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Oral Medicine Geriatrics

Geriatrics

• many changes in oral health due to a combination of natural aging, medications, lifestyle factors
• key conditions

Xerostomia

• reduced function of saliva glands leads to decrease in saliva flow
• worsened by medications (antihistamine, antidepressants, diuretics), diabetes, dehydration
• xerostomia lead to difficulties in chewing, swallowing ,speaking, increase risk of caries, perio, infection due to buffering effect of saliva

Recession

• natural aging causes recession, also poor OH, perio, toothbrush abrasion
• recession lead to sensitivity, discomfort, increase risk of caries

Enamel wear and sensitivity

• natural wear with age, parafunction, mastication, erosion
• tooth sensitivity, higher risk caries

discolouration

• aging causing enamel to thin, yellow dentine more visible (intrinsic discolouration), smoking, drinking coloured liquids, poor OH (extrinsic)
• affect appearance and self esteem

Tooth loss

• perio, caries, trauma
• affects phonetics, mastication, self esteem, facial support/appearance

increase risk of perio

• decline in oral hygiene and difficulty maintaining proper oral care, chronic conditions
• causes bone, gingival loss, mobility, tooth loss

oral mucosa

• thinner and less resilient with age, higher risk of developing infections or sores, especially in those who wear dentures
• irritation, soreness, greater susceptibility to fungal infections

difficulty eating

• loss of teeth, poor fitting denture, dry mouth, certain medication affecting dysphagia
• can lead to malnutrition, weight loss, difficulty enjoying meals

increased risk of oral cancer

• older adults more likely to develop due to long term alcohol, tobacco use, exposure to HPV
• difficulty in recognising early symptoms may lead to later diagnosis

Prevention/management

• regular checkup
• good OH
• good hydration
• good diet and nutrition
• avoid tobacco, limit alcohol

Caries

• teeth last longer now
• age related saliva changes and poor diet
• gingival recession
• greater likelihood of medication induced xerostomia

Perio

• very constant risk for elderly as PDL and bone has an expected lifespan

Candidiasis

• due to
  • denture
  • salivary gland dysfunction
  • drugs that alter oral flora or immune function )antibiotics, antineoplastic, corticosteroid and immunosuppressing drugs)
  • DM
  • malnutrition and other immunocompromising conditions
• types
  • acute pseudomembranous
  • hyperplastic
  • atrophic
  • angular cheilitis

Denture stomatitis

• poor denture hygiene, continual and night time wearing of removal dentures, accumulation of denture plaque, bacterial and yeast contamination of denture surface

Xerostomia

• polypharmacy
• head and neck radiation
• general health
• older age

MRONJ

• exposed bone in maxillofacial region that does not heal within 8 weeks of being identified by a healthcare provider in a patient that is currently or has been on bisphosphonates who does not have a history of radiation therapy in the craniofacial region

Oral Health and oral cancer in Elderly

Oral cancer

• prevalence increase with age, particular concern 65yo+
• exposure to risk factor
  • tobacco, alcohol, betel nut, UV radiation, high risk HPV