Treatment planning considerations in the older adult with periodontal disease

Abstract

Periodontal health in the elderly is influenced by numerous factors, including systemic conditions, patient compliance, age‐associated changes, and restorative procedures. The numerous comorbidities seen in the elderly necessitate individualized approaches for treatment planning. In this paper, we review how age, comorbidities, oral hygiene, and restorative dental procedures collectively influence the treatment and management of the periodontium in the elderly. The elderly population is predicted to double in 30 years, which will have an economic impact the dental profession needs to plan for. Preventative and noninvasive treatment, supportive periodontal therapy, and patient‐specific maintenance plans are imperative to maintaining oral health in the older population. Multiple coexisting changes, including xerostomia, altered wound healing, altered bone physiology, altered microbiome, and diminished plaque control, can add complexity to periodontal management. Considerations of the patient's general health, the selected periodontal treatment plan, and the selected completed restorative procedures need to be considered. The influence of caries, fixed prosthodontics, partial dentures, shortened dental arch, and implant therapy can have unintended impacts on periodontal health in the elderly. Adverse periodontal outcomes in the elderly can be minimized by carefully assessing the patient's medical history, impact of medications, functional needs, properly finishing and contouring restorations to avoid plaque accumulation, and designing restorations to allow access for hygiene. Partial dentures can be a source of plaque accumulation leading to periodontal disease, caries, and recession around abutment teeth. A shortened dental arch should be considered as a functional and cost‐effective alternative to partial dentures. With dental implants, the patient's tissue phenotype, keratinized tissue quantity, risk of peri‐implantitis, and patient access for maintaining adequate oral hygiene are all important to consider. Implant risk‐assessment tools show promise by providing a systematic approach for early diagnosis to avoid future complications.

The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study

“…The oral healthcare giver has to take into consideration any other coexisting pathologies-other health issues such as xerostomia, presence of dental plaque, caries, prosthetics and also systemic diseases that could lead to altered wound healing and altered bone physiology and could influence the treatment and the prognosis [ 16 ].…”

Antimicrobial agents in dental restorative materials: Effect on polymerization, short‐term drug release and biological impact

“…Resin‐based composites are nowadays commonly applied as permanent filling materials. However, their use also encompasses use as temporary dental restoration materials (e.g., temporary crowns and bridges), which in the same way as subgingival composite restorations may be in close contact with the gingival tissue, which may be inflamed [7, 8]. In this context, several scientific studies investigated the provision of dental restorative materials with antimicrobial ingredients usually used in dental prophylaxis like octinidine (di)hydrochloride (ODH) or chlorhexidine diacetate (CHX).…”

Research progress of implant restoration in the treatment of periodontal disease

“…Some other studies have also shown that smoking is one of the important factors affecting bone loss around implants. [19] In related studies, smoking patients with periodontal disease have significantly lower repair success rate than non-smoking patients, and the probability of peri-implant inflammation is about 80-85% and 20-30% respectively. (3) Diabetes: another important risk factor for periodontal disease is diabetes mellitus.…”