Download to read offline
Geriatric Dentisty by Dr. Kyi Khant.pptx
- 1. 1 Geriatric Dentistry Kyi Khant(HouseSurgeon) Group 7 6.5.2025
- 2. 2 Contents INTRODUCTION DEFINITIONS CLASSIFICATIONS COMMUNICATION WITH GERIATRIC PATIENT CLASSIFICATION AGE & NUTRITION FACTORS AFFECTING NUTRITION
- 3. 3 Contents TREATMENT PLANNING CONCLUSION Case Report Article Review REFERENCES
- 4. 4 Introduction Geriatric dentistrydeals with delivery of dental care to the elderly citizen. It is concerned with diagnosis, prevention and treatment of dental problems associated with normal aging. The elderly require a different approach, modified treatment planning, and knowledge of how the tissue changes associated with senescence affect oral health service.
- 5. 5 Definitions Gerodontology orGerodontics: The branch of dentistry that deals with the oral health problems of the older people. Geriatric Dentistry: The provision of dental care for adult persons with one or more chronic debilitating, physical or mental illness with associated psychosocial problems. (D.C.N.A. 1989, Jan)
- 6. 6 CLASSIFICATIONS The youngold (65-74 years) -Can live life independently. The middle old (75-84 years)/ frail elderly -Live in community with support. The old old (85 & above) -Dependent on community completely for survival.
- 7. 7 According to Heartwell- Those who are well preserved emotionally and physiologically. Those who are really aged and chronically ill. Those who fall between these two extremes.
- 8. 8 According to psychologic reactionsto aging process - Realists - They are philosophical and exacting, enjoy their old age. Resenters - Indifferent and hysterical types, will not listen to the advice, neglect oral hygiene & rarely seek dental care. Resigned - In between group. Vary in emotional and systemic status.
- 9. 9 Communucation with geriatric patients Communication is essential because it is an act of sharing. It is participation in a relationship involving a deep understanding of the patient. Dentists are considered to be masters of technical skills, able to provide quick solutions to problems best solved through patiently and effectively communicating with patients.
- 10. 10 Benefits of effectivecommunication Patient may disclose more information Enhances patient satisfaction Builds rapport between patient & professional involved in decision making Leads to more accurate diagnosis Better patient adherence to treatment Patient more open to seeking further care
- 11. 11 Age & Nutrition 1. To establish a balanced diet which is consistent with the physical, social, psychological and economic background of the patient. 2. To provide temporary dietary supportive treatment, directed towards specific goals such as caries control, postoperative healing, or soft tissue conditioning. 3. To interpret factors peculiar to the denture age group of patients, which may relate to or complicate nutritional therapy.
- 12. 12 Factors contributing tonutritional problems in the elderly are- I. Oral 1. Changes in ability to chew food 2. Changes in taste and smell 3. Drug induced xerostomia Il. Physical 1. Changes in ability to absorb and utilize nutrients 2. Changes in ability to metabolize nutrients 3. Changes in energy requirements and activity 4. Effects of medication on appetite and nutrient absorption and utilization
- 13. 13 Factors Affecting Nutrition Phyisological factors Psychosocial factors Functional factors Pharmacological factors Oral factors
- 14. 14 Physiological factors: Witha decline in lean body mass in the elderly, caloric needs decrease and risk of falling increases. Vitamin D deficiency malabsorption of food-bound vitamin B12. Zinc and vitamin B6 deficiency Dehydration Overt deficiency of several vitamins is associated with neurologica and/or behavioral impairment B1 (thiamin), B2, niacin, B6 , B12, foliate acid, vitamin C and vitamin E.
- 15. 15 Psychosocial factors: Elders,particularly at risk, include those living alone, the physically handicapped with insufficient care, the isolated, those with chronic disease and/or restrictive diets, reduced economic status and the oldest old.
- 16. 16 Functional Factors: Functionaldisabilities such as arthritis, stroke, vision, or hearing impairment, can affect nutrition.
- 17. 17 Pharmacoligical factors: Mostelders take several prescription and over-the counter medications daily. Prescription drugs are the primary cause of anorexia, nausea, vomiting, gastrointestinal disturbances, xerostomia, taste loss and interference with nutrient absorption and utilization. These conditions can lead to nutrient deficiencies, weight loss and ultimate malnutrition.
- 18. 18 Tissue Involved InAging Bone – osteoporosis Alveolar Bone – resorption Muscles & Nerves – disuse atrophy, neuropathies Salivary Gland – xerostomia , Sialolithiasis Oral Mucosa – Thin/Inelastic Periodontal tissue – Recession
- 19. 19 Tooth’s structure changes- The enamel: Attrition,abrasion,erosion, abfration. Dentin - Pathologic effect of dental caries, abrasion,attrition or other operative procedures cause variable changes in dentin .Increased number of dead tracts & sclerotic dentin
- 20. 20 Cementum -Thickness of cementum is one of the criteria to assess age of an individual. Increase in thickness at the root by 5 to 10 times with age.Permeability decreases with age. Pulp –Decreased sensitivity to stimuli and reduced blood supply.
- 21. 21 PERIODONTIUM- Decrease innumber of fibroblasts. Decrease in collagen and elastic fiber content. Decrease in organic matrix production. Width of periodontal space increases with occlusal loading.
- 22. 22 Oral Mucosal Changes EpithelialAtrophy : Epithelial layers are less in number. Mucosa, submucosa, connective tissue decrease in thickness. Decrease in surface area of the oral mucosa. Reduction in number of elastic fibers. Decreased repair potential
- 23. 23 Tongue and tastesensation- Number of taste buds decline with age. At 70yrs, taste buds decrease to 1/6th of those present at the age of 20yrs. Acuity of taste sensation is decreased because of depapillisation.
- 24. 24 Salivary Flow Changes Xerostomia : Due to medication for gastric complaints, depression,insomnia,hypertension, allergies, heart problems and many other geriatric problems,Sjogren's syndrome, radiotherapy. Decreased flow of saliva Poor retention of denture Poor taste sensitivity Irritation of mucosa Difficulty for bolus formation and deglutition
- 25. 25 Mastication anddeglutition:Masticatory ability is decreased in partially or fully edentulous persons. Changes in residual ridge: Residual Ridge Resorption (RRR): A chronic, progressive, irreversible, and cumulative process. Definition: Reduction in the size of the bony ridge beneath the mucoperiosteum. Resorption Ratio: In edentulous individuals, the maxillary and mandibular residual ridge resorption occurs at a 1:4 ratio. Resorption in the edentulous maxilla is generally four times less than in the mandible
- 26. 26 Skin Changes- Wrinkles,puffiness and pigmentation. Upper lip droops Reduction in concavity and pout of the upper lip. Flattened philtrum, deepened nasolabial grooves
- 27. 27 Treatment Planning Assessmentof provisional treatment plan Primary care Definitive treatment plan Secondary care Tertiary care Prevention and Maintenance
- 28. 28 ASSESSMENT OF OLDERADULT Steps involved are: 1. Identification data. 2. Information source. 3. Medical history and physical evaluation. 4. Patient questionnaire. 5. Patient interview and summary. 6. Dental history and evaluation. 7. Chief complaint. 8. Extra and intra oral examination. 9. Diagnostic aids. 10.Prosthesis.
- 29. 29 Four possible treatmentplans Fixed crown and bridge alone Limited use of crown with partial denture Overdenture Total extraction and complete denture
- 30. 30 Primary care Instantrelief of pain Management of periodontal diseases Identify and treat the causative factor for deterioration of oral health Treatment of active caries and basic restoration Examination of TMJ
- 31. 31 Definitive treatment plan Accurate assessment Plan treatment If necessary,revise initial treatment plan Secondary care Include Recontruction procedure- Individual tooth Occlusion 1.Comformative 2.Re-organised
- 32. 32 Tertiary care Prevention: Oral hygiene instructions, Flouride mouth washes Monitoring : Regular recall Check stability of restoration® Minor occlusal adjustments Maintenance : All restorations require to be maintained(recurrent,marginal seal,cementing media) Come at a time when disease develop or progress
- 33. 33 Treatment planning forpartially dentate patients with good prognosis- If prosthodontic replacement of teeth is required, the majority receive removable partial dentures (RPDs) to meet functional and aesthetic demands. Acrylic RPDs often gain retention through extending over the soft tissues or engaging with the embrasure spaces of remaining teeth.
- 34. 34 RPDs constructedwith a cobalt- chromium framework can be used to minimize gingival coverage & ensure that components do not encroach on root surfaces.
- 35. 35 In additionto caries prevention strategies and conservative management of cavities, this strategy also includes the use of resin- bonded or cement-retained bridges to maintain shortened dental arches where anterior teeth are missing. Resin-bonded bridges offer a good treatment alternative to RPDs
- 36. 36 Glass fibre-reinforcedcomposite bridgework can also be used to restore patients with a shortened dental arch. These functionally- oriented treatment strategies aim to reduce the burden of maintenance for older adults.
- 37. 37 Shortened dental arch concept(SDA) -Kayser in 1981 Relevant for patient aged 50 - 80years Provides sub optimal but acceptable functionality Anteriors and premolars are strategic parts Sufficient adaptive capacity - with 4 occluding units One unit corresponds to a pair of occluding premolars
- 38. 38 Advantages of SDA Simplification of extensive restorative management Easier maintenance Good prognosis for remaining teeth SDA is applicable to Caries and periodontal disease confined to molars Good long term prognosis for anteriors and premolars Financial and other limitations to dental care
- 39. 39 Treatment planning forpartially edentulous with poor prognosis Immediate dentures - for appearance and function Over dentures - retaining some roots prevent RRR improves retention, comfortnand biting force Retention highly compromised – Precision attachments
- 40. 40 Immediate Denture Thegoal of Immediate Denture therapy is to maintain satisfactory appearance & function during the post-extraction phase of treatment. Removable partial dentures can be used to replace mainly posterior teeth in the first instance. After a suitable transitional period, six months is usually sufficient, the clinician may convert the transitional partial denture to a complete immediate replacement denture. Occasionally, it is possible to rebase the immediate replacement dentures but,in most cases, new replacement complete dentures would be required after 6-12 months.
- 41. 41 OVERDENTURES One possiblealternative to complete tooth loss is the retention of a number of strategically important teeth and the utilization of overdentures. Overdentures have proven to be very successful, especially in the mandible where bone resorption can severely compromise denture stability and retention.
- 42. 42 Treatment planning incompletely edentulous patients- 1.Complete Denture 2.Implant supported denture- -Used to stabilize complete removable prosthesis. -Help to over come functional, psychological and physiological consequences of edentulousness. -Help to preserve alveolar bone and biting force.
- 43. 43 Challenges ofProsthodontic Treatment for Older Patients • Tooth loss over time leads to dental arch disruption (drifting, tipping, supraeruption). • Resulting challenges include: • Hygiene difficulties • Periodontal problems • Nonparallel abutments • Food traps
- 44. 44 CONCLUSION The treatmentoptions for geriatric patients is determined by several factors such as the general health, nutritional status, oral health status of the patient, the patient's degree of cooperation, economic resources, knowledge of the prosthodontist's judgment and technical skills.
- 45. 45 A 65-year-oldfemale patient reported with missing posterior teeth and mobile teeth, requiring immediate replacement with a denture. A primary impression was made, casts were duplicated, and a tentative jaw relation was established to record the vertical dimension at occlusion (VDO) . A surgical stent was fabricated to guide alveoloplasty after the removal of remaining teeth, and the patient was delivered with an immediate complete denture on the same day of extraction and alveoloplasty Case Report
- 46. 46 Discussion Interim Immediatedentures preserve esthetics, phonetics, occlusion, and provide psychological support to the patient . The technique involved fabricating a surgical guide for alveoloplasty, aiding in modifying the ridges and maintaining ridge shapes during the healing period . Maintaining the existing vertical dimension at occlusion and centric relation is fundamental for the success of removable prostheses
- 47.
- 48.
- 49. 49 Article Review Title:Transitional Complete Denture – A Case Report Author: Dr. R. Muthukeerthana Journal: International Journal of Dentistry Research (2023) Objective: To describe a case of a 65-year-old female who received an immediate complete denture following tooth extractions. To highlight the benefits of preserving vertical dimension, esthetics, and phonetics through immediate dentures. Key Findings & Methodology Case Summary: Patient had generalized periodontitis with missing posterior teeth. Immediate complete denture was fabricated to replace extracted teeth.
- 50. 50 Methodology Primary Impression& Jaw Relation – Ensuring proper occlusion. a.Marking & Extraction Strategy – Staged extraction plan. b.Denture Fabrication & Alveoloplasty – Use of a surgical stent for ridge shaping. c.Post-op Adjustments & Follow-ups – Checked for retention, stability, and sore spots. d. Results Improved facial height, phonetics, and function. Healing observed, and a final denture was fabricated after 3 months
- 51. 51 Critical Analysis &Conclusion Strengths: ✅ Provides a detailed step-by-step approach. ✅ Highlights the importance of preserving vertical dimension. ✅ Demonstrates how immediate dentures support esthetics and function. Limitations: ❌ Long-term success and patient adaptation need further evaluation. ❌ No comparison with other treatment options (e.g., implant-supported prosthetics). Conclusion: Immediate dentures offer a practical solution for edentulous patients. Further research is needed on long-term stability and adaptation
- 52. 52 REFERENCES Prosthodontic treatmentfor ednentulous patients, Boucher, Eleventh edition. Syllabus of complete denture prosthesis , Charles M. HeartWell Essentials of complete denture prosthesis prosthodontics ,Sheldon Winkler Zarb - Bolender, Prosthodontic treatment for edentulous patient, 12th edition Final Year Prosth: Lecture Notes 2024
- 53.