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As people are generally living longer it is to be expected that there will be a greater proportion of older patients seeking dental treatment. It is as well for a dentist to recognise this and be mindful of any particular needs or problems this may bring. Dental treatment has changed in emphasis from the old idea of patching up decayed teeth where feasible and extracting teeth that are too far gone, to the idea that decay and gum disease are preventable, and that the ideal is for everyone to keep their teeth for life. A popular notion some generations back was that teeth were nothing but trouble and should be removed and replaced with dentures. We now know that this is erroneous because loss of teeth leads to loss of the bony support for them by a gradual process of resorption. This means that, following extraction of teeth the jawbones gradually diminish in size over time, with the consequence that there may come a time in later years, when there is insufficient bone to enable implants to be placed, or even to adequately support a denture any more. There is then, the dilemma facing the dentist with older patients, knowing that it is best in general terms to conserve each and every tooth, but at the same time aware that the older the patient, the less able he or she may be to tolerate complex or lengthy procedures. The restoration of a broken down tooth may for example, entail root canal therapy first, followed by the construction of a post and crown. Root canal treatment is fiddly and time-consuming at the best of times, but may be complicated in the older patient by canals that have become calcified and blocked, making them difficult to ream out and clean properly. The root canal treatment may itself require several lengthy visits, and then there would be several more to construct post and crown. These considerations may lead to a mutual decision between dentist and patient to take a simpler line of treatment and extract the tooth. The more complicated and time-consuming dental treatment is, then of course the more it is likely to cost, and this may be a further limiting factor for the older patient. The patient may be a retired successful businessman, able and willing to afford the best treatment options, or may be a pensioner with limited means. Whether patients over 50 are more less inclined to spend money on their teeth varies enormously, depending on the individual’s personal circumstances and whether or not they have insurance of any kind. It is essential therefore that both dentist and patient take into account the financial implications of treatment. A patient over the age of 50 is quite likely to have one or more health problems or be taking medication to prevent problems. Conditions such as high blood pressure, diabetes, a history of rheumatic fever or heart valve prostheses all need to be taken into account. There may be a special need for antibiotic cover for invasive dental treatment, or special measures to control bleeding. It is essential for the dentist when treating the older patient to have a full and up to date medical history, and even on occasions to liaise with the patient’s medical practitioner. Gum disease is very common amongst adults, ranging from a mild inflammation of the gums with little or no evident symptoms (gingivitis), to more serious disease where there is pocketing of the gums, shrinkage and loss of gum tissue, and consequent loosening of teeth (periodontitis). When gum disease has reached this level it is often difficult to reverse the process, requiring lengthy sessions of scaling and polishing of teeth, surgical removal of loose gum tissue, and the establishing of extremely good oral hygiene, in order to reduce the harmful bacterial population in the mouth. As gum disease is progressive, usually caused by inadequate oral hygiene over many years, it is likely to be present in the mouths of many over 50-year olds, and presents again the dilemma of whether an attempt should be made to save teeth or not. Another factor to consider here is the recent evidence suggesting a link between poor gum health and cardiovascular disease. It is recognised that people with gum disease have an increased risk of developing blocked arteries and heart problems. Where teeth, especially a lot of teeth, have been extracted early on in life, there may well have taken place considerable resorption of bone in the jaws with the result that insufficient bone may remain for implants to be possible. Some dental clinics may refuse implants to elderly patients because of the likelihood of insufficient bony support. Patients of 50 and over can be more demanding in terms of their expectations of dental treatment, especially when it comes to appearance. Often, men are as vain as women, though less inclined to admit it, and their secret expectations of an expensive bridge may be that it should make them look younger. A dentist has to be careful to explain before treatment, the limitations on what is possible, and to advise on what might best suit a patient when it comes to cosmetic issues. Patient might want brilliant white crowns put on his or her front teeth whilst the dentist may be aware that this would make the crowns too noticeable and too artificial looking. Older patients are thus likely to represent something of a challenge to the dentist for a multitude of reasons. They may find it difficult to attend the surgery and have to have assistance in order to be able to attend, or even require domiciliary visits. They may be suffering physical conditions such as rheumatoid arthritis or stroke, making it difficult for them to walk, or from mental conditions such as Alzheimers which make for difficulties in communication. The dentist’s duty is to help the patient whatever their age, but being aware of likely issues and problems can help to make this easier. For more information about dental implants (tannimplantat) or dentist prices (tannlege priser) for older patients, please visit Baltic Dental Services at http://www.baltic-dental.com. Written by Carl Ascher
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