A Note on Senior Citizens and Dental Care

Treating senior citizens for dental care can be challenging.  There are a lot of things to consider: overall health, dental health, pain, finances and patient concerns to name a few. Besides doing a thorough examination it’s vital to communicate with the patient and find out what the expectations are.

I recently had new patient – female in her early 70s in excellent health.  She had much restorative dentistry (crown, bridges, veneers) which are holding up fairly well with the exception of veneers on her lower teeth which popped off several years ago. Now that she is clenching heavily, replacing the veneers is not necessarily a great idea since they may pop off and break again. She can’t keep a bite guard in her mouth throughout the night without having it come out. A conservative treatment would include having a free handed composite restoration that will bond to the tooth and offer protection for the exposed tooth structure. On some of her crowns she exhibits abfractions at the gum line (these are areas where tooth structure will pop out from the area where the enamel and root meet due to grinding or clenching). These abfraction areas can get so large that the nerve can be exposed! By placing a filling at the gum line the deep areas can be protected from further tooth loss without replacing the crown. With these conservative treatments this patient will be able to keep her teeth without needing expensive treatment down the road.

I had another patient a few years ago, about the same age, who was a stroke victim and had lost some mobility for both walking and, as is important for us, his ability to keep his teeth and gums clean. For this patient I tried to clean up his decay and keep what teeth that I could hold on to so that he might avoid needing a partial denture for missing teeth. But this turned out to be a problem for him. His home care was very poor and I could not keep up with the decay in his mouth. He wound up having several teeth extracted, and then he moved. No doubt, patients who lose manual dexterity or their mental faculties present the toughest challenge to the dentist. Treatment for this group is centered around their comfort and palliative treatment including extractions and decay control, plus cleanings.