The Aging Mouth

Question 1

what percent of people age 75+ are edentulous?

Answer 1

25.8%

Question 2

what percept of people age 65+ have experienced dental caries?

Answer 2

96%

Question 3

what percent of people age 65+ have untreated dental caries?

Answer 3

18-19%

Question 4

what is the incidence of new coronal caries in older adults?

Answer 4

43.3%

Question 5

what is the average number (increment) of tooth surfaces per person (in older adults) developing caries?

Answer 5

1.22

Question 6

what is the attack rate (proportion) of at-risk surfaces developing caries in older adults?

Answer 6

1.4/100 (one new caries lesion per person per year)

Question 7

T or F:

findings suggest that new decay among older adults is similar to or higher than that in children

Answer 7

true

Question 8

T or F:

caries among the elderly is less likely to remain untreated than caries in children

Answer 8

false

it is more likely to remain untreated

Question 9

what is the root caries prevalence among older adults aged 65-74? what about >75?

Answer 9

65-74 = 12%
>75 = 17%

Question 10

what is the reported distribution of root caries in the mandible? maxilla?

Answer 10

• mandible: molars > premolars > anterior (not Dr. E’s personal observation)
• maxilla: more evenly distributed

Question 11

dentin demineralizes at a pH of ___. enamel demineralizes at a pH of ___.

Answer 11

dentin = 6
enamel = 5.4

Question 12

what are the 7 main root caries risk factors?

Answer 12

• dentin demineralization
• previous caries experience
• clinical attachment loss
• plaque
• quality and quantity of saliva
• lack of fluoride
• diet

Question 13

what are the pros and cons of using amalgam to restore root caries?

Answer 13

• pro: greater longevity than composite

- con: more secondary caries compared to GI

Question 14

what are the pros to using GI/RMGI to restore root caries?

Answer 14

• fluoride release
• high caries risk patients
• 80% greater caries reduction than composite

Question 15

what are 3 restorative materials for root caries?

Answer 15

amalgam, composite, and GI/RMGI

Question 16

other than the 7 main root caries risk factors, what are some other risk factors?

Answer 16

newly exposed roots, number of exposed roots, active periodontal therapy, smoking, onset of systemic illness, lack of social integration and support, number of periodontal pockets >3mm, less than 9 remaining teeth

Question 17

what restorative material is anti-cariogenic, reasonably esthetic, chemically bonds to dentin, and acceptable for minimally invasive preparations and ART (atraumatic restorative treatment)?

Answer 17

glass ionomer

Question 18

as the periodontium ages, there is a(n) ___ in collagen synthesis in the gingiva, resulting in ___

Answer 18

• decrease

- dekeratinization and thin irregular epithelium

Question 19

as the periodontium ages, there is a(n) ___ in cellular components of the periodontal ligament with a(n) ___ in irregularity

Answer 19

• decrease

- increase

Question 20

as the periodontium ages, there is a(n) ___ in alveolar bone density

Answer 20

decrease

Question 21

T or F:

there is an increase in the prevalence of periodontal disease in older adults than younger

Answer 21

true

Question 22

T or F:
periodontal attachment loss increases with age and the percentage with advanced periodontal disease (pockets >5mm) increases as well

Answer 22

false
although periodontal attachment loss does increase with age, the percentage with advanced periodontal disease decreases in the oldest

Question 23

in older adults, severe attachment loss is more often associated with ___ than ___

Answer 23

recession than pocketing

Question 24

T or F:

age is a predictor of progressing periodontal disease, not new disease

Answer 24

true

Question 25

T or F: in older adults, there is a higher prevalence of advanced periodontal disease and a somewhat lower prevalence of mild to moderate

Answer 25

false there is a higher prevalence of mild to moderate periodontal disease, and a somewhat lower prevalence of advanced disease

Question 26

what are the 3 main affects that aging has on the pulp?

Answer 26

- secondary dentin = diminished pulp volume - decreased cellularity, vascularity, and innervation with increased fibrosis - increase in pulp stones

Question 27

what affects does diminished pulp volume have?

Answer 27

- decreased risk of pulpal exposure - decreased pulpal sensitivity - increased difficulty with pulpal diagnosis - increased difficulty with canal access if endo is required

Question 28

what affects does decreased cellularity, vascularity, and innervation with increased fibrosis have on the pulp?

Answer 28

- reduced reparative capacity | - reduced response to EPT, cold (may need dry ice)

Question 29

late pulp breakdown often results in apical periodontitis in the aging population. what is a complication of this? what % of people >60 have one or more teeth with apical periodontitis of pulpal origin?

Answer 29

- may be slow and asymptomatic (difficult to diagnose) | - 62%

Question 30

what are 5 types of pulpal therapies?

Answer 30

- direct pulp capping (not predictable) - pulpotomy (no evidence base, experimental) - cell activity promotion (cements containing MTA) - pulpal regeneration (research being done) - root canal therapy (legitimate and predictable in older teeth)

Question 31

what are some endo challenges in older teeth?

Answer 31

- access orientation, existing restorations, tooth alignment/rotations, small chambers (calcification) - negotiating and enlarging canals

Question 32

what are some things to keep in mind when performing endodontics on older teeth?

Answer 32

- light and magnification - lubricants - small files (1/2 sizes may be needed for dense peritubular dentin) - develop a smooth glide path - verify orientation

Question 33

before you get to the teeth, you should always ___

Answer 33

assess the patient first

Question 34

what is included in the general physical and functional patient assessment?

Answer 34

medical history, social history, cognitive function, physical dexterity, affect/motivation

Question 35

how is functional status evaluated?

Answer 35

activities of daily living [ADL] (bathing, dressing, transferring, continence, feeding

Question 36

what are 6 instrumental ADL's?

Answer 36

obtaining food, cooking, managing finances, phone usage, housekeeping, and taking medications appropriately

Question 37

how should you obtain a complete medical and functional history?

Answer 37

readable forms, oral review, determine and use caregiver if appropriate, medical consultation

Question 38

how should you obtain a complete drug history?

Answer 38

have patient's bring bottles, and ask specifically about OTC products

Question 39

what are some important considerations with obtaining a complete drug history?

Answer 39

- multiple diseases may lead to polypharmacy | - metabolic changes lead to differences in drug absorption, distribution, metabolism, and excretion

Question 40

___% of older adults have one or more chronic diseases and are often taking ___ medications at once

Answer 40

80%, 3-12

Question 41

what are some pain management risks with older adults?

Answer 41

- use NSAIDS with care (renal toxicity) - many older patients have impaired renal function - use narcotics with care - older patients may be at risk for fall