Introduction:

Geriatric dentistry is a specialized field within dentistry focused on delivering dental services tailored to the needs of elderly individuals. It involves diagnosis, prevention, management, and treatment of problems associated with older adults. Dental treatment for geriatric patients typically begins at the age of 65 years and older. At this age, patients might be subjected to dental disease and restorative procedures. These procedures cause adverse effects on the pulp, periradicular, and surrounding tissues. The combination of dental needs and an increase in pathosis along with greater expectations lead to more endodontic procedures for older adults.

Age changes in teeth:

• Wear and attrition

• Change in form and color

• Increase in brittleness of enamel

• Resorption

• Obliteration of dentinal tubules

• Dentinal sclerosis

• Reduced blood supply to teeth

• Increase in pulp stones with age

• Calcification

Endodontic challenges in geriatric patients:

• Psychological issues

• Dry mouth

• Removable partial dentures

• Pulpal calcifications

• Communication challenges

• Postural problems

• Gingival recession

• Rubber dam isolation

• Periodontal problems

• Heavily restored teeth

• Erosion

• Abrasion

• Attrition

Diagnosis and treatment plan:

• Chief complaint:

The most common cause of pain in older individuals is a pulpal or periapical issue that requires root canal treatment or extraction. Patient must be asked about the stimulus, or irritant that causes pain. The nature of the pain (radiating/localized) must be asked. This information helps determine whether the source is pulpal or periapical.

• Past dental history:

From the past dental history, the patient’s knowledge about the dental treatment can be assessed. The psychological attitude and expectations of the patient can be understood.

• Medical history:

As patients are in an old-age group, they should be asked whether they are taking any medications or undergoing any therapy. Aging can result in respiratory, central nervous system, and cardiovascular changes. The renal and liver functions of the patients should be considered while prescribing the drugs.

• Examination of the patient:

Extraoral and intraoral examinations must be conducted to get useful information regarding the disease and previous treatment done. Mostly, older individuals are affected with:

-   Missing teeth

-   Gingival recession

-   Root caries

-   Reduced mouth opening

-   Continued cementum deposition

• Pulp Vitality Tests: Cold tests, heat tests, electric pulp tests, and test cavities help assess the pulp. These tests are not fully accurate due to extensive calcification and reduced size of the pulp cavity.

• Radiographs: Radiographs help in identifying the status of the tooth and plan the treatment accordingly. The following problems are encountered while taking the radiographs:

- Presence of exostoses, tori, and denser bone requires increased exposure time for proper diagnosis.

- Older individuals might be less capable of holding the film in an accurate position

• Treatment plan:

1. The main aim of the treatment is the removal of the pain and infection

2. It is safe to obtain valid consent for medically compromised patients

3. Morning appointments are preferable

4. Single appointment procedures are preferred as these patients might have physical problems

• Anesthesia: As the volume of the pulp chamber is difficult in geriatric patients, intrapulpal anesthesia is difficult. The depth of the anesthesia must be checked before repeating the procedure.

• Isolation: Rubber dam serves as the best method of isolation

• Access to canal orifice: Radiographs help in the determination of canal position, axial inclination of root & crown, root curvature, and extent of the lesion

• Cleaning and shaping: DG 16 explorer is used for the initial assessment of the orifice

- Nickel-Titanium files no rake angle is preferred for cleaning and shaping

- Identifying apical constriction can be challenging in older patients due to decreased periapical sensitivity.

• Obturation: The lateral compaction technique is preferred in these patients.

 Prognosis:

The prognosis depends on many local and systemic factors in the case of vital pulp. In the case of nonvital pulp, the repair is slow due to:

• Atherosclerotic changes

• Reduced rate of bone formation and resorption

• Increased mineralization of the bone

• Altered viscosity of connective tissue

Conclusion:

Geriatric dentistry is crucial for safeguarding the oral health and holistic well-being of older adults, who often encounter various oral health issues such as tooth loss, periodontal disease, dry mouth, and oral cancer as they age. This specialized field of dentistry provides tailored care specifically designed to address the distinct needs of elderly patients. This includes conducting thorough oral assessments, implementing preventive strategies, administering restorative procedures, and effectively managing oral diseases.

References:

1.    Charles H Rankin. Geriatrics in Endodontics. Tuft University 2007.

2.    Geriatric Endodontics: Meeting the Challenge. Australian Dental Association 2009

3.    Holm-Pederson P, Loe H. Textbook of geriatric dentistry. 2^nd edition London: Wiley; 1997

(By Dr. ANJALI KV)