Clinical
Caries prevention for older people
P
rojections by the Central Statis- tics Office for the Pensions Board (2005) indicate
that, in Ireland, life expectancy is expected to increase for both males and females, and that the proportion of the population aged over 65 is projected to rise from ıı per cent currently to ı7 per cent by 2026. This trend is set to continue
through to 2056, by which time it is estimated that older people will comprise 29 per cent of the Irish population. This projected pattern of population ageing will have profound consequences for Irish dentistry. These emerging trends have significant implications for the clinician (Burke et al., 20ıı). The older, now partially dentate generation, will present with a variety of oral conditions that reflect a lifetime’s expo- sure to adverse activities and pathological influences. The dental diseases to which the older generation are particu- larly prone include attrition, periodontal disease, missing teeth, poor-quality alveolar ridges, ill-fitting dentures, mucosal lesions, oral ulcera- tion, xerostomia, oral cancers and rampant caries (Chalmers, 2006) (Figure ı). The available data world-
wide shows that dental caries is a major cause of tooth loss in older people, with resulting social and behavioural difficul- ties. Maintaining a natural, functional dentition of more than 20 teeth into old age plays an important role in having a healthy diet rich in fruit and
22 Ireland’s Dental magazine
Martina Hayes explains how to adapt and treat the changing age profile of the Irish patient
vegetables, a satisfactory nutri- tional status and an acceptable body mass index (Mercenes et al., 2003). Many older people also carry
the burden of systemic medical conditions such as arthritis, hypertension, lung disease and cancer. These can all reduce the priority of oral hygiene. Many older people are also dependent on daily medica- tions, and xerostomia is a side-effect of many commonly prescribed drugs such as anti-
Diminishing eyesight can also hinder proper hygiene tech- niques (Shay 2009). Patients may be embarrassed to admit to any decline in physical capa- bilities. Dentists and dental hygienists should consider this possibility if they observe a decline in oral hygiene in an older patient and highlight aids such as toothbrush grips, electric toothbrushes, holders for interdental floss and mouth- washes. Older patients may experience other barriers to
“Patients should have their caries risk assessed at every dental examination to ensure that any changes will be detected as early as possible”
hypertensives and anxiolytics. Dry mouth is a major risk factor for dental decay – saliva is essential to neutralise acid produced by bacteria and to flush away debris. Loss of manual dexterity,
secondary to arthritis or neuromuscular degeneration, presents many older patients with an additional obstacle in maintaining adequate plaque control. Something as simple as holding a toothbrush can be difficult and manipulation of dental floss is often impossible.
dental care such as limited financial resources, difficul- ties in accessing transport and dental phobias, due to past experiences or negative perceptions of the profession. It is well known that dental
caries can be prevented or arrested in its early stages. Patients should have their caries risk assessed at every dental examination to ensure that any changes will be detected as early as possible. Individually tailored oral hygiene instruction and dietary
advice should be given to all patients. Any advice should be provided in written form for the patient to refer to, or to give to a relative or carer to read. It is advisable to use a large font and to limit advice to a few key messages. The simplest home-based measure to reduce caries risk is to incorporate a mouthwash into the daily routine. These are easy to use and do not require a high level of manual dexterity. Alcohol-free mouthwashes are more suitable for patients with dry mouth and there are a number of mouthwashes specifically formulated to ease the symptoms of xerostomia. One such example is the Biotène system, which includes mouthwashes, gels and tooth- pastes containing bioactive enzymes, designed to protect teeth and soft tissues (Fig 2). Patients should be advised to avoid using fizzy drinks or acidic sweets to alleviate their dry mouth and instead to direct them to an alternative such as sugar-free chewing gum. While many older patients will be aware of the role of sugar in dental disease, the dangers of acid erosion may be less well known among this group. Fluoride mouthwashes can
be a sensible additional source of fluoride and daily use of 0.2 per cent sodium fluoride mouthwash is frequently recommended for patients at high risk of caries. It may be preferable to ask patients to use the mouthwash at a different time of day to tooth brushing. This allows spacing of fluo- ride exposure throughout the day to maximise its benefit;
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