Dentistry for the aging population
“Patient age alone is never a limiting factor.” Frauke Müller | Switzerland Professor and chair of gerodontology and removable prosthodontics University Clinic of Dental Medicine, Geneva
We age healthier and live longer than we did a few decades ago. What does this mean for the oral health of elderly patients? Gerodontology facts A geriatric patient shows physiological signs of aging, e.g., decline in mobility and function, tactile perception, vision and manual dexterity. These signs are generally progressive and irreversible up to the point that the patient may become dependent on help for their daily activities. When we provide a denture for such a patient, special considerations are necessary. Also, the legal contexts, e.g., patient consent and compliance, are different compared with younger patients. Gerodontology is a specialty combining all disciplines of dentistry. It also overlaps with other disciplines, e.g., nutrition and public health. We still do not have many independent gerodontology departments worldwide, but the specialty is becoming more recognized, and university structures are adapting.
Our life expectancy has changed over the decades. Some 50 years ago, geriatric dentistry was barely developed, and there was a reason for that. The average age of the edentulous patient cohort was often 50–60, which is no longer the case.
Now we have studies with 85+ as the patients’ average age. We lose teeth much later in life, due to our healthier lifestyles, and there have been developments in dental materials, implants and regenerative dentistry. If all goes well, we can keep all our teeth right to the end. But due to much longer life expectancy, we may still experience some tooth loss. And edentulous patients are quite different from the ones we had 50 years ago. They are much older! Their mucosa is more fragile and inelastic. Their spongiosa becomes more brittle and affects the alveolar crest. The bony structure of joint articular tubercle is also subject to atrophy, so there are a lot of changes in the temporomandibular joints. We also have loosening of the ligament structures and atrophy of muscle bulk. Patients may lose about 40% of their musculature over their lifetimes,
which leads to less precise and less coordinated motor skills. We also see changes in the central nervous system and neuroplasticity, whereby the brain cannot easily adapt to the movement patterns of a new dental arch. All these factors should be considered when we define the occlusion for an elderly persons' prosthesis.
Do teeth age faster than the rest of the body? The oral cavity is part of the general human organism and may age the same way. Sometimes chronic oral diseases are the first indicators of something happening to the body. For example, with the onset of neurodegenerative disease, we lose weight in a very short time. The first sign is usually when dentures loosen. Patients come to see us, even if denture relining was done just six months previously. Analyses show the patient has weight loss and should be sent for more in-depth evaluations.
Osseointegration happens in older age too. Elderly patients should benefit from what modern dentistry offers, just like younger patients. Implants are very helpful for elderly patients, e.g., for retention of dentures. We also know that osseointegration happens in older age. In fact, the survival rates for implants are very good – over a 10-year observation period, 9 out of 10 implants will still be in place.¹ Age
“Elderly patients should benefit from what implant and regenerative dentistry offers, just like younger patients.”
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