions such as cardiovascular disease and diabetes. Systemic changes due to the aging process, dietary changes and potential chronic systemic disease are also risk factors the elderly face. Medications can also have effects on their oral health. They also have a decrease in immune regulation. Also, many elderly are in long-term care homes where oral health is not prioritized. With all of these risk factors the elderly are at an increased risk for developing periodontitis.

(Liberty University, 2019)

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Bowen, D., & Pieren. J. (2020). Darby and Walsh Dental Hygiene Practice Theory and Practice (5th ed). Elsevier.

CDHA. (2022). Oral care tips for seniors and their caregivers. The Canadian Dental Hygienists Association. Retrieved from https://files.cdha.ca/dhcanada/seniors/oral_health_seniors_EN.pdf