prefer salivary stimulants over salivary substitutes when considering the benefits of each product and the potential side effects (American Dental Association, 2021b). Dental professionals should advise their patients that dry mouth increases the risk of dental decay and periodontal disease. Patients should be advised to maintain meticulous oral hygiene and to schedule regular appointments for professional cleanings. A dentifrice containing fluoride should be recommended to decrease the risk of caries. Some dental professionals may elect to prescribe a prescription fluoride mouthwash or dentifrice. Professionally applied fluoride varnish may be considered as a valid preventive strategy as well. Chlorhexidine mouthwash may be prescribed to reduce the risk of periodontal disease. Dental professionals should advise patients to avoid mouthwashes containing alcohol; these may be irritating (American Dental Association, 2021b). Patients should also be advised to minimize or eliminate the consumption of alcoholic beverages given the desiccating effect of alcohol. Dentifrices that contain sodium lauryl sulfate have been found to irritate oral mucosa (Mool, 2020). However, some dentifrices that do not contain sodium lauryl sulfate have been formulated for patients with dry mouth and have been shown to cause less irritation of oral mucosal tissues and decrease the potential for the development of aphthous ulcers (Mool, 2020; The Oral Cancer Foundation, 2022).
Contraindications for pilocarpine include: ● Heart disease. ● Chronic obstructive pulmonary disease. ● Hyperthyroidism. ● Epilepsy. ● Parkinson’s disease. ● Asthma. Dental professionals should work with their patients’ physicians to determine if this prescription medication is the appropriate therapy to manage dry mouth in their dental patients. Sugarless hard candy (Kumar & Gupta, 2018) and sugar-free chewing gum may stimulate saliva and may also help to decrease dental decay (Aluckal & Ankola, 2018). Xylitol gum has been found to be effective in saliva buffering, reducing the amount of Streptococcus mutans , and increasing salivary flow compared to chewing paraffin pellets (Janakiram, Deepan Kumar, & Joseph, 2017). The effectiveness of nonprescription products for dry mouth can provide temporary relief for the xerostomic patient. There is a plethora of sugar-free gums, mints, and lozenges, as well as moisturizing sprays and gels that can provide temporary relief of dry mouth, but their use must be repeated several times during the day (Geisinger & Doobrow, 2022; The Oral Cancer Foundation, 2022). Other authors suggest that patients suffering from dry mouth
DENTAL CARIES AND THE OLDER ADULT
Prevalence Community water fluoridation has increased the number of people who retain their natural teeth throughout their lifetimes. One of the consequences of this longer retention of natural teeth has been an increase in the prevalence of decay in older adults (Rapp, et al., 2019). In the United States there is a 40% prevalence of carious lesions among adults 75 years of age or older (Rapp et al., 2019). Nearly 96% aged 65 years or older have had a carious lesion (Centers for Disease Control and Prevention [CDC], 2019b). The annual incidence of coronal caries among geriatric patients is 1.4 surfaces per 100 susceptible surfaces while for root surface caries the annual incidence was 2.6 surfaces per 100 susceptible root surfaces (Vasthare, et al., 2019). Older adults residing in long-term care facilities have an even higher incidence and a more rapid progression of caries (Vasthare, et al., 2019). The prevalence of untreated tooth decay for people between the ages of 50 and 64 years was 22% and 16% for those 65 years of age or older with a higher risk of untreated carious lesions among those of a lower socioeconomic Major predisposing factors Multiple factors may contribute to dental caries in older adults. One risk factor is arthritis, a major chronic condition affecting more than 50% of adults older than age 65 (American Dental Association, 2021a; McGuinness, 2022). Arthritis results in a diminishment of dexterity, which impairs the older adult’s ability to perform daily oral hygiene. Additionally, a change in the diet of many older adults to one comprising more carbohydrates, specifically more simple sugars, increases the risk of decay. This predisposition for sweets may be genetically driven or may be a product of the declining sense of taste in many older adults (Rapp, et al., 2019). Xerostomia, or dry mouth, is another major risk factor for dental caries. Saliva contains buffering elements and antibacterial properties that protect the teeth from decay. As previously mentioned, more than 400 medications are
status (CDC, 2021). The prevalence of untreated tooth decay is twice that among people who are non-Hispanic black, Mexican American, poor or who have less than a high school education compared to those who are non-Hispanic white, not-poor and have had more than a high school education (CDC, 2021). The incidence of root caries in older adults varies both between countries and within countries. European studies report a prevalence of 50.8% while surveys in North America reflect a prevalence of 36% and 34.6% prevalence among the Asian nations with a nearly equal gender prevalence of 34.5% male and 33.3% female. Overall, root surface caries are estimated to afflict four of ten older adults (Pentapati, Siddiq, & Yeturu, 2019). A rapidly aging population who are retaining their teeth may increase the prevalence of root surface caries in the future, especially among those with xerostomia, functional or cognitive limitations, or who reside in nursing homes in which oral health maintenance is not prioritized. known to contribute to dry mouth (Wynn, et al., 2021). Older adults are particularly susceptible to dry mouth because of their high use of prescription drugs. One study among 2,500 female respondents 65 years of age and older revealed that 23% used 5 or more medications and 12% used more than 10 medications (Pocket Dentistry, 2020). Dementia is also more prevalent in older adults. Ninety-six percent of all cases of Alzheimer’s disease are late onset, occurring after 65 years of age (Alzheimer’s Association, 2017). Individuals with cognitive impairments may forget to perform oral hygiene regularly or may even forget how to perform oral hygiene. Dental appointments may be forgotten or forgone because of an older patient’s difficulty in sitting through appointments. In addition, Alzheimer’s disease is known to affect salivation (American Dental Association, 2021a) and some drugs prescribed for patients
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