● Inevitably many patients who are in the midst of bisphosphonate therapy will lack ideal oral health and can require invasive dental treatment such as extractions. A systematic review of the literature lacks a consensus for the prevention of (MRONJ) for those patients in the midst of bisphosphonate therapy and for whom an acute odontogenic problem requires a procedure such as an extraction which cannot be delayed. However, some protocols which have been suggested to reduce the development of (MRONJ) include: ● The use of prophylactic antibiotics. ● Pre-procedural rinse with 0.12% chlorhexidine gluconate. ● The use of an atraumatic surgical technique. Dental clinicians must make an honest self-assessment of their surgical skills and should only perform oral surgery if it can be done in an efficient and atraumatic fashion (Abed & Al-Sahafi, 2018; Otto, et al., 2018; The American Dental Association, 2019a). In 2011, the American Dental Association (ADA) published recommendations for managing the care of patients receiving antiresorptive medications (not just bisphosphonates) based upon the opinions of an expert panel. These recommendations can be found at http://www. ada.org/en/member-center/oral-health-topics/osteoporosis- medications (American Dental Association, 2019a). than age 75 experiencing hearing impairment; it is usually symmetrical, although there can be a significant hearing variation between each ear (National Institute on Deafness and Other Communication Disorders, 2017; National Institute of Aging, 2018). It becomes difficult for these older adults to distinguish certain consonant sounds (S, F, TH, P, and T; these sounds are easy to recognize visually from lip movements). Older adults may also process sound less quickly, and background noise may exacerbate the problem. Hearing aids may not address these issues. Dental professionals may consider the following techniques to compensate for hearing problems in their patients: ● Stand directly in front of the patient when talking. Do not talk while turning or walking away. ● High frequency hearing is often lost, so speak in lower/ deeper tones. ● Speak slowly and clearly. Do not shout. ● If appropriate, remove your facemask when speaking with the patient. If wearing a mask is necessary, consider one with a see-through inset. ● Reduce background noise (radio, television). ● Use gestures and facial expressions when speaking. Dental patients should be asked if they have hearing impairments. If they have hearing aids, they should be asked to wear them to enhance communication. If hearing aids are not available, dental patients with hearing impairments may need a pencil and paper to communicate. Age-related decline in taste has also been reported. Reduced ability to taste and dysgeusia (distortion of taste) occur more frequently in adults age 65 and older. Taste buds on the tongue are the afferent link in the sensation of taste. The decrease of the sensation of taste during aging is caused by a decrease in the number of taste buds, changes in the neural processing of the sensation of taste and a decrease quality and /or quantity of saliva (Stanford Health, 2022). Regardless of the etiology, taste dysfunction has clinical implications in the practice of dentistry. An older adult with a decreased sense of taste may add more sugar and salt to foods, thus incurring a higher risk of caries and of developing and/or exacerbating hypertension.
For dental patients taking oral bisphosphonate, preventive dental care is critical as well. Patients with osteoporosis receiving oral bisphosphonate therapy should maintain excellent oral hygiene and obtain regular professional dental care (American Bone Health, 2019; Otto, et al, 2018). Among the recommendations for dentists regarding management of dental patients who have been diagnosed with osteoporosis are considerations for patients who have not begun bisphosphonate therapy and for those who have been on a bisphosphonate regime. Before the start of bisphosphonate therapy dental clinicians must: ● Complete a comprehensive oral and radiographic examination and routine dental examinations thereafter. ● Inform the dental patient that the risk of osteonecrosis of the jaw is low. ● Inform the patient that the risk can be reduced with good oral hygiene and regular dental care. ● Remove any teeth that are non-restorable or which are periodontally questionable or hopeless as they can become a foci of infection later. Poorly fitting partial; or complete dentures must be adjusted, relined or remade to prevent mucosal ulceration with the potential of in infection which could extend into the bone. Aging changes in the sensory system Visual decline is a normal part of aging. Visual acuity in people with healthy eyes begins to decline after age 40 with the prevalence increasing with advancing age (Cleveland Clinic, 2020a). One natural result of aging is presbyopia , a loss of flexibility in the lens of the eye that manifests in an inability to focus on near objects and often requires correction with glasses for reading. Older adults may also have reduced color vision with these changes occurring in the absence of any disease and degeneration (Elawad, Hamad, & Elawad, 2017). Dental professionals should be aware of, and sensitive to, these normal aging changes in vision. For example, older adults may need their glasses to fill out paperwork or to look at their teeth or mouth in a mirror. Older adults may have trouble discerning color intensities, functioning in low light, or judging distances, all of which can put them at risk of falls. Dental offices should be well lit and clutter-free to help reduce this risk. Other visual changes that are not a direct result of aging but are often seen in older adults include cataracts, macular degeneration, and glaucoma. When a person has a cataract, the lens of the eye becomes cloudy, impairing vision in low light. In glaucoma, aqueous humor builds up inside of the eyeball, placing pressure on the optic nerve, sometimes leading to visual impairment. Glaucoma may result in blindness but is often treatable with nonsurgical interventions. In macular degeneration, the macula, or “spot,” on the retina that provides acute vision deteriorates, often leading to severe loss of vision and even blindness (Cleveland Clinic, 2020; U.S. National Library of Medicine, 2017a). Dental professionals should ask about these visual pathologies when reviewing the patient’s medical history and make appropriate accommodations in the dental office. Vision difficulties may impair the older adult’s ability to adequately perform daily oral hygiene. For this reason, oral hygiene aids may be recommended, such as floss holders, electric toothbrushes, and tongue scrapers. It may be necessary to increase the frequency of recall visits. Hearing also declines with aging. Age-related hearing loss, or presbycusis, is prevalent, with nearly one-third of those age 65 and older and almost one-half of those older
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