Late Elder Caries (Courtesy: Prof. Michael MacEntee)
Prevention in the older dentate patient Brunton and Kay British Dental Journal Vol. 195 (No. 5) 2003
Determinants of caries risk Check diet Hx for fermentable carb Check frequency of consumption not confined with mealtimes Amount and nature of plaque Amount and nature of saliva Check Medical Hx (xerostomia, cariogenic medication, cognitive function) (Brunton & Kay, 2003)
Determinants of caries risk Socio-economic status e.g. dentally motivated, dental aspiration, caries in family Past disease experience (FMS) Current disease experience (DS) Attendance pattern (regular or pain only) Fluoride and CHX Others e.g. bridge or RPD (Brunton & Kay, 2003)
Caries Prevention: High Risk Baseline radiograph Prophylaxis Fluoride vanish over a 3-month period Brushing twice daily with fluoridated toothpaste Rinsing daily for 1 min. w/ 0.05% NaF mouth wash at bedtime Rinse weekly with a CHX solution for 6 wks OHI and diet counseling Recall @ 6mt: repeat radiograph; restore any lesion > middle 1/3 of dentine; if progression detect repeat CHX and F vanish 2-3 times/6 mts Monitor pt 6 monthly until risk falls to mod. or low (Brunton & Kay, 2003)
Caries Prevention: Mod. Risk Prophylaxis Fluoride vanish 3-month period Brushing twice daily with fluoridated toothpaste Rinsing daily for 1 min. w/ 0.05% NaF mouth wash at bedtime Monitor lesion size and depth whether new lesion arise at 6-12 monthly intervals until risk moves to low. If lesion progress or new lesion arise increase application of F vanish and give dietary advice. (Brunton & Kay, 2003)
Caries Prevention: Low Risk Brushing twice daily with fluoridated toothpaste Review at 12-18 month intervals to check for white spot formation and proximal radiolucencies (Brunton & Kay, 2003)
Active root caries - soft lesions (Fejerakov and Kidd, 2003)
Arrested after 4 months (brushing w/ fluoride toothpaste only)
Oral cancer screening examination is advocated on a regular basis for all older persons. Erickson LErickson L. Dent Clin North Am. 1997 Oct;41(4):727-50. Dent Clin North Am.
http://www.cda-adc.ca/jcda/vol- 74/issue-3/index.htmlhttp://www.cda-adc.ca/jcda/vol- 74/issue-3/index.html A special issue on oral cancer in the Journal of Canadian Dental Association (JCDA) was published in April 2008 featuring the guidelines and other informative articles.
Guidelines for Oral Health Care for Long-stay Patients Dependent, Dysphagic, Critically and Terminally Ill Patients People with Mental Health Problems People with a Physical Disability http://www.bsdh.org.uk/guidelines.html
“Health is seen as a resource for every life, not the objective of living” (1986 Ottawa Charter for Health Promotion) “Health is one quality of life but health is usually means not ends” (Green & Kreuter, 2005)
“People seek health to be more effective, attractive, productive, a better parent, a better lover, live longer, livelier, more independent, comfortable, and respected lives.” (Green & Kreuter, 2005)
Acknowledgement: Ms. LeeAnn Donnelly, Registered Dental Hygienist; Drs. Michael MacEntee and Chris Wyatt ELDERS Research Group, University of British Columbia Drs. Ronald Ettinger and Jane Chalmers College of Dentistry, University of Iowa