Advanced Age
This page is dedicated to discussing treatment techniques, oral hygiene education, and dental disease prevention for patients typically over the age of 60.
Many are surprised to learn the way we sufficiently care for our teeth and prevent disease varies through three phases of life: pediatric (ages 0-17), adult (ages 18-65), and geriatric (age 65+). What more, the techniques in these ranges are effective in their general age groups.
I believe the availability of advanced age dental treatment is not as well-known as it should be, among both patients and dentists, nor is it distinguished. The reason for this is because it typically takes a prosthodontist (a dentist with an additional 3 years of residency education) to provide the full range of restorative treatment options. Otherwise, techniques have to be learned by general dentists after school, something done by choice.
In advanced age, it is imperative to have a dental office capable of providing a vast range of treatment techniques and materials to manage complex problems which can occur in teeth through advanced age. If an office is not skilled providing advanced restorative options, medical workups, and surgical dental procedures, a senior citizen may be forced to visit several specialists in the course of care, each of which possess some of the fragmented knowledge that is otherwise lacking from a general dental office. The result is a greater number of doctors attempting to coordinate, a disruption in efficiency and transportation, and also the risk for financially debilitating experiences with specialist fees. This is further confounded when one considers many geriatric treatment needs are not procedurally complex to warrant a specialist.
In fact, a new discipline recognized in the dental profession is that of dentists with advanced education in geriatric dentistry. Such dentists provide dental care in accordance with age-specific principles, and the treatment results and health differences are profound.
Some examples include:
The use of reverse-exhaust dental handpieces. Standard dental handpieces eject air towards the bur, and therefore, the soft-tissue next to a tooth. In cases where the bur is near the gums, this air can lift the gum tissue in the elderly whose collagen fibers lack rigidity, causing an air embolism – a life-threatening complication of air in the soft tissue of the body or in the blood. It’s a reason some dentists will pull teeth rather than fix them in the elderly. They simply don’t have the surgical equipment to fix them.
Educating advanced-age patients about the degree of gum recession in their mouths and the cavity risk from exposed root structure is also imperative. This is because the dental crown of a tooth (the tooth above the gums in younger years which is white and covered in enamel) is cavity resistant and often takes 3-5 years to develop a cavity. Interestingly, root structure does not have enamel, is quite soft, and can cavitate in as little as 6 months. Because the crown and roots are often exposed in advanced age, geriatric patients need to be taught to brush the top half of their teeth, then go back and brush the bottom half – because toothbrushes are not wide enough to get the entire exposed tooth in one brushing session.
Providing the dental filling material known as “glass ionomer” to fix cavities in the root-structure teeth of teeth is imperative in advanced age dentistry. This is because, interestingly, there are various “tooth-colored” filling materials, and they perform different among age groups. The standard tooth-colored filling is called a “resin-based composite”. These are what most people receive, however resin-based composites must be glued into teeth. For all younger age ranges, cavities typically happen in the white enamel, which is dry, and the glue bonds very well. In geriatric teeth, many cavities form on the more vulnerable root structure, which is naturally moist, and resin-based composites do not glue well. In fact, they leak prematurely. For root cavities, glass ionomer is a tooth-colored filling material which naturally adheres to tooth structure, is anti-cavity, and is the only filling material which provides a complete hermetic seal – preventing any bacterial infiltration between the filling and the tooth structure. The reason these are not used elsewhere is because they don’t bond as well to enamel in youthful areas of teeth. It is difficult to describe how important glass ionomer is to the geriatric community and the dentists who care for people in advanced age. Its use is also surprisingly uncommon among general dental practices. Patients can actually go through medical ailments, stop brushing their teeth for prolonged amounts of time, and these fillings resist cavitation.
Providing “geriatric crowns” are also exceptional services to offer those with advanced age. Standard dental crowns are designed to last beyond 20 years, and many reach 40 years of service. They can cost around $1,500 each. Many geriatric people have limited funds and numerous fatigued crowns on their teeth reaching performance limits. As a result, a elderly person may be faced with replacing crowns on as many as half their teeth, or extracting these teeth if they cannot afford the enormous expense crown replacement requires. A geriatric crown is a crown made in the office by the dentist out of a resin material, designed to stabilize a patient and last around 5-10 years. They also cost a fraction of the price. These can be life changing for the elderly community, and they are a service offered by dentists with training in geriatric techniques.
Prolonging existing dental work and preventing cavities is another important philosophy for the elderly. This is done by making mineral carrier trays for high cavity-risk patients. These trays are clear, thin, and placed over teeth after a mineral paste is dispensed inside them, and the result is minerals are physically pressed against tooth surfaces and infuse into the teeth, strengthening them from cavities. This is something every advanced age patient with a cavity risk of moderate to high should have, and people with limited ambulation or brushing abilities can wear such trays daily and still avoid cavities. All the result of calcium, magnesium, fluoride, and phosphate. A common term for such appliances are called “fluoride trays”. The fees for these range from $300-750, and can pay for themselves if they prevent so much as one or two cavities.
Training in pharmacology: advanced age dentists routinely work with medically complex patients, understand how to relate a patient’s list of medications to dental care, and offer invaluable additional safety. This is included in all care, however with the geriatric, numerous additional medications typically exist.
Lastly, another exceptional feature for advanced age dentistry is the use of pulse oximetry. Because many people in older age breathe through their mouth, dental work can often impede normal respiration. Ideally, oxygen levels remain between 94-100%. When a patient’s oxygen saturation drops below 85 for longer than 5minutes, the patient is at risk of developing brain ischemia and tissue death, brain damage, as well as a heart attack. Some patients during dental visits when left unmonitored will drop below this level and never know it. Monitor blood-oxygen levels during procedures is an excellent additional source of protection to receive in advanced age dentistry.