انت هنا الان : شبكة جامعة بابل > موقع الكلية > نظام التعليم الالكتروني > مشاهدة المحاضرة

Lec. 5 Preventive program for elderly people

الكلية كلية طب الاسنان     القسم التقويم والاطفال وطب الاسنان الوقائي     المرحلة 5
أستاذ المادة حسن فليح فرحان السلطاني       6/8/2011 7:29:55 PM

                                                                                         
Preventive program for elderly people
Elderly has been defined as a chronological age of 65 years old or older.
Those from 65 through 74 years old are referred to as "early elderly" and those over 75 years old as "late elderly."

Physiological age changes:
I- General body changes:
The changes in the elderly are:
1- Impairment of tissue repair. 
2- Loss of muscle mass (sarcopenia) and strength.
3- A reduction in the metabolic rate. The basal metabolic rate (BMR) reduces with age. After 20 years of age it drops about 2% per decade.
4- Reduction in cellular reproduction, this delays the repair process.
5- Reduction in the blood circulation.
6- Increase in fibrosis.
7- Degeneration of the elastic and nervous tissue.
8- A loss of cartilage and bone.
II- Oral changes:
A- Oral soft tissues: These include:

1- Decrease in taste bud function.
2- Increase in the size and number of Fordyce spots (enlarged ectopic sebaceous glands in    the mucosa of the mouth, lips, cheek and tongue), lingual varices and foliate (leaf-like) papillae.
3- Decrease in the thickness of the epithelium and mucosa.
4- Decrease in saliva flow (xerostomia) and changes in its composition.

B- Dental hard tissues:
1- Tooth wear is a natural age-related factor. There is a loss of tooth tissue due to:
1. Attrition resulting in a loss of occlusal morphology.
2. Abrasion can be excessive at the cervical margins as a result of prolonged incorrect tooth brushing techniques.
3. Erosion may be more evident as a result of prolonged intake of acid- based or sugary medication.
2- Enamel is less permeable (permeability of enamel come from continuous ionic exchange).
3- Cementum undergoes continuous deposition with age.
4- The volume of secondary dentine increases.
5- There is a reduction in cellularity in the alveolar bone and the surface in contact with the periodontal ligament appears more jagged.

 

C- Dental pulp:
1- Increase in fibrosis and a decrease in vascularity.
2- Increase in pulp calcification. Pulp stones are more evident.
3- The volume of the pulp decreases with age, owing to the deposition of secondary dentine.
D- Periodontium:
1- An increase in fibrosis.
2- A decrease in cellularity, vascularity and cell turnover is found with an increase in age.
3- Collagen and protein synthesis decrease.

Pathological change
I- Systemic              II- Oral

I- Systemic: It includes:
A. Endocrine disorders:
1. Hypofunction of the adrenal glands (Addison s disease):
This can produce symptoms of tiredness and confusion.

2-Hyperfunction of the adrenal glands (Cushing s syndrome):
This can be due to, for example, a pituitary or adrenal tumors or by high steroid dosage.

3 -Diabetes Mellitus:
It is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. Diabetes Mellitus is of 2 types (Type I and Type II) Type II diabetes is the most common type seen in older people. Diabetes mellitus accelerates the periodontal diseases, high risk of fungal infection, decreased salivary flow, and increased caries if uncontrolled.

4-Hyperparathyroidism:
Excess of parathyroid hormone (PTH) which responsible for calcium homeostasis- is usually a result of a tumor in parathyroid gland. It results in demineralization of the bone, causing possible bone fractures, and renal calculi may develop because of the excretion of high levels of phosphate and calcium.

5 -Hypothyroidism (myxoedema):
This is a condition in which the body lacks sufficient thyroid hormone (thyroxin). Since the main purpose of thyroid hormone is to maintain the body s metabolism, people with this condition will have symptoms associated with a slow metabolism. Its incidence increases with age and such patients appear lethargic and slow, have cold dry skin and may have an enlarged tongue. They respond poorly to stress.
 
B-The immune system: It may be impaired due to:
1-Immunesuppressive drugs.
2-Malignancy.
3-Disease such as DM, Gushing disease.
Those patients are at high risk for fungal and viral infection and oral ulceration.

C-Cardiovascular disorders:
Hypertension and ischemic heart disease become more common with an increase in age. Anemia is also more common in the elderly. Generally, the greatest problems with patients with cardiovascular disorders are associated with general anesthesia.

D-Muscular system:
There are a number of muscular dystrophic diseases which are associated with a decrease in the bulk of the muscle, with slower contractions and less precision of control.

E-Neurological disorders:
1) Parkinson s disease:
The symptoms include tremor of the hands and arms, drooling due to swallowing difficulties, postural instability and speech difficulties.

2) Alzheimer s disease:
This is a form of dementia and is due to a wasting of nerve fibers in the brain.

3) Cerebrovascular accident (stroke):
This is more common in elderly. It is caused either by ischemia or due to hemorrhage.

F-Psychiatric disorders:
1) Depression:
This condition is not specifically related to age but is not uncommon in the elderly.
• These patients may exhibit signs of oral neglect.
• They may have symptoms of xerostomia due to drug therapy.

Preventive and treatment program for elderly patient with systemic disease.
The dentist should follow the following:
1. The approach to an elderly patient should be with respect because elderly patient have a lack of self- motivation and low self- esteem.
2. Elderly patient usually require extensive oral hygiene instruction and supervision with plenty of positive encouragement.
3. Avoidance of waiting for long time before the patient enters to the dentist.
4. Appointments are best keep short.
5. Elderly patient may have difficulty in swallowing and may tolerate treatment better in an upright position; they may have to be treated in their own wheelchair or in a domiciliary setting.
6. Patients on steroid therapy are susceptible to a steroid crisis and their physician may advice an increase in dosage when undergoing stressful dental treatment.
7. Dental treatment for the patient with Parkinson s disease can be improved by the provision of moldable head support and mouth probe and the treatment can usually be more successful if undertaken within 2 hours of taking anti¬parkinsonian medication.
II- Oral: It includes:
A) Leucoplakia:
This presents as white patches on the oral mucous membranes which cannot be removed by scraping. It most commonly occurs between the ages of 40 and 70 and is more common in males (65%). It is usually located around the buccal gingiva or the floor of the mouth. It can be associated with tobacco, alcohol or chronic persistent irritants, such as ill-fitting dentures. It requires investigation since these lesions can be considered to be pre-cancerous until proven otherwise.

B) Oral cancer:
Oral cancer is a relatively uncommon condition it does increase in occurrence in older adults. The most common sites are the lips followed by the tongue. Approximately 90% of oral carcinomas are squamous cell carcinomas.

C) Candidal infection: This can be either chronic or acute.
Acute candidosis (candidiasis) or thrush is most common in the young, elderly and the immunosuppressed. It presents as a creamy white slough which can be gently removed to reveal a raw red mucosa, usually on the palate, oropharynx or cheek. The patient often complains of discomfort on eating, but it can be painless.
Chronic candidosis (candidiasis) or, more commonly, denture stomatitis is usually symptom less. It is commonly seen on the palate underneath a full or partial upper denture, as a reddish area with some white patches.
Treatment is topical or systemic antifungal agents (Nystatin 100,000 unit 4 times daily for 7 days).

D) Lichen planus:
The intraoral presentation can be bilateral and/or symmetrical white patches affecting the buccal mucosa, tongue and attached gingivae. Lichen planus has been divided into erosive, plaque-like, reticular, atrophic or bullous.

E) Herpes zoster:
Acute self-limiting viral disease, and is due to reactivation of varicella¬zoster virus. More common with the increase in age.

F) Pemphigus:
This is an autoimmune chronic skin disease. The first identifiable lesions are found in the mouth and are more common in females than


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .