with memory impairments may contribute to dry mouth (Wynn et al., 2021). Gingival recession also predisposes a tooth to caries, particularly on the root surfaces. Although not considered a Prevention and treatment of caries Adequate oral hygiene is the most important factor in preventing caries. Dental professionals should counsel patients appropriately regarding the importance of and techniques for daily oral hygiene along with the importance of regular professional cleanings. Dental professionals should be familiar with modified toothbrushes and other oral hygiene tools that may assist the older adult who has cognitive deficiencies or dexterity problems. More frequent recall appointments may also be appropriate. Dental professionals should also counsel patients to reduce the frequency of sugary snacks and drinks. Self-applied and professionally applied fluoride has been found to be effective in reducing caries in adults of all ages, including older adults (Tan, et al., 2017). Dental professionals may consider fluoride varnishes in their high- risk older patients, although application of silver diamine fluoride is more effective in preventing and arresting caries than fluoride varnish (Horst & Heima, 2019). No difference in adverse events was reported when comparing traditional fluoride varnish and silver diamine fluoride. However, a more recent systematic review of silver diamine fluoride studies found that black staining of the teeth caused by deposition of black silver phosphate into arrested carious lesions was a common occurrence (Horst & Heima, 2019). In 2016, silver diamine fluoride received approval by the U.S. Food and Drug Administration (FDA) for the arrest of caries in adults and children although initial clearance was for the treatment of tooth sensitivity (American Dental Association, 2021c). Various treatment modalities can be used as a means of decreasing the risk of carious lesions among the geriatric population. Professionally applied 2.26% fluoride varnish or 5% fluoride varnish, fluoride mouth rinses, prescription-strength fluoride gels or toothpaste, and the use of chlorhexidine on a daily basis to reduce the level of cariogenic bacteria are among the products that can be used to reduce the risk of carious lesion development on any surface of a tooth (Rapp, et al., 2019). Dental recall appointments should reflect the caries risk of each patient and the level of oral hygiene displayed between recall appointments. Individualized oral hygiene instructions must be provided to the patient or their caregiver by the dental team. Treatment of dental caries involves removing decay and restoring the tooth with appropriate restorative material.
normal result of aging gingival recession is a predominant etiologic factor in the development of root surface caries with about 10-20% of these lesions extending subgingivally beneath the already receded gingiva (Tan, et al., 2017).
Amalgam is an acceptable restorative material in the posterior quadrants but may necessitate removing more tooth structure than other restorative material to obtain retention. Composite is also an acceptable restorative material but quite technique-sensitive and must be placed in a dry field. This may be difficult to achieve in institutionalized older adults or other older adults who are compromised, either physically or cognitively. Glass ionomer cement has been suggested as the material of choice for restoring root caries because it releases fluoride, does not irritate the pulp, and adheres to root surfaces, which enhances its ease of placement. Conventional glass- ionomers release fluoride and also have the capability of fluoride uptake (Kampanas & Antoniadou, 2018; Rapp, et al., 2019). Conventional operative techniques are typically recommended, but atraumatic restorative treatment (ART), in which decay is removed with hand instrumentation and the tooth is restored with glass ionomer cement (GIC) or a resin-modified glass ionomer cement (RMGIC), may be appropriate. The success rate for long-term retention of these restorations is 92% 2-3 years after placement for Class III and Class V restorations and was 73.8% for the Class III (anterior) restorations (Shivanna, et al., 2020). The success rate for the retention of these restorations at 30 months for Class II restorations was 51% with low success rates for the retention of Class III and IV restorations (Saber, El-Housseiny, & Alamoudi, 2019). The placement of these restorations is very technique sensitive; the contamination of blood and/ or saliva on the prepared tooth surfaces will compromise the bond strength and lead to failure of the restoration. In teeth severely broken down by caries, with advanced mobility and those which are a source of recurrent infection, extraction may be the only treatment option (Arsenault, et al., 2020). Extractions should be the treatment of last resort, especially for frail, medically compromised, and institutionalized older adults. The decision to retain and restore a tooth compared to its extraction for geriatric patients must consider function and esthetics, finances, concurrence of systemic diseases and the ability of the patient to maintain adequate oral hygiene for a restored tooth (Arsenault, et al., 2020).
RECOGNIZING ORAL-SYSTEMIC LINKS IN THE OLDER ADULT POPULATION In the past several decades, hundreds of studies have explored a potential link between poor oral health and a variety of systemic diseases. Findings in many studies have been controversial, and a definitive cause-and-effect relationship has yet to be established. Only long-term, repeatable studies can prove whether a relationship exists.
Nursing-home-acquired pneumonia A number of systemic diseases that are common in older adults have been linked to poor oral health. One of the best documented associations is that between poor oral hygiene and aspiration pneumonia. Bacteria colonizing the mouth due to poor oral hygiene in long-term care facility residents may be aspirated or pushed into the respiratory tract during intubation. In fact, aspiration of oral bacteria found in the biofilm of dental plaque has been proposed as a primary cause of aspiration pneumonia in long-term care residents (Glick, 2019). Aspiration pneumonia among nursing home residents is the second most prevalent infection, with a
prevalence that ranges between 30% and 69.6% (Sarabia- Cobo, et al., 2016). Nursing-home-acquired pneumonia is a chief cause of hospitalization and death among older adults living in U.S. long-term care facilities (Griffith, et al., 2020). Research has shown that oral hygiene interventions save money and decrease both morbidity and mortality. The consistent use of a professional oral hygiene regimen and tooth brushing after every meal improves oral hygiene and also reduces the incidence of aspiration pneumonia (Teramoto, 2020). An analysis of multiple clinical studies and randomized controlled trials investigating the effect of oral
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