Geriatric dentistry

Human tongue infected with oral candidiasis - more commonly known as oral thrush

Periodontal Disease

Paralysed and functionally dependant patient receiving dental care

Intra-oral photograph showing full upper denture and natural lower teeth with mandibular central incisors missing

Extra-oral photograph showing a completely edentulous maxillary and mandibular arch

Full acrylic removable upper/maxillary denture

Geriatric dentistry is the branch of dentistry focused on providing dental care to older adults, including the diagnosis, prevention, management, and treatment of problems associated with age-related diseases. The mouth is often referred to as a "mirror of overall health," emphasizing that oral health is integral to general health. In the elderly population, poor oral health is considered a significant risk factor for general health problems. Older adults are more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical or mental disabilities. As a result, the elderly form a distinct group requiring specialized care.

Ageing Population

The global population is ageing rapidly, with a significant increase in the number and proportion of elderly individuals. Between 2000–2005 and 2010–2015, life expectancy at birth increased from 67.2 to 70.8 years. By 2045–2050, it is projected to rise to 77 years. These improvements can be attributed to advancements in modern medicine and medical technology.

The population of individuals aged 60 and over is growing faster than any younger age group and is expected to more than double by 2050. This demographic shift significantly impacts society's ability to meet the growing demand for geriatric dental care.

Older adults have become a major focus of the oral health industry. The increasing prevalence of age-related dental problems is largely due to advances in dental treatments and preventive measures that have enabled individuals to retain their natural teeth longer. However, as they age, retained teeth are more susceptible to severe oral diseases.

Geriatrics as a Dental Specialty

Australia

In Australia, geriatric dentistry falls under the "Special Needs Dentistry" specialty, which is recognized by the Dental Board of Australia. Age-related problems and medications can complicate oral health conditions, requiring specialized and individualized treatments. It is important to recognize that ageing is a natural process and should not be equated with disease.

United Kingdom

In the United Kingdom, the General Dental Council recognizes thirteen specialties, but geriatric dentistry is not one of them. Instead, Special Care Dentistry addresses the prevention and management of oral health conditions in individuals with disabilities or impairments, including older adults.

United States

In the United States, geriatric dentistry is not formally recognized as a specialty by the American Dental Association. However, institutions like Harvard Dental School offer advanced training in geriatric dentistry, equipping professionals to address the unique needs of older adults.

Canada

In Canada, the Royal College of Dentists of Canada does not recognize geriatric dentistry as one of its nine specialties.

The Geriatric Patient

Frail elderly patient receiving dental care

The elderly population can be classified based on age or functional independence. Common classifications by age include:

• Young-old (65–74 years)
• Middle-old (75–84 years)
• Oldest-old (85 years and above)

From a dental perspective, classifications focus on the patient's ability to access and manage dental care:

• Frail elderly: Individuals with chronic conditions or disabilities requiring assistance.
• Functionally dependent elderly: Individuals unable to maintain independence and often homebound or institutionalized.

Dental Health of the Geriatric Population

The geriatric population faces unique dental challenges, including higher risks for plaque, calculus, and dental caries due to reduced self-care capabilities. Improvements in oral health have decreased edentulism, but retained natural teeth are more prone to severe diseases.

Medical Conditions Affecting Oral Health

Intraoral photograph showing severe dental conditions

Age-related changes in physiology and chronic conditions such as dementia, arthritis, and diabetes significantly affect oral health. Conditions like xerostomia (dry mouth) are common due to polypharmacy, further exacerbating dental issues.

Oral Changes in Ageing

Common oral conditions in older adults include:

• Tooth loss
• Dental caries
• Periodontitis
• Dry mouth
• Oral cancer

Changes in saliva composition and reduced immune function make older adults more susceptible to infections such as oral thrush. Additionally, enamel wear, dentin sclerosis, and pulp calcification affect tooth structure and function.

Dentures and Edentulism

Edentulism

Completely edentulous maxillary and mandibular arches

Edentulism, or tooth loss, impacts aesthetics, function, and quality of life. The use of dentures can restore functionality but requires proper maintenance.

Denture Cleaning and Maintenance

• Remove dentures at night.
• Clean dentures daily using a soft brush and non-abrasive cleaning agents.
• Soak in appropriate solutions to remove stains.

Barriers to Dental Care

Older adults face barriers such as limited mobility, cognitive impairment, and inadequate access to dental facilities, particularly in residential aged care settings. Multidisciplinary approaches, including the involvement of oral health therapists, are essential to improve care quality.

Practical Suggestions

Management strategies for geriatric patients include:

• Establishing consistent oral care routines.
• Providing care in quiet, distraction-free environments.
• Using simple communication techniques and visual aids.