PERIODONTAL TREATMENT FOR OLDER ADULTS

PERIODONTAL TREATMENT FOR OLDER ADULTSXerostomiaMedications - tricyclic antidepressants, antihistamines, antihypertensives, and diuretics.Radiation treatment for oral, head, neck, and thyroid cancersSjogren's syndromePoorly controlled diabetesBone marrow transplantationThyroid disorders and Depression

Symptomscompromised chewing, speaking, tasting, or swallowingincreased risk for caries, periodontal disease, and candidiasis.

CandidiasisLong-term use of medications such as antibiotics, steroid therapies, or chemotherapy.Diabetes mellitusHead and neck radiation therapyhuman immunodeficiency virus

Acute Pseudomembranous candidiasis- white lesions that can be wiped away with gauze, leaving an erythematous area.Chronic atrophic candidiasis seen under a maxillary denture, generalized redness or generalized burning of mouth.Angular cheilitis crusting and soreness of creases or commissures of the lips.Review of Dental HistoryPast restorative, periodontal, and other dental treatment; head and neck cancer and its treatmentAllergies Oral hygiene care techniquesTobacco and alcohol useProblems associated with dental treatment. Past injuriesPerception of past and future dental treatment outcomesFluoride status of the drinking water (bottled, well, community)Type of toothpaste used (fluoride versus nonfluoride).Review of Medical Historyreview of past and current medical and mental conditions including allergies and invasive procedures.careful evaluation of systemic diseases and disorders, particularly those that influence dental treatment such as bleeding disorders and use of anticoagulants, diabetes, heart valve problems, cardiovascular conditions, stroke, artificial joints,use of corticosteroids. A consultation with the individual's physician is advisable, especially for individuals with medical problems or if complicated or invasive procedures are planned.

Intraoral and Extraoral ExaminationA complete head and neck examination of soft tissues.Skin of the face and neck should be inspected and palpated for lesions, enlarged lymph nodes, or both. Intraorally, the lips, cheeks, tongue, gingiva, floor of mouth, palate, retromolar trigon, and oropharynx should be inspected and palpated to detect soft tissue abnormalities red or white patches, ulcerations, orswellings.Periodontal StatusOlder adults who retain teeth are likely to be less susceptible to periodontitis.Severe loss is detected in only a small proportion of older adults.Periodontal disease in older adults is probably not due to greater susceptibility but instead is the result of cumulative disease progression over time.

Factors affecting the periodontal status in older adults:general health statusimmune statusdiabetesnutritionsmokinggeneticsmedicationsmental health statussalivary flowfunctional deficitsfinancesRisk Assessment

ASA Physical Status Classification SystemStatus 1 - A normal healthy patientStatus 2 - A patient with mild systemic diseaseStatus 3 - A patient with severe systemic diseaseStatus 4- A patient with severe systemic disease that is a constant threat to lifeStatus 5- A moribund patient who is not expected to survive without the operationStatus 6 - A declared brain-dead patient whose organs are being removed for donor purposes

Treatment PlanUnderstanding and documenting periods of active disease versus quiescent periods.The risks and benefits of both surgical and nonsurgical therapy should be considered.Amount of remaining periodontal support or past periodontal destruction, tooth type, number of occlusal contacts, and individual patient preferences.A nonsurgical approach is often the first treatment choice.Surgical technique should minimize the amount of additional root exposure . Individuals responding best to surgical therapy are those who are able to maintain the surgical result.Contraindications for surgeryNot able to comply with treatment,poor oral hygiene, medically or mentally compromised or Functionally impaired

Non-surgical ApproachProper debridement (scaling ,root planing and irrigation)Thorough oral hygeine instructionsTopical antibiotic therapyLightweight, electric-powered toothbrushesInterproximal brushes, shaped wooden toothpicks, or mechanical flossing devicesChemotherapeutic agentsChlorhexidine (0.2%) - older adults who have difficulty with plaque removal and those who take phenytoin, calcium channel blockers, and cyclosporins and are at risk for gingival hyperplasia.Listerine (eucalyptol, thymol and menthol)

Topical fluorides Dentifrices, rinses, and gels that contain concentrations of 230 to 1500 PPM fluoride ions.Professionally applied fluoride gel, foam, or varnish products (9050 to 22,600 PPM) fluoride ions.

Saliva substitutessalt ions, a flavoring agent, paraben (preservative), cellulose derivative or animal mucins, and fluoride.Saliva stimulants sugarless candies, chewing gum.

Implants in older adultsAge is not considered as an important risk factor for implants.Thorough risk assessment is essential.