Modified Treatment Planning

Old but still mentally and physically healthy patients usually do not require any changes in dental treatment planning. However, in patients who are mentally and/or physically handicapped, the treatment plan must be adapted to the actual situation. Teeth with a questionable prognosis should probably be extracted. A perhaps somewhat extreme approach would be to treat periodontally only those teeth that can be expected to be maintained until life’s end.

Missing teeth in non-visible jaw segments beg the question of whether replacement is necessary. If replacement is un-her/his age-related inflexibility, often knows better what to do—or what not to do—than the dental team itself.

Also severe systemic diseases such as diabetes, Alzheimer’s, tumors, autoimmune disease, Parkinson’s, hematologic disorders, and medication side effects must influence the oral/dental treatment plan significantly.

In general, manual dexterity decreases with age. Elderly patients with diseases such as those listed above may often not understand the importance of oral hygiene, or may be incapable of performing it. It is not always possible to replace the manual toothbrush with an electric device or by medicinal oral rinsing (CHX; cf. p. 235). The result is often greater plaque accumulation, and as a result, gingivitis and even periodontitis. Statistical studies have demonstrated that periodontal diseases develop more rapidly and more severely in the elderly as compared to young persons (Im-feld 1985). Nevertheless, periodontitis can no longer be categorized as a “disease of aging.”

In addition to the previously discussed systemic health problems and oral hygiene difficulties of elderly patients, the dentition will also exhibit manifestations of age such as attrition, abrasion, gingival recession and tooth discoloration.

Avoidable for functional reasons, a removable partial denture is often preferable to a fixed reconstruction.

It is better to incorporate a dental prosthesis at an age at which the patient can become accustomed to it, instead of persisting with years-long (decades-long) periodontal therapy, leading finally only to a complete denture that the patient can no longer successfully accept.

Teeth need not be maintained “at all costs” in elderly patients; rather it is the sense of oral well-being (health, function, phonetics, esthetics) and therewith the patient’s own feeling of self worth.

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  • Category: Dental disease