Aging changes in the cardiovascular system The walls of arteries stiffen with age, leading to an increased susceptibility to elevated systolic blood pressure in older adults. Atherosclerosis is so prevalent in humans that it has been described as an inevitable occurrence in old age (Fajemiroye, et al., 2018). It is important for dental professionals to screen for blood pressure abnormalities in all patients, but it is necessary to do so in older patients (American Dental Association, 2020). Aging results in dilation and stretching of the veins, leading to varicose veins in some older adults. Lingual varicosities Aging changes in the urinary system Aging alone does not cause urinary incontinence, but it is a fairly common condition, especially among older women. It is estimated that about 11%-21% of elderly individuals living in a community and about 84% of individuals with dementia who are nursing home residents experience urinary incontinence (Lim, 2017). Patients who experience this problem should be scheduled for short dental appointments or allowed restroom breaks as required during dental appointments of a longer duration. Other
are varicose veins found under the tongue. Although lingual varicosities may appear abnormal, they are a normal variation of oral tissues in older adults and should be distinguished from pathological changes by dentists. Cardiac output has been found to decrease with age (Fajemiroye, et al., 2018). Because less oxygen is delivered to body tissues, older adults may tire more quickly. Dental professionals should be aware of this change, and they should make appropriate accommodations – including shorter appointments – for older adult patients. authors have described a decreased bladder capacity, poor neuromuscular control, compromised connective tissue function, decreased cognitive function, and limited mobility in older adults, which can all contribute to incontinence problems (National Institute on Aging, 2022; University of Florida Health, 2020). Dental professionals should be aware of urinary changes associated with aging and make appropriate accommodations – such as frequent bathroom breaks – for their older adult patients.
NORMAL ORAL CHANGES RELATED TO AGING: IMPLICATIONS FOR DENTAL PROFESSIONALS
Aging changes in the dentition Although many people, including both lay people and dental professionals, believe that tooth enamel becomes more brittle with age, there is little research to document such a change. Normal aging changes of the enamel include a decrease in width and changes in shape and color. The translucency of enamel diminishes with age, and teeth often appear darker in older adults (Pocket Dentistry, 2021; Jananee & Deepika R., 2017). As a result, older adults may desire esthetic dental treatment. Staining of the teeth is characterized as extrinsic or intrinsic. Extrinsic staining of the teeth develops from the pigments of foods, beverages, and the use of tobacco products. Intrinsic discoloration occurs when chromatogenic material is incorporated into the dentin and enamel before or after tooth eruption. As a person ages pupal inflammation and the formation of sclerotic dentin decrease the light-transmitting properties of teeth, which leads to the darkening of the teeth. It can be challenging for an at-home or in-office bleaching to completely remedy the cumulative effect of intrinsic staining (Monika, et al., Aging changes in the oral mucosa Oral epithelium thins with age, making it more susceptible to abrasion and injury. Special care should be taken with evacuation tips to avoid abrasion of oral tissue. Cotton rolls and parotid pads should be moistened prior to removal to avoid abrasion of friable oral mucosa. Gentle handling of tissue is important when oral surgical procedures are indicated. Topical anesthetic should also be rinsed from the oral mucosa to avoid sloughing of the tissue. Gingival recession and reduction in alveolar bone height in older adults are not a part of normal aging but instead result from disease and factors in the oral environment. Gingival
2015). Porcelain veneers are another option for cosmetic enhancement of anterior teeth, but the associated fees may be beyond the financial ability of these patients. Pulp stones are more common among older adults. In addition, a marked reduction of pulpal nerve and blood supply normally occurs with aging. There is an increased deposition of secondary and reparative dentin, particularly on the ceiling and floor of the pulp chamber, leading to a smaller pulp chamber. These deposits of dentin become sclerotic, and the dentinal tubules become obstructed (Jananee & Deepika, 2017). These changes often result in a reduction of tooth sensitivity. As a result, older adult patients may be less symptomatic regarding sequalae of caries or pulp infection. Due to the reduction in pain perception, dental professionals may also find that some older patients may prefer not to receive local anesthesia when dental treatment is provided. inflammation develops more rapidly in older individuals. Potential reasons follow: ● Gingival recession is more common in older adults, and recession may predispose the patient to plaque accumulation leading to inflammation. ● Increased inflammation may result from a reduction in the immune response that occurs with aging. Dental professionals should be aware of this predisposition for gingival inflammation and take appropriate steps to remove sources of irritation, including sharp edges of abraded teeth and restorations, and they should provide appropriate oral hygiene care and education.
XEROSTOMIA IN OLDER ADULTS
Prevalence Xerostomia is the subjective complaint that the mouth is dry; this perception may or may not be associated with actual hyposalivation. Studies have shown the feeling of dry mouth is not always associated with hyposalivation and, conversely,
when someone has a clinically reduced amount of saliva, he or she does not always report a dry mouth (Wynn, Meiller, & Crossley, 2021).The prevalence of xerostomia in the general population is imprecise due to limited data and
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