1-Geriatric prosthodontics.pdf

Geriatric Prosthodontics 1 Reference: Allen, P.F., McKenna, G. and Creugers, N., 2011. Prosthodontic care for elderly patients. Dental update, 38(7), pp.460-470.  2 Aging is a “biological reality, which has its own dynamic, beyond human control. It is a compl...

Geriatric Prosthodontics 1 Reference: Allen, P.F., McKenna, G. and Creugers, N., 2011. Prosthodontic care for elderly patients. Dental update, 38(7), pp.460-470.  2 Aging is a “biological reality, which has its own dynamic, beyond human control. It is a complex process, in which there is progressive functional decline due to the accumulation of molecular damage over time. Ageing is the accumulation of changes over time and it is a multidimensional process including physical and psychosocial changes.  3 People can be classified according to their age in to : Pediatric (> 1 month to < 19 years Neonatal (birth to 1 month) of age) Adult (19 to < 65 years of age) Geriatric (= 65 years of age) Kastner et al 2006 4 NEW WHO CLASSIFICATION 2019 0-14 years old: Children 15-24 years old: youth 25-64 years old: Adults 65+ years old: Older persons 5 Geriatrics is a specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults 6 7 Gerodontics The treatment of dental problems of aging persons. Gerodontology The study of the dentition and dental problems in aged or aging persons. Glossary of Prosthodontic terms 2005  8 Challenges  9 The geriatric population is the most rapidly growing segment of the general population. 13% 4.00 4.00 6.3% 3.63 3.00 3.57 3.00 1.6% 2.52 2.68 2.00 2.00 1.00 1.00 0.77 0.87 0.00 0.00 0-29 30-59 60+ 0-29 30-59 60+ In Billion as of 2010 In Billion as of 2013 * The United States Census Bureau 10 Saudi Arabia Population Aged 65+ (1950-2050) 8.00 6.00 5.86 4.00 2.00 2.46 0.11 0.18 0.37 0.78 0.00 1950 1970 1990 2010 2030 2050 U.N. Population Division, World Population Prospects 2006: The Population Data Base. 11 Medical Condition  12 As more people live longer and become elderly, there will be an increase in chronic conditions and illnesses. Hypertension (59.1%) Hearing 19.9%* impairments Diabetes mellitus (57.3%) Visual 46.1%* Illnesses Stroke (34.9%) speech Dementia (28.5%) Cognitive impairment Osteoarthritis (24.2%) 29.6% Alzheimer (21.4%) olfactory and gustatory Osteoporosis (17.2%) orthopedic Ischemic heart diseases (16.7%) *In Saudi Arabia by AL-SHAMMARI ET AL 2000 *In Saudi Arabia By Al-Modeer et al 2013 13 Chronic disease, physical and mental disabilities make the elderly people more susceptible to oral conditions or diseases. In the other hand, poor oral health have considered to be a risk factor for the general health. 14 Polypharmacy 68-95% of persons 65 years or older take medication. Salih et al founded that 58.3% of elderly persons ( 61+ years ) in Riyadh are consider to be polypharmacy. Salih Et al 2013 15  16 Geriatric oral health and oral manifestation  17 Oral changes can be experienced by elderly as a result of aging, systemic diseases, pharmacotherapy, functional disabilities, and cognitive impairment. Diet, nutrition, sleep, psychological status, and social interaction are all affected by impaired oral health.  18 Oral Mucosa Dry thin smooth mucosal surfaces Loss of elasticity and stippling Bacterial and viral infection Delayed wound healing Precancerous lesions Autoimmune-related disorders Burning mouth syndrome  19 Dentition Discoloration Loss of enamel Tooth Loss Sclerotic and secondary dentin Cementum thickness Reduced pulp dimensions Diminished nerve supply Increased coronal and root surface caries Pulpal calcifications External root resorption 20 Periodontium Gingival recession Loss of periodontal attachment Loss alveolar bone 21 Salivary Glands Obstructions Hypofunction Bacterial infectious Neoplasia 22 Oral motor and sensory functions Alterations in mastication Alterations in swallowing Alterations in taste function diminished food recognition and enjoyment 23 Challenges ´ Longer life expectancies ´ Chronic diseases ´ Oral manifestations ´ Retention of natural teeth into old age ´ More Dental diseases ´ Removable denture limitations ´ Old patients are more informed and more demanding 24 General considerations in geriatric dental treatment 25 Consider simple treatment plan approach. Take care of light level ( safety glasses ). Verify the best possible appointment. Consider comfortably position. Evaluate the patient ability to tolerate the appointment duration, 26 Speak loudly, slowly and with eye-eye contact. Avoid Medical terminology. Take good medical history – indirect questions-. Assess the patient functional ability. Inspect for oral manifestations. 27 Treatment Strategies 28 ´ Minimally Invasive Dentistry ´ Functionally oriented treatment planning: problem-oriented approach ´ Successful transition from the partially dentate to the edentulous state ´ Maintaining Key teeth: Overdentures ´ Use of Dental Implants 29 The decision to replace teeth should be based on whether prosthetic replacement will improve function, appearance and comfort. The prosthetic treatment in elderly patient is better to follow problem-oriented approach to avoid overtreatment. Patient should address his complication such as functional disturbance, poor masticatory performance, esthetic and phonetics. 30 Partially dentate patients with teeth of good prognosis ´ Removable Partial Dentures - Unless addition is planned, Co/Cr is preferred - Hygienic principles for RPD design 31 32 Partially dentate patients with teeth of good prognosis ´ Shortened Dental Arch - Preserve anterior teeth in preference to molars - Healthy functioning dentition of at least 20 teeth without the need for oral prosthesis - Case selection 33 Partially dentate patients with teeth of good prognosis ´ Minimally Invasive Dentistry - Caries prevention - Resin bonded FPDs 34 Restorative challenges in older patients include Erosion Abrasion demineralization rampant coronal and root caries recurrent caries 35 Restorative techniques in older adults is similar to that in younger population. But plastic restorative materials are preferred as these restorations can be readily and inexpensively repaired or replaced. Root carious has less visibility, accessibility and isolation. For that, glass Ionomer Cement (GIC) is the choice of restorative material due to the it’s adhesive property allowing minimum preparation, fluoride release, reasonable esthetics, biocompatibility and less technique sensitivity as compared to composites.  36 Caries activity will continue to remain high and unpredictable which might even increase with advancing age. Fluoride rinses along with periodic topical fluoride application regime is advisable. Fluoride varnishes, Automated toothbrushes, Chlorhexidine and Xylitol containing candies will help to maintaining low caries activity. 37 Partially dentate patients with teeth of poor prognosis - Questionable patient motivation - Advanced periodontal disease - Poorly controlled caries - Advanced tooth wear - Financial considerations 38 Partially dentate patients with teeth of poor prognosis ´ Transition to edentulousness - Transitional partial denture to replace posterior teeth at first - Convert it to a complete immediate denture after 6 months - Replace the immediate denture after 6-12 months 39 Partially dentate patients with teeth of poor prognosis ´ Maintaining key teeth: Overdentures - Especially in the mandible - Enhance support for the denture - Preserve alveolar bone - Preserve sensory feedback and proprioception - Psychological benefits 40 41 42 Completely edentulous patients ´ Complete dentures - Well extended - Balanced articulation - Copy dentures  43 Consider horizontal overlap to provide adequate facial support. If patient suffer from xerostomia , consider regular periodic calls and prescribe artificial saliva and denture adhesive. Consider decrees the characterization of the denture to facilitate the denture cleaning. Consider adding a name tag in the denture specially when there are more than edentulous patient in the home. 44 Completely edentulous patients ´ Implants - Preserve alveolar bone - increase bite force - Implant retained mandibular overdenture should be considered the first choice treatment for edentulous patients 45