Mark Allen: Conservative Dentistry for the Elderly

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COLTENE’s Mark Allen applauds conservative dentistry for elderly patients

Caries compromises dental and general health and has proven association with systemic diseases and conditions [1,2,3] and the modern approach is to support patients, using preventive behaviour to avoid caries in the first place. Home oral hygiene during the COVID-19 crisis and dental surgery closedown has become essential; and the preventive message is even more important under the ‘new normal’.

But older people will have received little in the way of preventive education in their youth. The last Adult Dental Health Survey (ADHS) in 2011 (a new one is due soon) talked of an older generation with a “better outlook” than their predecessors, although “the legacy of higher disease levels earlier in the life course and different patterns of dental care remain visible” [4].

What does this mean? Statistically it means that, after a lifetime of biting and chewing, older patients who suffered under the old ‘drill and fill’ dental regime will present with more existing and failed restorations [5]. And, due to limited dexterity, toothbrushing might prove more difficult making them more prone to caries, which, in combination with the “physiological, psychological and functional” impact of aging prove a significant problem [6]

They may also not be attending routine preventive appointments due to mobility issues, worries about needing treatment and confusion over costs [7]. Other age-related risk factors include dehydration, xerostomia caused by medication and cancer treatments, ¬and a lower standard of nutrition.

Even if an older patient is receptive to preventive behaviour it may be too late to halt established oral disease and restoration treatment may be required, for which a conservative, minimally invasive approach is preferred. Minimally invasive dentistry encompasses the entire restoration process, from “cavity preparation design, techniques to material selection” and has a wealth of benefits for patients [8].

Prioritising the preservation of natural tooth material is not a new idea ¬– but materials technology has had to catch up. For example, a quote from 1951: “loss of even a part of a human tooth should be regarded as a serious injury, never to be considered lightly” [9]. Nearly 70 years later, dentists employ cutting-edge techniques and materials to deliver minimally invasive dentistry as a matter of routine. Dentists now have a more profound understanding of the caries process and practice has finally developed to match.

As our elderly population continues to grow [10] the dental team will need to know how to treat these vulnerable people with dignity and respect – while also ensuring they get the best dental care. Conservative, comfortable, ethical caries management and treatment, which does not damage the surrounding dental tissue, means less time in the chair and a better surgery experience for those who are elderly and infirm.

Toothache and/or oral pain can be debilitating and isolating for anyone; for a vulnerable, older patient, the impact could be significant. An elderly person who has found it difficult to eat or speak due to dental pain, will welcome a fast and effective procedure that not only restores oral health but also lead to better physical and psychological health. They will be able to eat better, communicate better, and enjoy a better quality of life.

Minimally invasive dentistry is stable, functional and cost-effective. A restorative treatment can be wrapped up during a single appointment. Older patients want to retain their original dentition whenever possible and will prefer a dentist who prioritises conservative treatment, avoiding any unnecessary damage to healthy tooth structures, instead of simply selecting the easiest option.

A minimally invasive approach benefits all patients, especially elderly patients. Dentists who use the techniques and select the right materials to deliver this kind of ethical, efficient treatment for caries will still see brilliant, stable results every time.

Author:

Mark Allen is the Managing Director for COLTENE, UK and Ireland. He advises: “Suitable for restoring carious defects, COLTENE’s BRILLIANT COMPONEER™ is a veneering system comprised of prefabricated shells, for aesthetic anterior restorations in a single visit, no laboratory required.

“This is great for dentists, who can offer a high-quality outcome despite minimal time in the chair – and for patients, who will appreciate a great result that preserves both dentition and supporting tissue.”

References:

1] Glodny B, Nasseri P, Crismani A, Schoenherr E, Luger AK, Bertl K, Petersen J. The occurrence of dental caries is associated with atherosclerosis. Clinics. 2013 Jul; 68 (7): 946-53.

2] Latti BR, Kalburge JV, Birajdar SB, Latti RG. Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics. Journal of Oral and Maxillofacial Pathology: JOMFP. 2018 May;22(2) :282.

3] Kane SF. The effects of oral health on systemic health. Gen Dent. 2017 Nov;65 (6):30-4.

4] The Health and Social Care Information Centre. Executive Summary: Adult Dental Health Survey 2009, 24 March 2011. Click HERE: (accessed January 2020).

5] Adult Dental Health Survey 2009.

6] Chen X, Naorungroj S, Douglas CE, Beck JD. Self-reported oral health and oral health behaviors in older adults in the last year of life. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2013 Oct 1; 68(10): 1310-5.

7] Chen X, Clark JJ, Preisser JS, Naorungroj S, Shuman SK. Dental caries in older adults in the last year of life. Journal of the American Geriatrics Society. 2013 Aug; 61(8): 1345-50.

8] Murdoch-Kinch CA, McLEAN ME. Minimally invasive dentistry. The Journal of the American Dental Association. 2003 Jan 1;134 (1): 87-95.

9] Markley MR. Restorations of silver amalgam. The Journal of the American Dental Association. 1951 Aug 1; 43(2): 133-46.

10] Overview of the UK population: August 2019. Office for National Statistics, 23 August 2019. Link: Click HERE (accessed January 2020).

Photo by Marisa Howenstine and Oren Atias on Unsplash