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PubMed1994

[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.

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PubMed1990

[Cases of prosthodontic tissue reconditioning in geriatric dentistry].

In elderly patients, recurrent fractures of the lower denture must raise the question of a neurological deficit as cause of the occluso-prosthetic imbalance. Hypotonicity of the peri-oral mastication musculature, especially the masseters, may explain the alteration of the prosthetic supporting surface due to shriveling of the mandibular arch, along with an osseogenesis at the point of flexion of the mandible. The rest and activity muscular imbalance, resulting from unilateral mastication, may cause lingual dysfunction and deviation of the tongue at rest. If this problem is not controlled within an acceptable period of time, one should expect psychological, biological and physiological consequences affecting the patient's physical condition. The restoration of the denture fracture is insufficient. Reconditioning must be performed in order to replace the existing prosthesis in the patient's function, allowing him/her to recover a normal psychological, biological and physiological balance. In conclusion, in geriatric dentistry, the objective of reconditioning is, not only to restore a functional occlusion, but also the psychological, biological and physiological balance of the patient. This is an unvaluable advantage, especially if this contributes to maintain or restore an often precarious health.

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PubMed1991

Geriatric dentistry and prevention: research and public policy.

Changing demographics, including the increase in life expectancy and the growing numbers of elderly, has focused attention on the need for dental research activities to be expanded for geriatric dentistry. The elderly are at greater risk for oral disease, since gains in longevity result in more medically compromising conditions or systemic disease with oral manifestations. Also, as edentulism decreases and as more teeth are retained by the elderly, the pattern of oral diseases and the treatment of dental conditions will be altered. Barriers to self-care and professional care must be removed, and prevention and early intervention strategies must be formulated to reduce the risk of oral disease. Risk factors for oral diseases in the elderly can be reduced by personal home-care regimens, professionally provided preventive, diagnostic, and therapeutic care, changes in high-risk behavior, and a supportive environment. Generating new information about the prevention of oral diseases and conditions that have an impact on the elderly requires a substantial research effort. A research agenda for the elderly should include: epidemiologic studies of relevant oral diseases and related risk factors; investigations of patient and provider attitudes and behavior related to oral health; studies of the relationship between general health and oral health; development and testing of preventive and treatment strategies for conditions such as xerostomia, root caries, secondary caries, and gingival recession; and studies for the evaluation of the impact of the aging population on the dental delivery system. Public policy options to support geriatric oral health care and research are limited by the Government's pre-occupation with cost containment and the lack of visibility for dental programs.(ABSTRACT TRUNCATED AT 250 WORDS)

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