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Endodontic therapy and the elderly patient – Mark Allen – Coltene

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  Posted by: The Probe      27th June 2019

The challenge that the UK’s ageing population will present to health and social care provision is a pertinent topic. In 1948, when the NHS was founded, just over half of the population lived beyond the age of 65; now that figure is around 14 per cent.[i]Although there is new evidence that life expectancy is stalling[ii], according to projections over 20 per cent of the UK will be aged 65 or over by 2027.[iii]

Advances in research, science and technology have given us wonderful things, but a longer life isn’t always a healthier one. Dentists, like healthcare professionals in every discipline, will be treating more patients who are physically and mentally frail and find it hard to communicate. Older patients can lack the dexterity to clean their teeth properly and diet is often poor because shopping for and preparing healthy meals from scratch is problematic. They may miss routine appointments. Older adults can be susceptible to xerostomia and impaired salivary flow can cause a range of oral health problems, such as a propensity to dental caries. The patient may wear dentures, or the teeth may be heavily restored following decades of wear and tear. Gingival recession is more common in the elderly too.  

 

On a positive note, tooth retention has increased. In the last Adult Dental Health Survey, the majority of adults in everyage group – including the over 85s – were dentate; the first time this has been the case in the series.[iv]This also reflects the increasing trend to want to avoid extraction (if possible) and preserve the natural teeth. This will apply to your older patients too and is another challenge that dentists will be facing.

The modern dental landscape has shifted towards prevention, but practitioners will be treating elderly patients who may have been subject to years of dental disease and invasive procedures – even if they do present with a generally good level of oral health. Endodontic therapy will be required in some cases, to maintain their level of oral wellbeing that, in turn, will support general good health. Endodontics to save a tooth from extraction may be deemed necessary if the tooth is needed in order to help support surrounding prostheses in place. Other strategic reasons to treat a patient endodontically include if extraction would affect function, speech and eating and/or aesthetics. Practitioners should not underestimate the impact that poor aesthetics can have on the confidence and self-esteem of elderly patients. Being too embarrassed to speak or smile can be devastating, exacerbating any feelings of social isolation, loneliness and ultimately depression that are common for this vulnerable demographic.

During treatment planning for elderly endodontic patients, there are many risk factors that need to be taken into consideration before proceeding. Consent to dental treatment means that they understand the alternatives, limitations and consequences as well as what the process entails, including rehabilitation and aftercare. The elderly patient must be motivated to maintain their oral health following endodontic therapy. A full and thorough assessment of medical as well as dental history is important. Pre-tests, as well as the usual radiographs, will need to determine if and how old age has affected the pulp and surrounding tissue. There is the possibility of various pulpal changes due to ageing – including a decrease in the number and size of pulpal cells, vascular changes and arteriosclerotic changes – as well as issues due to dentine formation.

Once the patient has consented to treatment and all the relevant checks have taken place, efficient and ethical preparation is key. Proper irrigation of the root canal system will increase the chances of the treatment being a success. Reinfection for an elderly patient could have devastating consequence, so all debris and microorganisms must be assiduously removed. Along with scrupulous cleansing, the impact of any injury to this delicate area for elderly, vulnerable patients would be tremendous. In order to achieve endodontic success for these individuals, the practitioner must not only have the required level of skill, but selecting the right products and tools is fundamental. CanalPro™ Irrigation Solutions from COLTENE can be used for the irrigation/debridement of root canals during and after instrumentation. Multiple solutions are available to achieve a variety of goals, such as dissolving vital and necrotic tissue and lubricating the canal system. In order to cleanse well, the canals must be enlarged and shaped properly and endodontic practitioners might want to try the HyFlex™ EDM NiTi files, also from COLTENE.

Dental professionals will not only be treating more elderly patients in the future, but more edentate elderly patients, who want to avoid extraction just as much as younger ones do. Get endodontics right for this age group and you can dramatically improve both their general as well as their oral health related quality of life. Successful endodontic therapy for elderly adults requires skill, excellent planning and the very best tools for consistently successful outcomes.

To find out more visit www.coltene.com, email info.uk@coltene.comor call 01444 235486

 

References

[i]Making our health care systems fit for an ageing population. The King’s Fund. Published 6 March 2014. Link: https://www.kingsfund.org.uk/publications/making-our-health-and-care-systems-fit-ageing-population(accessed November 2018).

[ii]Stalling life expectancy in the UK. The King’s Fund. Published 28 September 2018. Link: https://www.kingsfund.org.uk/publications/stalling-life-expectancy-uk(accessed November 2018).

[iii]Office for National Statistics. Overview of the UK population: November 2018. Release date: 1 November 2018. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/november2018 – the-uk-population-is-ageing(accessed November 2018).

[iv]Adult Dental Health Survey 2009 – summary report and thematic series. NHS Digital. Published 24 March 2011. Link:https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series(accessed November 2018).


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