Den 401

Geriatric Dentistry and

Dentistry for People with
Intellectual, Learning, and Developmental
Disabilities

2018
Special Care Dentistry

Dentistry for those who require

care and attention
in addition to that needed
for most healthy patients.
 Den 401
Part 1
Geriatric Dentistry
Part 2
Dentistry for those with intellectual,
learning, and/or developmental
disabilities
 Special Patients and
“People” Language

“Disabled Patients”
or
“Patients with Disabilities?”
 Den 401
Objectives
•To identify normal and pathologic oral
health-related conditions associated with
Special Care,
•To develop insight into which of these may
benefit from clinical intervention, and,
•If so, what are best practices for seeing that
this is done and how they may or may not
differ from those for other people.
 Course
2018

• Objectives
– Participants should have enhanced ability to:
• Appreciate major characteristics of the population
of older adults.
• Be aware of common medical, physical, and
behavioral conditions of older adults.
• Plan and deliver dental care to Special Patients.
 Attendance

• According to EIOH Curriculum Committee

regular attendance important for best
education.
– 80% required for credit.
• NOTE: Attendance sign-in registered near
start of class. If late, e-mail to:
ralph_saunders@urmc.rochester.edu.
 Grade for
Den 401
– Based on final exam composed of ~35
multiple choice and short answer questions
about all content from class sessions,
including, but not limited to, PowerPoint
presentations (posted on Blackboard).
– Exam and evaluation will be in final course
session.
 Introduction to
Part 1
Geriatric Dentistry
2018
 Geriatric Dentistry
• Today
– Objectives
– Schedule
– Exam/grade.
• Normal oral tissue changes with age.
• Epidemiology of oral diseases in older
adults.
 What is Geriatric Dentistry?
• Care of all patients > 65 years old.

• Care of nursing home

patients.

• Care of older adults who

have conditions benefitting from some special
care and attention.
 Life Span
Life Expectancy
 Life Span
-The maximum number of years for individuals
in a group.

Life Expectancy
-The average number of years for individuals
in the group.
 Why study
Geriatric Dentistry?
 Why Study Geriatric Dentistry?

• The life expectancy of the population is

increasing.
• People are keeping teeth longer.
All of us are aging..
Projected Population of the U.S.
by Age 1900 - 2050
 Per Cent Population > Age 65, LE*
Country % LE Country % LE Country % LE

Brazil 7 77 Germany 20 79 Peru 6 72

Canada 16 81 Haiti 3 61 Philippines 4 71

China 9 75 India 5 67 Romania 15 73

Columbia 6 74 Iraq 3 70 Spain 17 81

Croatia 17 76 Italy 20 82 Ukraine 16 69

Cuba 12 78 Mexico 6 76 UK 17 80

Ecuador 6 76 Netherlands 15 80 USA 13 78

Egypt 4 72 Pakistan 4 66 Venezuela 5 74

*Life Expectancy CIA Handbook 2010

Normal (Physiologic)
Oral Tissue Changes

with Age
 Enamel
• May be more brittle, due to fluid loss.
• More cracks, due to chronic trauma.
• More deeply colored, due to wear and
absorption of pigments from foods,
smoking, etc.
 Dentin

• May be more brittle due to fluid loss.

• Becomes increased proportion of tooth
structure due to deposition of secondary
and tertiary dentin.
 Periodontium
• Thickness of cementum increased, due to
tooth wear and ongoing tooth eruption.
• Increased fibrosis of periodontal ligament.
• Attachment loss with recession and
decreased alveolar bone levels, due to
chronic exposure to plaque and other
irritants.
Age 8 Age14 Age 35 Age 55

Reduction in Size of Dental Pulp with Age

 Dental Pulp

• Size decreases due to deposition of

secondary and tertiary dentin.
• Remaining tissue less cellular and more
fibrous.
• Decreased circulation and innervation.
Epidemiology
of
Oral Disease
in
Older Adults
 Epidemiological Data
on Oral Health
Most is from U.S.
National Health And Nutrition
Examination Surveys (NHANES)
Prevalence of Edentulousness

•The prevalence of
edentulousness is
highest in older adults

1988

2002
 Number of Teeth

Number of teeth
(n=19) is lowest
in older adults..
Prevalence of Complete Tooth Loss
Coronal Caries
Coronal Caries

•20% of older
adults with untreated
caries.
•Only slightly
lower than other
age groups.
Dental
Chair on
Custom
Mobile
Platform
(Cost $950.)
ADA News
January 2016
Root Caries

•Highest (12%)
in older
adults.
 Periodontitis 2012
Age Group (Yrs.) %Severe %Moderate %Mild
30-34 1.9 13.0 9.4
35-49 6.7 19.4 10.4
50-64 11.7 37.7 7.9
65+ 11.2 53.0 5.9

Severe >2 interprox sites > 6mm AL

Moderate >2 interprox sites > 4mm AL
Mild >2 interprox sites >3mm AL
AL = Attachment Loss

Eke P et al. Prevalence of periodontitis in adults in the U.S.: 2009-10.

J Dent Res. 91: 914-920, 2012
 Prevalence of Mucosal Lesions
by Age Group (NHANES, 1996)
Age Group (Years) % with Mucosal Lesion
17 – 29 19.01
30 – 39 22.58
40 – 49 28.55
50 – 59 36.40
60 – 69 39.37
> 70 42.63
 Family
members
helping
out.
Number
Of
Dental Visits
 Attendance of Older Adults in
General Dentistry at EDC
in 2011 and 2013

Patients and visits increased by ~0.5%.

 Summary
• Physiologic changes with age are evident in
enamel, dentin, dental pulp and periodontal
tissues.
• Older adults have the highest levels of
edentulousness, root caries, moderate
periodontal disease, and mucosal pathology.
• The number of annual dental visits by older
adults is relatively low, but is increasing.