PERIODONTAL TREATMENT FOR OLDER ADULTS

Xerostomia Medications - tricyclic antidepressants, antihistamines, antihypertensives, and diuretics. Radiation treatment for oral, head, neck, and thyroid cancers Sjogren's syndrome Poorly controlled diabetes Bone marrow transplantation Thyroid disorders and Depression Symptoms compromised chewing, speaking, tasting, or swallowing increased risk for caries, periodontal disease, and candidiasis.

Candidiasis Long-term use of medications such as antibiotics, steroid therapies, or chemotherapy. Diabetes mellitus Head and neck radiation therapy human 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 History Past restorative, periodontal, and other dental treatment; head and neck cancer and its treatment Allergies Oral hygiene care techniques Tobacco and alcohol use Problems associated with dental treatment. Past injuries Perception of past and future dental treatment outcomes Fluoride status of the drinking water (bottled, well, community) Type of toothpaste used (fluoride versus nonfluoride).

Review of Medical History review 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 Examination A 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, or swellings.

Periodontal Status Older 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 status immune status diabetes nutrition smoking genetics medications mental health status salivary flow functional deficits finances

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

Treatment Plan
Understanding 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 surgery Not able to comply with treatment, poor oral hygiene, medically or mentally compromised or Functionally impaired
Non-surgical Approach Proper debridement (scaling ,root planing and irrigation) Thorough oral hygeine instructions Topical antibiotic therapy Lightweight, electric-powered toothbrushes Interproximal brushes, shaped wooden toothpicks, or mechanical flossing devices

Chemotherapeutic agents Chlorhexidine (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 substitutes salt ions, a flavoring agent, paraben (preservative), cellulose derivative or animal mucins, and fluoride. Saliva stimulants sugarless candies, chewing gum.
Implants in older adults Age is not considered as an important risk factor for implants. Thorough risk assessment is essential.