Periodontal treatments
Introduction: The presence of systemic diseases, polydrug treatment and other physiological consequences of aging mean that the elderly patient must be considered a special case.
Anesthesia in the elderly : in the elderly, local anesthesia is often sufficient for minor procedures.
In surgery, anesthetics with vasoconstrictors are preferable because they decrease the systemic resorption of anesthetics, increase their duration of action and ensure effective local hemostasis.
However, frequent systemic pathologies in elderly patients or current medications contraindicate certain molecules and require certain precautions.
The elderly patient tolerates stress less and less under local anesthesia, which encourages the joint administration of sedative premedication.
Diazepines, which have only minimal effect on the cardiovascular system, are often prescribed the evening before surgery.
Diazepam (2.5mg orally) 1 hour before surgery can be given to alleviate the patient’s anxiety.
Periodontal treatments : a patient in good general health, showing moderate progress in the senescence process, will often be treated in a comparable way to a young patient.
On the contrary, a patient whose general state of health is weakened and who presents disorders linked to the aging process must be treated in a reasoned manner in order to offer him only therapeutic alternatives compatible with his evolution.
1-Plaque control : in the elderly, physical and mental deterioration linked to senescence has direct consequences on the effectiveness of the patient’s hygiene.
Thus musculoskeletal disorders (polyarthritis), reduced sensory capacities (visual, tactile, proprioceptive or olfactory) can lead to physical deficits incompatible with the provision of care and therefore the maintenance of a good plaque index.
The presence of root caries linked to poor hygiene, physiological salivary changes and dietary changes can increase plaque retention.
Equipment: The electric toothbrush is known for its effectiveness in plaque control. The use of dental floss mounted on a floss holder and an interdental brush with an adapted handle promotes plaque control by the patient.
It should be kept in mind that the use of oral hygiene equipment can be complex depending on the degree of loss of autonomy and cooperation of the elderly patient.
Due to the increasing prevalence of cervical caries, the use of a highly fluoridated toothpaste is recommended (a frequency of 3 brushings per day). The use of fluoridated mouthwash may also be beneficial.
2-Non-surgical treatment : frequent visits are necessary in order to maintain oral health and adapt hygiene equipment to the patient’s developments.
In the presence of xerostomia or degenerative diseases, visit intervals of 1 to 2 months are recommended.
Treatments should be done in short sessions. During scaling and surfacing, root instrumentation should be limited so as not to be iatrogenic at the root surface level.
3-Surgical procedures in the elderly:
The majority of surgical procedures in the elderly consist of dental extractions, pre-prosthetic and periodontal surgery.
Surgical procedures will be performed in a hospital setting for patients with severe systemic conditions presenting a life-threatening risk.
Tooth extractions: these can cause certain difficulties: hypercementosis can modify the root morphology; teeth that have undergone repeated restorations are weakened and risk fracturing during extraction procedures.
Impacted teeth are only extracted in cases of extreme necessity (cysts, infections).
Osteoporotic bone in elderly patients is at risk of fracture and requires gentle, non-traumatic surgical procedures.
4-Pre-prosthetic surgery : pre-prosthetic surgery has seen its indications decrease in recent years with the arrival of implant techniques.
Minor pre-prosthetic surgery can be performed in the office under local anesthesia, in cases where mucogingival defects interfere with the stability and retention of a prosthesis.
These include floating ridges, retromolar trigones, floating tuberosities or thick folds which often develop in the vicinity of poorly adapted prostheses.
In the case of significant gingival hyperplasia, often of traumatic origin, regularization of the ridge is necessary.
The absence of attached gingiva in areas subject to prosthetic friction may be due to the gingival graft technique.
The patient’s age does not constitute a contraindication to periodontal surgery, unlike the general state of health.
The surgical principles remain the same but must be adapted to the patient’s changes.
Periodontal healing appears to be very little modified in the elderly despite the cellular modifications of senescence (reduction in fibroblastic activity, in the rate of collagen formation, alterations in vascularization).
Healing times will be longer than in young patients.
Alveolar ridge augmentation: in the elderly, the progressive resorption of the edentulous alveolar ridges leads to severe bone atrophy, which results in instability of the prostheses. The solution to this problem involves an increase in the volume of soft tissues or bone tissues and the choice depends on the degree of alveolar resorption as well as the extent of the edentulous ridge (partial, total).
There are three surgical possibilities:
- augmentation of the crest by surface gingival graft or by buried connective tissue
- augmentation by bone graft or bone graft substitute
- augmentation by guided bone regeneration techniques (particularly partially edentulous ridge)
In completely edentulous patients with excessive crestal bone resorption, bone grafts (autogenous bone, bone graft substitute) can be used. However, these procedures are reserved for healthy people and the hospital environment is preferred for the elderly.
Periodontal treatments
5-Implant surgery:
Implants can support a structure that serves as retention for removable prostheses.
No correlation has been demonstrated between implant failure and patient age.
The presence of certain systemic diseases may, however, limit the indications for this technique. The attitude towards patients with heart disease would be reserved.
Furthermore, although implant treatment of elderly patients with a high probability of osteoporosis remains satisfactory and the prognosis favorable, success implies a longer healing period.
However, the limitations of the surgical technique are related to bone insufficiency and the prognosis related to oral hygiene. Thus, problems that may require surgical intervention (severe maxillary atrophy) must be evaluated according to the disabling nature of the defect, the patient’s ability to tolerate surgery and his life expectancy.
Temporomandibular joint involvement : Dysfunctions in the elderly are as common as in young adults. However, they are significantly different in their symptoms and in their therapeutic approach.
Surgical treatment remains exceptional. Functional treatments (even in the presence of significant joint remodeling ) are preferred and prove effective, both for relieving pain and for improving functional, muscular and joint restrictions.
Conclusion : An elderly and healthy patient can undergo surgical procedures provided that certain precautions are taken. Elderly people often suffer from multiple pathologies requiring appropriate precautions. Surgical procedures are only undertaken when necessary and when the benefit/risk ratio is well assessed.
Periodontal treatments
Bibliography:
-F.Anagnostou, MH Sawaf, P Bouchard, JP Ouhayoun EMC Oral cavity and senescence: oral surgery in the elderly. 23-433-A-10
-Phillipe Bouchard periodontology and implantology
Periodontal treatments
Wisdom teeth may need to be extracted if they are too small.
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Bad breath can be linked to dental or gum problems.
Bad breath can be linked to dental or gum problems.
Dental veneers improve the appearance of stained or damaged teeth.
Regular scaling prevents the build-up of plaque.
Sensitive teeth can be treated with specific toothpastes.
Early consultation helps detect dental problems in time.