certainly a close inspection of the skin in the head and neck area is warranted. Dentists should be familiar with the pathologic hallmarks of the two most common types of skin cancer – basal cell carcinoma and squamous cell carcinoma – as well as the clinical presentation of the most deadly type of skin cancer, melanoma. In the United States more than 40% of melanoma cases afflict patients 65 years of age or older with an increasing trend in morbidity and mortality compared to the same class of malignancies in younger patients (Garcovich, et al., 2017). Dental professionals should refer patients with suspicious lesions to physicians. Solar lentigines , also known as “age spots,” are noncancerous, round or oval lesions ranging in size from 1 to 5 cm. Solar lentigo is highly prevalent in White older adults. These lesions develop due to the cumulative effects of exposure to the sun between the third and fifth decade of life, after which the formation of these lesions accelerates (Nigam & Knight, 2017). These discolorations present as light- or dark-brown lesions with irregular borders. Because these lesions are found only in sun-exposed areas, they are often located on the face. In general, dentists should be able to distinguish between solar lentigo and skin cancer lesions. Another skin condition that may mimic cancer is seborrheic keratosis . This type of growth typically appears on the head, neck, or trunk of the body; ranges in color from light tan to black; and develops in a single growth or a cluster of growths. with decreased renal blood flow with a subsequent decrease in clearance of drugs and an increased risk of adverse effects (Massoud et al., 2017; Ruscin & Linnebur, 2018). Liver mass decreases 20-30% and hepatic blood flow also declines 30-50% in older adults, adversely affecting metabolism of many drugs (Jin et al., 2020; Massoud et al., 2017). For these reasons, dental professionals must exercise caution when prescribing medications for older adults, starting with the lowest effective dose of the medication and increasing the dosage only as needed and tolerated (Massoud, et al., 2017). which is refractory bone exposure in the mandible or maxilla. Older adults and those with periodontal disease are at a higher risk of developing medication-related osteonecrosis of the jaw (MRONJ); American Bone Health, 2019; American Dental Association, 2019a). Bisphosphonates may also be used intravenously to treat osteoporosis, Paget disease, and cancers that metastasize to the bone. The risk of developing MRONJ is much greater in those who receive IV bisphosphonates ([1-10% reported incidence] compared with those who were taking oral bisphosphonates [0.001%- 0.01% reported incidence]; (American Dental Association, 2019a). Various protocols have been suggested to minimize the development of MRONJ after oral or periodontal surgery for those patients who have been treated with oral or IV bisphosphonate medications. The use of an antibiotic prophylaxis regimen, post-procedural antibiotics, the use of a chlorhexidine mouth rinse just prior to the procedure, and an atraumatic surgical technique are potential components of a protocol that seeks to minimize the development of MRONJ however their success in preventing MRONJ has not been established (Otto, et al., 2018). Dental clinicians must make an honest self-assessment as to whether their surgical skills are sufficient to perform a surgical procedure that is efficacious and as atraumatic as possible.
The test is performed by gently grasping a bit of skin on the back of the hand and pulling it up for a few seconds, then releasing it and observing it for return to its original state. Skin remaining elevated after being released is a sign of dehydration (U.S. National Library of Medicine, 2017b). Melanocytes are the pigment-making cells of the skin. These cells protect the skin from damaging ultraviolet (UV) rays. The number of melanocytes decreases with age, which in turn increases the risk of skin cancer. Epidermal cell turnover decreases with age, which also makes skin more susceptible to skin cancer in older adults. Epidermal cell production decreases up to 50% between the ages of 20 and 70 (Nigam & Knight, 2017; Tobin, 2017). Further, the number of immune cells present in the skin decreases with age. Forty to fifty percent of Americans who live to age 65 and beyond will have basal cell carcinoma or squamous cell carcinoma at least once in their lifetimes (Skin Cancer Foundation, 2017). Furthermore, older adults with malignant melanoma tend to have a poorer prognosis than younger patients, possibly at least partly because this type of cancer tends to be diagnosed later in this population (Garcovich et al., 2017). A total body skin examination (TBSE) included in the comprehensive geriatric assessment increases the chance of identifying l malignant lesions at a stage when treatment would be the least invasive and the long-term prognosis more favorable (Sinikumpu, et al., 2022). As members of the healthcare team, dental professionals play an important role in screening for skin cancer. Although a full-body examination is not within the scope of dentistry, Aging changes in body composition As the human body ages, lean body mass and water decrease, while fat mass increases. This change in body composition affects the distribution of drugs in older adults. Less body water may lead to higher concentrations of water-soluble drugs such as antibiotics. An increase in body fat results in an accumulation of fat-soluble drugs such as diazepam (Valium) and an increased half-life and effect (Ruscin & Linnebur, 2018). In addition, kidney tissue decreases in mass and function with aging (University of Florida Health, 2020). Glomerular filtration rates decline by 1% per year of life; this is coupled Aging changes in the skeletal system Bone loss begins to occur as early as 18 years of age, but it is a slow process. At approximately 40 years of age, bone resorption begins to exceed bone formation, and bone mass declines (Marieb & Hoehn, 2018). This shift in balance toward resorption results in an increase in osteoporosis in older adults. Postmenopausal women are particularly susceptible to osteoporosis because, with lowered estrogen levels, their bodies no longer inhibit the production of osteoclasts (bone-destroying cells). Decreased bone density can lead to a pathologic fracture of bone in which minimal or no force which would not induce any osseous injury in healthy bone can cause a fracture in bone of lesser density (Marieb & Hoehn, 2018). Although osteoporosis is generally considered a women’s disease, older men can be made susceptible by certain lifestyle factors and medications (Burmeister, et al., 2021). Dental professionals should be aware of this increased risk of osteoporosis and susceptibility to fracture in their older adult patients. Obtaining a careful medical history is necessary to determine what medications, if any, the patient is taking for osteoporosis. This is important because individuals diagnosed with osteoporosis may be taking bisphosphonates as well as newer types of antiresorptive drugs. Although the risk is low, some individuals taking oral bisphosphonates have developed osteonecrosis of the jaw,
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