Year : 2016 | Volume
: 27 | Issue : 1 | Page : 1--2
Ageing an opportunity for all
Angus William Gilmour Walls
Director, Edinburgh Dental Institute, 4th Floor, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA, UK
Angus William Gilmour Walls
Director, Edinburgh Dental Institute, 4th Floor, Lauriston Building, Lauriston Place, Edinburgh EH3 9HA
|How to cite this article:|
Walls AW. Ageing an opportunity for all.Indian J Dent Res 2016;27:1-2
|How to cite this URL:|
Walls AW. Ageing an opportunity for all. Indian J Dent Res [serial online] 2016 [cited 2019 Nov 23 ];27:1-2
Available from: http://www.ijdr.in/text.asp?2016/27/1/1/179804
Ageing is inevitable and affects us all. The population of the world is growing older rapidly. The life-expectancy of humankind grew more in the 20 th century than in the whole of the prior previous millennia of human evolution. This has occurred largely due to public health measures and changes in lifestyle that reduce the risks of death around birth and in younger people. The rate of change is far ahead of the ability of evolution to drive change. Indeed, the evolutionary process has been outflanked by humankind as evolutionary pressures are all about the ability of a species to reproduce rather than for longevity beyond reproductive age.
These changes are resulting in a unique series of challenges for humankind in terms of health and social care but also pose real challenges both in terms of dental education and in relation to the delivery of dental care. These challenges are compounded by the good news that people are retaining more teeth into their older age. This reduction in the rate of edentulism worldwide is undoubtedly good for people but poses educators and the profession challenges in terms of how we deliver high-quality care to those who still have no natural teeth, especially as there is an increasing social inequality in the proportion of people with no teeth so that edentulism is rapidly becoming a dental state associated with people from poorer socioeconomic backgrounds. This sector of the population is least likely able to afford the costs of dental implants and most likely to suffer in terms of poor dietary choices in terms of higher sugars and fats intake. Putting social gradients to one side, reduced numbers of people with no teeth will pose significant barriers to the delivery of complete denture prosthodontics education in undergraduate programs. If this cannot be delivered, the profession needs to think very carefully about how this undoubted and much-needed skill set can be maintained, complete denture prosthodontics is both skill and art, both need to be exercised regularly to be maintained.
Being dentate, or most likely partially dentate is not without its challenges in the future. Caries does not go away when we get old. The pattern of disease is different however, new pit and fissure or smooth-surface caries is relatively rare in current older cohorts, unless there is a significant change in the oral environment (e.g., with xerostomia). Caries in older adults usually occurs either around existing restorations or on exposed root surfaces where dentine is more susceptible to caries due to its higher pH for demineralization. Strategies for caries prevention are similar in older people compared with the young, minimizing free sugars intake, maximizing oral hygiene with the use of fluorides in various forms as a cornerstone. From time-to-time, and particularly in people with xerostomia, the addition of a calcium phosphate compound into the mix to provide mineral for remineralization and repair of any damaged tooth tissue is critical to preventing the development of decay.
Ageing results in alterations in the cell-mediated immune response that alter the pattern of inflammation in older individuals. This drives a more aggressive inflammatory response to plaque giving florid marginal gingivitis, the same changes in immune response mean that patients with deep pockets are more likely to see disease progression and those with shallow pockets less likely compared with the young.
Both periodontal disease and caries are diseases that require plaque to be present on the tooth surface. Both are preventable with plaque removal for periodontitis and a mix of plaque removal, minimizing acid attacks and enhancing remineralization for caries. The "simple" task of plaque removal does become more of a challenge for the older consumer as a consequence of a combination of sarcopenia making oral hygiene physically tiring, altered gingival architecture making the shapes of the surface to be cleaned more complex, particularly when they become concave rather than convex, and reduced visual acuity through presbyopia and cataract formation making it difficult for our clients to see what they are trying to achieve. Strategies need to be adopted to allow older people to cope with personal oral health care in their own terms rather than a rigid mantra of doing the same thing twice a day.
Dental care for older people is different and needs an adapted approach but the opportunity to help the oldest and some of the most vulnerable is a privilege that the profession needs to grasp and take forward.