Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
Last week I received a telephone call from a general dentist with questions regarding an elder patient. He had seen a new patient that morning that had both medical and dental problems. The patient was a 67 year old retired teacher requiring some restorative treatment, two crowns and a moderate periodontal therapy. His past medical history was significant for diabetes mellitus, hypertension, a cerebral vascular accident (stroke) and a total hip replacement 4 months earlier. This patient's medical history was typical of many of our older patients and his stroke, as well as his recent total hip replacement warranted special consideration.
The most common chronic disease of the elderly include heart disease, cerebrovascular disease, cancer, pulmonary disease, and diabetes. Each of which may raise special dental concerns. One example is curtailing the use of epinephrine containing local anesthetics in the cardiac patient. Stroke patients are frequently taking coumadin or other blood thinning medications that may impact the scaling of teeth as well as impressions for teeth prepared for crowns. Cancer and its treatment may cause reduced salivary flow resulting in an increase in caries. Patients with chronic obstructive pulmonary disease (C.O.P.D.) require being seated in a more upright position. Patients with diabetes are more prone to periodontal disease and are at higher risk of infection in the poorly controlled diabetic. The need to provide small "snacks" or having glucose drinks available if the patient's visit is lengthy should be considered. Many of the medications taken by older adults can also have adverse oral effects especially the anti-hypertensive and anti-depressant medications.
As the elderly population continues to grow, it will be even more important for the dental profession to be aware of these chronic diseases and impairments of old age. The Baby Boomer generation will soon become the largest segment of our population and that will produce more and more senior citizens along with more and more patients with medical issues. Awareness of health issues and medical treatments will enable us to treat our patients to the best of our ability.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery