Aging And Dental Health

1. Guidelines to treat dental patients with Visual Loss: Age-related visual impairment, such as cataracts, glaucoma or presbyopia, can diminish a person’s ability to process nonverbal conversational cues that are communicated visually. The following strategies can assist visually impaired older adults in the dental office:

• Large-print magazines in the waiting room
• Good lighting throughout the office; add spot/task lighting in areas used for completing forms
• Large print on prescription bottles
• Install blinds or shades to reduce glare
• Use contrasting colors on door handles, towel racks, and stair markers
• Ensure the patient can clearly see demonstrations and read written materials, including appointment cards and instructions.

1. Guidelines to treat dental patients with Physical Limitations/Loss of Mobility: Having a wheel-chair friendly practice and a staff member who can provide assistance in transferring the patient onto the dental chair is the first step towards treating such patients. Osteoarthritis or rheumatoid arthritis in the hand, fingers, elbow, shoulder, and/or neck can affect a person’s ability to maintain good quality home oral care. Here is what a dentist can advise such a patient:

• Modification of manual toothbrush handles (e.g., with Velcro® straps or attaching a bicycle handlebar grip)
• use of an electronic toothbrush with a wide, grippable handle can help accommodate for lost mobility
• Floss holders or interdental cleaners/brushes can aid in cleaning between teeth.
• Increasing the frequency of dental cleanings and examinations to promote optimal maintenance of oral hygiene.

Medication considerations - the frenemy called polypharmacy

• statins for hypercholesterolemia
• antihypertensive agents
• analgesics
• drugs for endocrine dysfunction, including thyroid and diabetes medications
• antiplatelet agents or anticoagulants
• drugs for respiratory conditions
• antidepressants
• antibiotics; and
• drugs for gastroesophageal reflux disease and acid reflux.

• analgesics
• laxatives
• vitamins and
• minerals

• Keep in mind the medication-related mechanisms implicated in xerostomia and salivary gland dysfunction in older adults.

• Always elicit proper medical history, especially for polypharmacy. The high prevalence of polypharmacy among older adults may lead to inappropriate drug use, medication errors, drug interactions or adverse drug reactions.
• Since cardiovascular disease is common among older individuals, it has been suggested that the dose of epinephrine in anesthetics should be limited to a maximum of 0.04 mg.
• It is recommended that even without a history of overt cardiovascular disease, the use of epinephrine in older adult patients should be minimized because of the expected effect of aging on the heart.
• Always monitor blood pressure and heart rate when considering multiple administrations of epinephrine-containing local anesthetic in the older adult population.
• Opioid-containing medications such as hydrocodone, oxycodone, and acetaminophen with codeine, should be avoided in older individuals with a history of falls or fractures, as such patients show an exaggerated response to central nervous system drugs.

Conclusion

Age alone is not the sole cause of dry mouth; medicines, disease and hydration status should be reviewed using the dry-mouth causes, risks and management guide.

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