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Decoding Gum health among the elderly

79.9% of elderly patients in India was found to have some form of periodontal disease. Read the article to understand the impact of aging on periodontal health.

dental care for elderly

Dental Care for the Elderly

In recent times because of the advances made in medicine and public health measures, there is a substantial increase in the life span of man.

In India, with its population of above 1 billion people, people older than 60 years constitute 7.6% of the total population, which amounts to 76 million.1

Elders above 65 years have health problems because of the aging process, which calls for special consideration.1 Older people are more susceptible to systemic disease that not only influences the patient’s ability to maintain oral hygiene and promotion of oral health but can be related to the occurrence of certain oral diseases. They may not be life-threatening, but they affect a person’s quality-of-life. Thus, planning treatment for the senior dental patient includes an understanding of the chronic diseases the patient lives with daily, as this play a critical role in the acceptance and success of the dental treatment plans. 1

elderly infographics

Prevalence of periodontal disease among the elderly in India

The prevalence of periodontal disease was found to be increasing with age.

  • 79.9% of elderly patients in India was found to have some form of periodontal disease.
  • Moderate periodontitis was seen in 21.4%, in the 65-74 years group; whereas severe disease, defined as at least one tooth with ≥6 mm probing depth, was seen in 18.1% in the 65-74 years group.2

Enhanced susceptibility to periodontal disease  in the elderly

Numerous changes occur in the tissues of the periodontium with increasing age. When the microbial plaque can accumulate, the elderly person accumulates more and develops gingival inflammation more rapidly and more severely than do younger individuals. This observation and the high prevalence of periodontitis among the elderly have led to the idea that the periodontium of the elderly is more highly susceptible to microbial challenge and destruction than is that of younger individuals.3

The Connection between Physiological changes and Periodontal disease in the elderly

Age-related alterations are present in the periodontium, and these must be differentiated from true oral/dental disease. Age alone does not cause critical periodontal attachment loss. 4

There are several significant physiological changes in the body that can lead to worsening periodontal disease4

  • There is an arrest in proliferative capabilities of cells, the oral epithelium is thinning, and there is less keratinization, with fibroblast alteration and less production of collagen.
  • The blood supply to the dental structures is degenerative, and there are signs of arteriosclerotic changes.
  • The periodontal ligament space gets narrower with less organized periodontal fibres, less cellular presence, and areas of calcification.
  • Type I collagen, the most abundant protein in the periodontium, decreases with age.
  • Decreasing mineral density in the alveolar bone and remodelling activity due to less osteoblast chemotaxis and less osteoclast differentiation.
  • Aged periodontal tissues show important deficiencies in the wound healing response
  • Tissues damaged from the inflammatory process will not get restored in the proper way.

The effects of periodontal disease are usually found to be more severe in older ages. This can be mainly due to biological alteration of the tissues and immune response or indirectly via physical, cognitive, and socio-economical impairment.4

Changes in salivary glands and salivary secretion with ageing

With age, there is a decrease in the function of the salivary gland. The implications of disordered salivary gland have a major impact on the maintenance of oral health. Saliva helps In the protection of the oral cavity and facilitates numerous sensorimotor phenomenon. However, the absence of saliva can have many deleterious consequences to the host.5

With increasing age, there are several changes in the salivary glands5

  • There is atrophy of acinar tissue
  • The proliferation of ductal elements
  • Some degenerative changes in both the major and minor salivary glands

This causes a normal, uniform decrease in the acinar content of salivary gland tissue.

Drug-induced xerostomia

This is most common in old age because high proportions of older adults take at least one medication that causes salivary dysfunction. The drugs which can cause dry mouth are6

  • Tricyclic antidepressants,
  • Antipsychotics,
  • Atropine,
  • Beta-blockers and
  • Antihistamines

Thus, the complaints of dry mouth are particularly frequent in those treated for hypertension, psychiatric or urinary problems.6

Systemic sequelae of periodontal disease in older adults

The presence of periodontal disease can affect the body in two ways:

  • Dissemination of bacteria into the bloodstream and
  • Through the effect of inflammatory mechanisms.

However, systemic diseases can also affect the oral cavity and vice versa.

Systemic diseases

The mechanism by with it affects periodontal health

Diabetes7

  • Diabetes and periodontal disease have a bi-directional relationship
  • Diabetic patients have an increased predisposition to the manifestation of oral diseases, which is associated with poor glycaemic control and therapeutic dentures.
  • The increased glucose level in the oral fluids makes it a breeding ground for microbes.
  • Respiratory infections8
  • Dental plaque can act as a reservoir of respiratory pathogens, especially in patients with periodontal disease.
  • Respiratory infection depends on the aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defence mechanisms to eliminate the contaminating bacteria, which then multiply to cause infection.

Cardiovascular disease9

  • Periodontal infections can aggravate the pathogenesis of atherosclerosis and thromboembolic events by providing repeated systemic challenges with liposaccharides and inflammatory cytokines.
  • Streptococcus sanguis and Porphyromona gingivalis infection induces platelet aggregation and activation and can lead to atheroma formation and thromboembolic events

Stroke10

  • Bacteria from periodontal pockets can enter the bloodstream and trigger systemic inflammation.
  • These inflammations can be an indicator of stroke risk

 

Periodontal treatment planning for the elderly

The main end goal of periodontal treatment in the elderly is to

  • To preserve function
  • Eliminate or prevent the progression of inflammatory disease and
  • Providing comfort, function, aesthetics, and ease of maintenance of oral health

Guidelines for the treatment of periodontal disease in older adults

Periodontal infection and inflammation diminish oral function, reduce the quality of life, imperil nutrition, and increase the patient’s risk of developing several chronic systemic diseases. Many research says that older adults generally respond to periodontal therapy similar to the way younger adults do.11

Therefore, it is vital to carefully review the patient’s medical history and prescribe medicines judiciously to prevent unwanted drug interactions.11

Evaluation of oral health in elderly patients

Figure 1: Evaluation of oral health in elderly patients12

The successful treatment of periodontal requires both meticulous plaque control by the patient at home and meticulous supragingival debridement by the dentist 11,12

Patient counselling tips for elderly patients with periodontal diseases- we should present it as an easy to understand infographic piece

  • Brush your teeth twice daily.
  • Use a  zinc containing toothpaste such as Pepsodent GumCare Plus with clinically proven gum health benefits,
  • Rinse your mouth after every meal
  • Visit your dentist every six months
  • Inform your dentist about any changes in your medication use.
  • Any sign of swelling or discomfort visit the dentist immediately

 

Reference

  1. Razak PA, et al. Geriatric oral health: a review article. Journal of international oral health. 2014;6(6):110-6.
  2. Shaju J, et al. prevalence of periodontitis in the Indian population: A literature review. Journal of Indian Society of Periodontology. 2011;15(1):29.
  3. Page R, et al. Periodontal Diseases in the Elderly: A Critical Evaluation of Current Information1. Gerodontology. 1984;3(1):63-70.
  4. Grusovin M, et al. The Treatment of Periodontal Diseases in Elderly Patients. Oral Rehabilitation for Compromised and Elderly Patients. 2018;:29-47.
  5. Vissink A, et al. Aging and saliva: A review of the literature. Special Care in Dentistry. 1996;16(3):95-103.
  6. Petersen P, et al. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology. 2005;33(2):81-92.
  7. Soell M, et al. The oral cavity of elderly patients in diabetes. Diabetes & Metabolism. 2007;33:S10-S18.
  8. Saini R, et al. Periodontitis: A risk factor to respiratory diseases. Lung India. 2010;27(3):189.
  9. Dhadse P, et al. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ?. Journal of Indian Society of Periodontology. 2010;14(3):148.
  10. Sfyroeras G, et al. Association between periodontal disease and stroke. Journal of Vascular Surgery. 2012;55(4):1178-1184.
  11. Boehm T, et al. The Epidemiology, Consequences and Management of Periodontal Disease in Older Adults. The Journal of the American Dental Association. 2007;138:S26-S33.
  12. Ettinger R, et al. Treatment planning concepts for the ageing patient. Australian Dental Journal. 2015;60:71-85.

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