Geriatric Dentistry in the 21st Century: Environment and Opportunity

The aging of the baby boomers in the 21st century is creating unprecedented numbers of vulnerable older adults. The increase in people keeping their teeth and their increasingly complex conditions all point to more people with more complex needs. Although these demographic shifts are providing unparalleled challenges for our health care system, they also bring new opportunities to develop and implement innovative systems for reaching and maintaining the oral health of older Americans.

Geriatric prosthodontic care

The geriatric population (age 65 and older) is the fastest growing segment nationally and globally. The large population will continue to increase because of baby boomers that have recently turned 65 years old. Within this cohort, there is much diversity in health, socioeconomic levels, education, and health beliefs. There is a decline in edentulism yet still there are oral health conditions that persist with age, such as caries, tooth loss, and increased needs for prosthodontic dental treatment. Several factors should be taken into account in geriatric prosthodontic care, including quality of life and psychosocial needs.

The development of geriatric dental education programs in Canada: an update

The Canadian population is aging, and the oral health needs of this aging population have changed. The majority of older people are now dentate, which means that they continue to need the services of a dentist, specifically dentists who have been trained in geriatric oral health care. This paper reviews the history of geriatric training in Canada. Such training remains inadequate at both the predoctoral level and the postdoctoral or fellowship level. If geriatric or special needs dentistry were to be accepted as a specialty program, it might become more attractive as a career path for dentists.

[Various aspects of dental prevention in the elderly]

The number of old people shows increasing tendency worldwide. The prevalence of oral diseases has been increased with age. In the older adult population tooth loss, dental caries and periodontal diseases frequently can be observed as characteristic features of their oral health condition. Additionally people in elderly are frequently suffered from other oral diseases such as xerostomia, orofacial pain, oral cancer. Results of the latest epidemiological studies show that the level of oral health of Hungarian old population is very low. In many cases oral healthcare can't show an optimal situation due to low economic and social circumstances. The present situation need more changes in oral care. It is necessary to recognize the risk factors, to treat the oral diseases properly and to organize an effective oral/dental care system for the old population.

Principles of geriatric dentistry and their application to the older adult with a physical disability

The older adult living with a physical disability faces many daily challenges. Limited hand function or impaired cognition often has profound effects on activities of daily life including oral hygiene. This article explores age-related changed in dentition and common causes of pathology of the oral cavity with special emphasis in populations with impaired hand function or cognition. This article will also assist the treating physician as it relates to oral diagnosis and patient management.

[Community aspects of geriatric dentistry--a literature review: 1975-2000]

The world's population is in transition, but there is an inevitable move in all societies towards an aging population. There is an agreement that the ability of the geriatric population to adjust to the "third age" depends on the will of the society and the community to provide services and to support this vulnerable and dependent population. The preponderance of oral health issues and their impact upon general health and quality of life have prompted a variety of geriatric related efforts over the last 20 years. Predoctoral and postdoctoral education and training efforts have been initiated, geriatric research agendas have started to yield important findings, and a few service programs have marginally helped improve dental care access for the geriatric population. Past discoveries have enabled large portions of the world's population to enjoy far better oral health than their forebears a century ago. Although different patterns of dental needs emerge throughout the world, the "silent epidemic" of oral diseases is affecting the most vulnerable parts of the population: the poor children, the elderly and many members of racial and ethnic minority groups. The review of the literature of community aspects of geriatric dentistry in the past twenty-five years will be introduced in two articles. The first article summarizes the important issues of demography, oral health condition, changes in attitude towards oral health of the geriatric population, oral health services given in geriatric institutions and mobile dentistry. The issues of law and ethics, development of public and community oral health programs for the geriatric population and plans as well as trends for the future will be discussed in the second article. Setting goals and presenting data are steps in the right direction but are not enough; the success will be measured by the ability to make things happen. The continuing anticipated growth of the geriatric population will, hopefully, be translated into a rising political power and to fruitful and practical health outcomes.

[Oral health of community-living elderly. 1. Condition of teeth, use of professional dental care and oral hygiene habits]

With the aim to get information on oral health, professional dental care and oral hygiene habits a study was performed on persons aged 60 up to 79 years in Haarlem, the Netherlands. After an interview an oral examination was performed, using a mirror and a pocket lamp. Of all persons approached, 376 (38%) participated in the clinical part of the study. In elderly persons with natural teeth (52% of all participants) the mean numbers of present teeth (third molars excluded), FT and obvious DT were 18.1, 10.8 and 0.7 respectively. The percentage of persons with natural teeth showed a strong relationship with level of education. A comparison with results of a study performed in 1986 showed that oral health in elderly persons is improved. Of all the elderly with natural teeth 91% visited their dentist periodically at least one time a year and 76% of them brushed their teeth at least two times a day.

Geriatric dentistry in the next millennium: opportunities for leadership in oral health

"The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective." Arnold Toynbee, British historian. Individuals throughout the world often view the passage of a new year as a time for re-evaluation of personal and/or professionals goals. The new millennium offers the dental profession a chance to view the future and observe the challenges and opportunities facing it. Professor Toynbee's observation is particularly poignant when one considers the improvements in oral health made in the last 100 years. Caries, once considered a ubiquitous oral disease, has been prevented in some children in developed countries. Research on periodontal disease continues to identify risk factors and the pathobiological mechanisms underlying the disease. Concurrently the population of the world is aging presenting new opportunities for improving oral health. In this paper the data on aging, chronic diseases and oral health is largely from the US but reflects to varying degrees other industrial countries. By integrating these demographic, epidemiologic and biologic data, one can paint a portrait of the future dental patient and their oral health needs. From this portrait, dental professionals can identify leadership opportunities to improve the oral health of an aging world population.

The future of dental care for the elderly population

The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.

Trends in predoctoral education in geriatric dentistry

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

[Geriatric dentistry: medical problems as well as disease- and therapy-induced oral disorders]

As in pediatric dentistry, management of the oral problems in elderly patients does not depend on the development of new technical skills, but rather on the knowledge of: biological, psychological and social aspects of primary (physiological or age-related) and secondary (pathological or disease-related) aging; atypical presentations of disease; multiple pathological conditions (polymorbidity, polypathophysiology, polypharmacy); an underreporting of disease; the importance of functional status; the role of an interdisciplinary team; Geriatric medicine refers to social, psychological and clinical aspects of disease in older adults. Geriatric dentistry deals with the respective aspects concerning oral diseases. Chronic conditions as well as their treatment (e.g. medication) are more common with advancing age. They may have major implications for dental practice, leading to changes in oral health behavior and attitudes of the elderly patient with sometimes detrimental effects on oral health. Therefore, different concepts in prevention, diagnosis and therapy of oral diseases are required for the oral care of older adults. Two important consequences must be considered: Firstly, the medical education of the dentist and the dental team must be improved. The dental team must become a member of the group of health-care professionals caring for an aging population (geriatric medicine) to meet the heterogeneous needs of as much as 75% of our future patients. Secondly, there is great need for education of all health-care professionals dealing with elderly patients about possible negative impacts medicine can have on oral health. Identification and diagnosis of oral disease as well as preventive measures must be stressed.

[Trends in geriatric dentistry and the future--from the point of view of masticatory function]

In recent years the number of aged persons in developed countries has been steadily increasing. Tooth loss is a typical age-associated stomatognathic change, and edentulism rates in Japan have been reported to be 30%. Dentures are made to restore oral functions after the natural teeth have been lost. However, there are also many stomatognathic changes associated with aging as well as oral manifestations of systemic diseases which can make the wearing dentures difficult in elderly persons. Some of the more significant changes occur in the structure of the mucosa, the function of the oral musculature, the temporomandibular joint, the taste perception, salivary function and the nervous system. Studies on the variety of physical and psychological dynamics associated with the aging process are necessary to provide the latest treatment modalities for the aged. The mastication and dentition status in elderly persons are suggested to be closely related with many kinds of physiological functions. On the other hand, stomatognathic functions are suggested to be influenced by the health of the entire body. They are supposed to have an interdependent relationship. The maintenance and care of occlusion are essential to guarantee the quality of life for the elderly. In future, the relationship between masticatory function and physical activities, such as physical exercise, blood flow, respiration, endocrine function, reproduction etc. require further investigation.

Research directions in oral health promotion for older adults

Health education and health promotion facilitate voluntary adoption of behaviors and provide educational, organizational, economic, and environmental supports for behaviors conductive to health. Health education and health promotion are complementary and any effort to eliminate oral disease requires both activities. Federal research initiatives in oral health promotion have encouraged more biomedical and behavioral research on oral health and aging through the establishment of research centers. Other initiatives have been established to speed the generation of basic and clinical research. Recent initiatives encourage research on aging and provide opportunities for oral health promotion during the coming decade. These include Healthy People 2000, the nation's health objectives for the decade; the NIH framework for the development of a strategic plan, and the NIDR Long-Range Research Plan, Broadening the Scope.

[Surgical dentistry and geriatrics in Senegal]

INTRODUCTION

Geriatric medicine is developing more and more as a specialism. Odontology is not behindhand. That is why, even in an African setting, when life expectancy is still not as high as in the West, we are finding ourselves treating older and older patients.

MATERIALS AND METHODS

During the course of the academic year 1989-1990, we treated 40 patients of both sexes, of different ethnic and social backgrounds aged from 55-89 years. Besides age, the patients had all undergone endo-buccal surgery, with the exception of parodontology surgery. According to sex: The forty patients comprised 27 men and 13 women. These figures are interesting and we will return to them during the discussion. According to age: The ages of our patients ranged from 55-89 years, with an average of 72. The distribution of age brackets shows a strong percentage (52.5%) of patients between 55 and 64 years of age. According to oral stage: In general, our patients neglect oral hygiene: 67.5% presented at least tartaric gingivitis. This negligence was evident in more men than women. According to general state: More than half the sample had at least one general pathological disorder. They ranged from cardio-vascular ailments, to differing digestive disorders, to neurological and endocrinal pathologics.

METHODOLOGY

The data was collected using the following 3 methods which slowly built up: questionnaire clinical examination the operation

RESULTS

The dividing-up of the different operations: we realised a total of 71 operations, this being an average 1.77 per patient. Distribution of pathological ailments according to type and nature: About 55% of our patients had a general pathology. Cardio-vascular ailments took first place with a frequency of 52.16%, followed by digestive problems with 26.08% neurological syndromes with 13.04% and ailments with endocrinal origins with a rate of 8.69%. Incidents during operation: incidents linked to the anaesthetic, incidents linked to the operation itself, post-operative incidents, healing.

DISCUSSION

Age: The most representative age-band was between 55 and 64 years (with a six ration of 1:5). Multiple extractions: Apart from a defective oral state, these extractions are always motivated by the need for prosthesis. All the patients were missing at least one tooth, confirming the thesis of Dubois, according to which "the repercussion of oral ageing appears in all its simplicity in either partial or total toothlessness".

CONCLUSION

Elderly Senegalese patients present serious oral problems since extraction comprises the main part of surgical odontological operations. A better way of dealing with these subjects, weakened by old age and general pathology, is desirable.

Geriatric dentistry

The over-55 age group--the most rapidly expanding portion of the population--until recently has been the least understood patient group treated in the dental office. During the last decade, the special dental care needs of geriatric patients have been the subject of many research efforts. Understanding the interactions between the systemic health problems and disease trends of the elderly and their oral health has helped the dental profession gain greater insight into treatment strategies tailored to their needs. Evaluation of the patient's systemic health is critical to identifying complicating factors that can interfere with or be exacerbated by dental treatment. Understanding these disease trends can also sensitize the dentist to the presence of previously undiagnosed oral signs of systemic disease. In addition to the patient's systemic health, oral and dental status and individual expectations and desires must be considered when developing a treatment plan. In considering all of these variables, optimal treatment can be rendered to restore function and aesthetics in a manner that will help maintain and improve the patient's health and psychologic well-being.

Training for the future: issues in geriatric dentistry

The following report was presented during the October regional meeting of the American Society for Geriatric Dentistry in Washington, DC. The needs for dentists who specialize in geriatric dentistry and dental curriculum in geriatrics are discussed, together with issues that face dental educators in geriatric dentistry.

The development of geriatric curricula in U.S. dental schools, 1979-1984

When data from a 1984 survey of U.S. dental schools were compared with data from a similar survey of the same schools completed in 1979, an increase in the teaching of geriatric dentistry to dental students was observed. While more topics are being taught in more schools, the depth and coverage are variable. Multivariate analyses revealed that more topics were likely to be taught if a course in geriatrics existed, if the course had existed since 1979, and if the course director was a dentist. Factors associated with the establishment of a course between 1979 and 1984 were that the school was located in a state with a large geriatric population and that financial assistance for patients through state or local government was available.