Geriatric dentistry

The population structure has changed fundamentally in recent years. There are more and more older people. This not only has a drastic effect on social conditions, but also creates new conditions for dental work.

For example, the dentist must adapt to an increasing extent to the treatment of patients of advanced age. In addition to the physiological organic changes of the chewing organ, physical and mental decomposition symptoms also appear. For this reason, geriatric dentistry (gerontostomatology) plays an increasingly important role in dental practice.

The colour of the teeth changes more to darker tones. This is mainly a consequence of the changes in the dentine caused by narrowing of the dentinal tubules and the pulp cavity. There are also deposits in the enamel caused by tobacco, red wine and various drugs.

The enamel also becomes more brittle due to the reduction of organic components. Years of abrasion lead to changes in the chewing surfaces, encouraged by teeth grinding, pressing and bad chewing habits. But also at the neck of the tooth and in the root area changes in discoloration and anatomical shape occur.

The gums recede due to bone resorption. The keratin layer of the gums changes and is therefore more susceptible to the entry of bacteria. This also applies to the oral mucosa, whose epithelial layer becomes thinner.

The glandular tissue of the salivary glands decreases in favour of fat cells. This leads to a reduction in saliva production, which in turn leads to a higher risk of caries. Since more soft food is eaten in old age, this also results in less stimulation of the salivary glands.

Drugs also play a greater role in old age and can – like psychotropic drugs – lead to reduced saliva production. In principle, the basic pillars of caries and periodontal prophylaxis are identical in younger and older people. This applies to nutrition, fluoridation and regular visits to the dentist.

However, the anatomical changes result in different conditions for oral hygiene in older people. Above all, the existence of prosthetic fittings provides new foundations for oral hygiene. In addition, there is a certain indolence of elderly people, which in extreme cases – when oral hygiene and dental care are totally abandoned – can lead to severe damage to the masticatory organ.

Manual dexterity is also often lost in old age. The necessary aids for oral hygiene are available. They are no different from those that are generally used.

The toothbrush and toothpaste are the most important instruments for oral hygiene. The electric toothbrush in particular facilitates tooth cleaning through its automatically executed movements. The use of dental floss is more difficult because it requires a certain amount of skill.

Interdental brushes and toothpicks offer a good alternative. Tartar on dentures can only be removed by the dentist. Soft plaque is removed with denture cleaning agents and special denture cleaning brushes and disinfected at the same time.

The receding gums create larger spaces between the teeth, which favours the build-up of plaque. If they are not removed, cervical and root caries can develop. This also applies to the prosthetic restorations worn in most cases.

Dentures with clasps in particular offer good starting points for plaque due to their niches. Therefore, cleaning the dentures is also important to preserve the remaining dentition. An uncleaned denture also leads to damage to the oral mucosa and favours damage to the periodontium.

If the patient is not able to carry out the necessary measures themselves, it is the responsibility of the nursing staff to ensure that the remaining teeth can be preserved as long as possible. Dentistry for the elderly is becoming increasingly important due to the higher life expectancy. When treating elderly patients, the anatomical conditions that change with age must be taken into account in the therapy.

Oral hygiene is of great importance, especially if a prosthetic restoration is present. The instruments are available and must be used by nursing staff if necessary.