Despite all efforts of dental professionals, the net prevalence of severe periodontitis was increasing globally between 1990 and 2017. Is the ageing tendency a possible explanation? Dr. Eric Thevissen has been highlighting the increasing need for supportive dental and periodontal care for elders for years now. Below are his answers to some of the questions raised during the Curaden Academy‘s webinar on ageing and periodontal disease.
If you would like to learn more about the connection between ageing and periodontal diseases, read the article written by Dr. Eric Thevissen. See the PDF of the study here.
1. How important are regular cleanings for patients with periodontal disease?
It is generally assumed and agreed that the more regularly a patient comes to see you and the more he/she receives cleanings and therapy, the better. But isn’t there a risk of overtreatment? To this purpose, the periodontal risk assessment index by Lang and Tonetti (1) (cfr supra) is designed to enable the practitioner to determine the optimal frequency and extent of professional support. It is specifically created so as to not have big intervals between cleanings.
Especially during this unique Covid-19 period, we’ve experienced patients delaying their dental visits for fear of contamination risk which has led to more patients with refractory periodontitis, complaining of periodontal abscesses. This obviously illustrates that supportive therapy is necessary and that the determination of risk levels prevents both undertreatment and excessive overtreatment. Last but not least, one shouldn’t forget to register full periodontal charts on a regular basis to keep an overview and detect in good time dormant sites which might need special attention or periodontal surgery.
2. Can dental care cause tooth loss over time?
In a publication by Vibeke Qvist et al., in 2015 (2), the evidence-based paradox was set that permanent tooth restorations are not permanent in the true sense of the term, since they have a limited lifetime and once restored, the filling is likely to be replaced several times in a patient’s lifetime in a cycle that might end with the destruction of the tooth – the so called ‘death spiral’.
Their recommendations were to wait with other treatments until it is obvious that arrestment of the disease is unlikely, and to prolong the durability of any restorations through optimal use of restorative materials, prevention of recurrent disease and improved diagnostics of restoration quality. It must be said that since the composite restorations are the gold standard, fillings seem to be replaced more often than in the amalgam age due to complications such as leakage, endodontic problems and tooth fracture.
“Especially during this unique Covid-19 period, we’ve experienced patients delaying their dental visits for fear of contamination risk which has led to more patients with refractory periodontitis, complaining of periodontal abscesses.”
3. Do you always recommend your patients to take out their dentures overnight?
It is strongly recommended to take dentures out overnight as the gums need some rest as well as ventilation. If the gums are covered twenty-four hours a day, they can become spongy and more vulnerable since bacteria and fungi (candida albicans) love to live in warm and humid conditions. Furthermore, especially around dental implants, overdentures cause plaque-related gingival hyperplasia, as the negative pressure of dentures triggers the gingiva to rise.
The gums get sensitive and start bleeding during home care, and implants become more difficult to clean and so develop biofilm. As a periodontist placing implants, during a patient’s visit I can easily see whether the dentures are being taken out or not, I don’t have to ask.
Ageing & periodontal disease: Look before you leap
How can you deal with the common symptoms of oral changes brought on by ageing? What is the link between general health and untreated periodontal disease? And how can you best prevent these problems with elderly patients? Find out more about ageing and periodontal disease from Curaden Academy’s webinar with Dr. Eric Thevissen.
4. Do you have any comments about the maintenance of implants for elderly patients?
This is a hot topic, although maintenance of implants is not only restricted to elderly people. In the new classification of periodontal diseases, the typical characteristics of implant mucositis and peri-implantitis are well defined, but there is still a way to go before we reach consensus about the treatment protocols. It was the team around prof Klaus Lang (3) who first published the article about cumulative interceptive supportive therapy, which aims to detect signs of infection before a substantial part of the supporting bone is lost.
The importance of preventive care has to be emphasised by trying to keep peri-implant mucosae healthy and firm from the first day on. As with natural teeth, the long-term success of implant therapy depends on maintenance therapy. Maintenance therapy should start with intervals of three months. Then the recall frequency can be adapted based on the plaque-control level of the patient, and the comparison of their present and past clinical measurements and X-rays. In some cases a high recall frequency is needed because of the presence of a local risk affecting one or more implants. Especially when patients with implant-supported prosthesis become disabled or when they develop impaired motor skills, they become dependent on family or relatives for daily hygiene care. In this domain there is still room for improvement.
Concerning therapy strategies, we see more questions than answers. Should it be done ultrasonically with special titanium-coated inserts so as to not harm the implants? Or should we clean implants with titanium brushes and saline water while working in an open field? Or should we rather choose the airflow device filled with chlorhexidine-containing powder for subgingival use? There are many possibilities, and a lot of research is still ongoing. What I regularly utilise myself is the rinsing of the implant pockets – on a regular basis – with the consecutive use of a mouth rinse containing chlorhexidine 0.12%, a hydroxy-peroxide with 3% volume, saline, and a polyvidon-jodium mouth rinse.
5. Has any specific research been done on the oral hygiene performance of elderly people?
If a patient’s general health condition gets worse or if he or she takes a lot of medication, oral health usually worsens. In this case, the patient’s relatives should check if the patient’s oral hygiene routine is still at a good level. The fact is that most nurses are not trained to effectively help the elderly to take care of their teeth, or there is not enough time for them to do so due to understaffing. On the other hand, some elderly patients refuse to allow nurses to take care of their oral situation. There is definitively a call for better assistance to dental hygiene in care homes for elderly people. In Belgium the first steps are being taken to organise the so called ‘care for special needs’.
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- Lang, N. P. & Tonetti, M. S. (2003) Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health & Preventive Dentistry 1, 7–16.
- Qvist V. 2015. Longevity of restorations: the ‘death spiral’. In: Fejerskov O, Nyvad B, Kidd E, editors. Dental caries: the disease and its clinical management. London (UK): Wiley-Blackwell. p. 443–456.
- Tamim, Abdul Naser & Junaibi, Arif & Banday, Ninette. (2010). Cumulative Interceptive Supportive Therapy (C.I.S.T). 10.13140/2.1.3208.4488.