Geriatric dentistry

Geriatric dentistry or geriodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.

Overview

Last century has witnessed a number of remarkable demographic changes related to health, diseases, longevity and mortality of the population all over the world. By now one third of the world’s elderly population is living in the developing countries and one out of twelve persons in the developing countries is over sixty five.

The twentieth century witnessed remarkable population ageing with regard to human longevity worldwide, and the twenty-first century is set to carry forward the gains in longevity further, both in the developing and the developed world. This rise in life expectancy is attributed primarily to the substantial reduction in mortality at different stages of life, which has been brought about by improved health care facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions. As a result of the increasing life expectancy, the proportion of the elderly in the total population is projected to be around 20% in India and 32% in the developed nations by 2050.

Keeping this increased life expectancy in mind, the age of retirement in many sectors in India is increasing and in some it has even gone up to 70 years. In some states, the retirement age has not been raised but this is because of the concerns regarding the resultant job cuts for the younger generation. As per the Government of India's classification, the elderly are those who are 60 years of age and above; these citizens become eligible for varied concessions offered by the government and other agencies. In the developed world, the elderly are those above the age of 65 years.

The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. In the elderly population poor oral health has been considered a risk factor for general health problems. On the other hand, older adults are more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical/mental disabilities. Thus, old people form a distinct group in terms of provision of care.

The dental diseases that the elderly are particularly prone to are root caries, attrition, periodontal disease, missing teeth because of earlier neglect, edentulism, poor quality of alveolar ridges, ill-fitting dentures, mucosal lesions, oral ulceration, dry mouth (xerostomia), oral cancers, and rampant caries. Many of these are the sequelae of neglect in the early years of life, for example, consumption of a cariogenic diet, lack of awareness regarding preventive aspects, and habits like smoking and/or tobacco, pan, and betel nut chewing. All these problems may increase in magnitude because of the declining immunity in old age and because of coexisting medical problems. As a result of poor systemic health, the elderly patient often does not pay sufficient attention to oral health. In addition, medications like antihypertensives, antipsychotics, anxiolytics, etc., lead to xerostomia, and the absence of the protective influences of saliva in the oral cavity increases the predisposition to oral disease. Financial constraints and lack of family support or of transportation facilities affect access to dental services in later life. The untreated oral cavity has its deleterious effects on comfort, aesthetics, speech, mastication and, consequently, on quality of life in old age.