The oral health goal set by the World Health Organization is for an 80-year-old to have at least 20 functional teeth. In the U.S., about 96% of seniors aged 65 and older have experienced dental caries, and nearly 16% people have no remaining natural teeth, according to NHANES data from 2017–2020. These statistics highlight the urgent need for improved dental care and prevention strategies for older adults.
Edentulous jaws, root caries, unhealthy periodontal and mucosal tissues are the main oral problems of the elderly. The main causes of tooth loss in the elderly are caries and periodontal disease, but the restoration rate of the elderly is low. The oral health problems of the elderly in China have become very prominent, and the treatment of oral diseases in the elderly needs to be paid more attention.
Features of Oral Diseases in the Elderly
The characteristics of elderly patients with oral diseases are mainly manifested as follows:
- Aging and Increased Susceptibility: As the patient ages, the functions of tissues and organs throughout the body gradually decline, and the body’s tolerance is significantly reduced, which objectively increases the chance of oral diseases.
- Severity and Complexity: Elderly oral diseases are characterized by severe illness, long course, and relatively complex treatment.
- Lack of Obvious Symptoms: Elderly patients with oral diseases lack obvious symptoms and signs, the initial clinical manifestations are not easy to detect, and the specific manifestations are diverse after the symptoms appear.
- Multiple Diseases and Complications: An elderly patient with oral disease may suffer from multiple diseases and complications at the same time.
- Systemic Diseases: Elderly patients with oral diseases are often accompanied by systemic and systemic diseases, such as coronary heart disease, hypertension, diabetes, etc.
Treatment Considerations for the Elderly
In the clinical treatment of elderly patients with oral diseases, appropriate treatment measures should be taken in combination with the diagnosis and examination results. The treatment characteristics of elderly patients with oral diseases are as follows:
- Disease Susceptibility and Repair Ability: Treatment should be carried out according to the characteristics of elderly patients with oral diseases. As the age of patients increases, the susceptibility of oral tissues to various diseases increases significantly, and the patient’s oral repair ability gradually weakens. In addition, the pathological atrophy and physiological shrinkage of periodontal tissues, as well as the widening of tooth spaces, may lead to food residues being impacted or retained. During treatment, attention must be paid to the patient’s oral bacteria problems to avoid the occurrence of caries and secondary diseases.
- Comprehensive Medical History Review: In the clinical treatment of elderly patients with oral diseases, doctors should fully understand the patient’s medical history and whether they have hypertension, diabetes, coronary heart disease, etc. When formulating treatment plans, attention should be paid to the patient’s circulatory disorders, blood congestion, accumulation of metabolites, and periodontal malnutrition. Symptomatic treatment drugs should be selected, and nursing guidance and health education should be provided in the later stage of treatment.
- Psychological Counseling: In view of the physiological and psychological characteristics of elderly patients with oral diseases, psychological counseling for patients should be strengthened in the early stage of treatment, and attention should be paid to observing the psychological changes of patients before and after treatment to ensure that patients better cooperate with medical staff for related treatment.
Comprehensive Oral Examination and Treatment
Perform a comprehensive oral examination of the patient and take panoramic radiographs. The elderly often suffer from caries, periodontal disease, edentulous and missing teeth, etc. In order to reduce the suffering of patients transferring to other departments and improve the efficiency of diagnosis and treatment, there is a comprehensive oral department responsible for diagnosis and treatment, formulate a practical and comprehensive treatment plan, make a good initial follow-up plan, and implement it after the patient agrees.
Preservation and Restoration Techniques
The elderly often have many residual roots and crowns. If there is no periodontal and apical periodontitis and it does not affect the restoration, try not to extract them. According to the condition of the remaining teeth in the patient’s mouth, the caries in the mouth that do not involve the pulp and are not loose and absorbed will be filled; the residual roots and crowns that can be retained after conventional treatment will be treated and retained; those whose physical conditions do not allow tooth extraction but can withstand root canal treatment should be treated with conventional treatment as much as possible.
If the residual root and crown can be retained after conventional treatment, they will be treated and retained. The residual root that can be used as abutment teeth will be restored with a post crown. If it cannot be used as abutment teeth, the gingiva will be removed after filling. For over-elongated teeth that are considered to affect the restoration effect, crown cutting will be performed after root canal treatment.
Use of Anesthetics and Tooth Extraction
In order to reduce the pain of elderly patients, imported anesthetics with thinner needles, such as Bilan anesthetic, are used when performing root canal treatment of vital teeth. For those who are allowed to extract teeth, teeth with no use value will be extracted as usual: such as residual roots less than 5mm in the bone, severe periapical lesions, curved roots that cannot be treated with root canal treatment, thin roots, oblique residual roots, repeated apical fistulas, residual roots that are difficult to control inflammation for a long time, etc. Patients with severe heart tube diseases need to be hospitalized or have their teeth extracted under ECG monitoring.
Denture Retention and Stability
Poor restorations should be removed, and patients with gingivitis and periodontitis should undergo subgingival cleaning of the remaining teeth and anti-infection treatment. After waiting for about 3 months for the extraction wound to heal, removable partial dentures, fixed dentures, overdentures, and full dentures can be performed according to the periodontal condition of the remaining teeth.
There is a mutually dependent relationship between teeth and alveolar bone. It develops with the growth and eruption of teeth and is maintained due to the kinetic energy needs of teeth. Functionless alveolar ridges can produce disuse atrophy due to lack of physiological stimulation.
Retention of Natural Teeth
In the past clinical treatment, all the remaining teeth in the mouth were often removed. As time goes by, edentulous ridges cause disuse absorption of alveolar ridges, and poor retention of full dentures is not conducive to restoring normal chewing function. By retaining natural teeth as much as possible, the incidence of edentulous ridges can be reduced, greatly improving the chewing function of the elderly. Since fixed dentures are more efficient in chewing than removable dentures and are easy to use, the elderly can more easily adapt to oral changes. Therefore, fixed and removable combined restorations are often used in clinical practice.
Crown and Bridge Restorations
According to the patient’s own conditions, crown and bridge restorations are performed after clinical treatment. The post crown can resist horizontal forces and protect the tooth root. The full crown surrounds the entire crown and plays a role in protecting the crown and preventing tooth fracture.
Design Principles for Denture Restoration
Most of the remaining teeth of elderly patients have different degrees of wear, looseness, tilt, twisting, elongation, many gaps in the edentulous space, and many isolated teeth. Therefore, the design of denture restoration is based on the principle of maintaining the health of the remaining teeth and the health of the alveolar ridge mucosa. The method of increasing the number of abutment teeth, increasing indirect supports, and avoiding the selection of isolated teeth as abutment teeth is adopted to solve the problem of denture retention and stability.
Full Dentures and Alveolar Ridge Retention
In view of the poor tolerance of grinding teeth during tooth preparation in the elderly, the problems of undercuts and seating should be compensated by trimming the model as much as possible during denture production. When making full dentures, the retention of the residual roots makes the alveolar ridge fuller, which increases the retention of the denture and improves the restoration effect.
Restoration of Chewing Function and Facial Appearance
In addition to restoring chewing function, facial appearance, language, etc., it is necessary to restore the normal central occlusion and rest position of the mandible as much as possible, and keep the mandible in the three physiological positions of occlusion, rest position, and mouth opening as much as possible. Preserving the patient’s physiological occlusal position is very important for the successful restoration of the elderly.
Focus on Teeth in Oral Restoration
Oral restoration focuses on teeth. Only by making a correct analysis and diagnosis of tooth loss and damage can good function and morphology be restored. The elderly have more missing teeth and are accompanied by periodontal disease. When doing fixed restoration, half a mouth of teeth or a full mouth of teeth are often used. Therefore, the physiological occlusal position must be preserved to avoid occlusal reconstruction and reduce the errors of restorations caused by occlusal reconstruction. Traumatic occlusion will bring serious consequences, and occlusal malocclusion will lead to failure of denture restoration.
Conclusion
In the clinical treatment of elderly patients with oral diseases, the patient’s symptoms, physical functions, psychological characteristics, and complications should be comprehensively considered. The treatment plan adopted must focus on scientificity, rationality, and feasibility to ensure that the patient recovers oral health as soon as possible and improves the patient’s quality of life.
