Older adults at a greater risk for oral health problems

Most people do not quite appreciate the importance of the close relationship between oral health and general health. Classically, the natural aging process puts older adults at greater risk for oral health problems because they experience declining physical and/or mental status, exposure to medications for age-related systemic conditions and reluctance to seek routine dental care. In fact, because of this reality, in some developed countries there are dental clinics that only attend to persons who are sixty-five years and older.

Studies have shown that people over 65 years of age account for at least one-third of all prescription drug use. Elderly patients seeking dental treatment are presenting medical histories that are increasingly more complex. Medications are a concern for the elderly because they cannot only alter the body’s defense mechanisms, but also the body’s physiologic, immunologic, and biochemical status. When elderly patients present themselves for dental treatment they are likely to be on multiple drug regimens, so the health professional will need to avoid complex drug regimens because they are costly, patient compliance decreased at this age and the chance for adverse drug reactions and interactions is greatly increased in this population. It is mandatory for dentists to have a comprehensive medical history before treatment or medications are prescribed. Elderly patients should furnish a list of all medications they are taking and their dosage to dentists before treatment is started. Many dentists will want to contact the patient’s primary physician and any other involved professionals before treatment is started, so bring this information with you on your first visit to the dentist’s office.
Medications taken by patients are responsible for dry mouth and other salivary gland problems; abnormal bleeding when brushing or flossing; gingival overgrowth; inflamed or ulcerated tissues; micro flora imbalance; mouth burning, numbness, or tingling; movement disorders; soft tissue alteration and taste alteration.
Many of the medications commonly prescribed to elderly patients have both systemic effects and product adverse reactions in the oral cavity. If an antibiotic is necessary, by all means take it as directed. However, if diarrhoea, especially bloody stools, occurs, call your dentist immediately. Elderly patients do not absorb antibiotics are readily as younger patients. Colon problems are not limited to elderly patients, but they are more frequent in that population. Many anti-inflammatory drugs cause gastric irritation, and may product ulcers.
The drug most commonly prescribed to the elderly are for treatment of cardiovascular disease. In this group, diuretics used to manage hypertension and drugs from the nitrate group used to treat anginal symptoms can cause dry mouth. Many antihistamines also contribute to dry mouth and eyes. Coumadin, a drug used to treat stroke victims is an anticoagulant that can cause bleeding problems when dental treatment is performed. Invasive treatment should not be done without close monitoring of bleeding times. Spontaneous bleeding in the mouth indicates over dosage.
Some antibiotics, such as tetracycline, can be inactivated when taken with antacids. Since many elderly patients take multiple medications and over-the-counter (OTC) items, they need to list on their health history all items (prescribed or OTC) before they see the dentist for treatment.
Aspirin is commonly taken for arthritic conditions. Some doses are near toxic levels. A reaction could be precipitated if the dentist were to prescribe one of the many common aspirin-containing medications to a patient who was already taking large doses of aspirin. It is generally recommended that aspirin intake be stopped one week prior to invasive dental treatment.
Codeine-containing analgesics are commonly prescribed for oral pain. A major side-effect is constipation. Patients should discuss this problem with their dentist and/or pharmacist before having any prescription filled.
Your dentist should know about heart disease, heart valve damage, joint replacements, and bypass operations before he starts your treatment. Some of these conditions might require antibiotic coverage as suggested by the American Heart Association, before treatment is started.
In general, the half-life of most drugs is increased in the elderly population. The diminished microsomal enzyme activity in the liver makes the metabolism of drugs slower, and excretion is prolonged because of renal clearance. This results in an increased duration of drug action in the elderly, making the chances of drug interactions and adverse drug reactions higher in this population in comparison with younger people.
 Written By Dr. BERTRAND R. STUART D.D.S

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