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

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)

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.

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

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

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.

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.

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