Oral hygiene

The state of oral health with which one reaches the third age is a direct consequence of the oral health care that has been taken throughout life.

The most common dental diseases associated with this population are related to trauma, tumor pathologies and, mainly, infectious diseases such as tooth decay and periodontal disease.

The changes in the structures of the oral system as a result of the aging of the person, that is, orofacial aging, are totally normal transformations in the majority of elderly adults. They are developed in two aspects: the structural modifications themselves and those related to their operation.

• Structural changes
  • Loss of teeth: due to cavities and gum (periodontal) diseases. Produces a significant aesthetic impact and chewing.
  • Thickening and receding of the gums, with greater exposure of the base of the tooth (increased root cavities).
  • Wear of the temporomadibular joint, with osteoarthritis, which causes pain and loss of strength when chewing.

• Functional changes
  • Decreased production and effectiveness of saliva, which is aggravated by the effect of multiple drugs. This causes a decrease in the taste sensation, increases the presence of cavities and affects digestion.
  • Alterations of the oral mucosa, with a greater risk for the development of infections, ulcers, canker sores and cancerous lesions, especially if there is a history of alcohol or tobacco consumption.
  • Decreased tooth sensitivity.

The main oral pathologies of the elderly are:

• Caries: infection of the tooth.
• Root caries: occurs at the root of the tooth, at the junction of the tooth with the gum. In the elderly they can be a major cause of loss of parts.
• Periodontal disease: gingivitis and periodontitis.
• Pathologies in the temporomandibular joint: arthritis and osteoarthritis.
• Oral tumors: 10% are malignant, being generally detected late for their correct treatment.
• Pulpitis: inflammation of the nerve of the tooth due to tooth decay or dental irritation, it is very painful.
• Bruxism: grinding, friction and / or strong occlusion of the upper teeth with the lower ones, especially those on the back. It is a consequence of abrasion (dental wear due to food intake) and breakage (tooth fracture due to excessive chewing force).

Having a deteriorated oral health can lead to a consequent difficulty in chewing, poor nutrition and malnutrition, difficulty in pronouncing correctly and damage to the self-esteem of the elderly, helping to social withdrawal.

In addition to the problems that directly cause dental pathology, the interrelation between these and general pathology must be taken into account. There are diseases and treatments that worsen dental problems and in turn these interfere with different pathologies and their therapies.

The main factors that aggravate dental diseases in the geriatric population are:

• Presence of other diseases (comorbidity): those that are related to oral health are diabetes, hypertension, osteoporosis, hematological diseases, liver disorders, kidney failure, nutritional disorders and mental disorders. When a patient presents any of these diseases, the dentist must establish the progress of the disease and the treatment before performing any intervention in the mouth. There are times when it is necessary to refer the patient to their treating physician for an evaluation.
• Drugs: Polypharmacy is common in older people. Some of the drugs tend to affect oral health, such as some analgesics, antidepressants, antihistamines, antipsychotics or antihypertensives, which as a side effect decrease the amount of saliva. When this is of long duration, it is common for there to be a recrudescence in the appearance of root cavities and oral candidiasis, in addition to discomfort in people with removable prostheses. For this reason, the joint collaboration of the treating physician with the dentist at the time of dental treatment is extremely important. When the patient is consuming anticoagulant drugs and the dentist must perform a procedure that involves bleeding, this drug must be suspended, with the doctor who determines when and for how long it will be suspended, leaving the dentist subject to his decision.
• Poor oral hygiene: generally associated with physical, motor and cognitive limitations that also affect this area, in addition to the performance of other hygiene habits.