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EXTREMES OF AGE
Chris Sproat
The elderly
The UK population is ageing, with 16% over the age of 65.
This group of patients will place increasing demands on
the dental services as their numbers continue to increase
and expectations of treatment rise. Maintenance of a
healthy dentition into old age is important for a good
quality of life and general wellbeing.
Epidemiology. In the last 30 years the number of people aged
65 or over has increased by 28%. This is mainly due to the
number of births in the post-war years with a lesser contribution from decreased mortality.
As people live longer the gap between life expectancy
and healthy life expectancy is increasing. This means that
we will experience more years of poor health.
Ageing is not just a physical process: there are important
social and psychological aspects which must be appreciated in order to deliver dental care appropriately.
To think of patients in terms of their biological age rather
than the chronological age is often useful when assessing
an individuals suitability for treatment.
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Extremes of age
Table 15.1
Oral side-effects of commonly prescribed drugs or class
of drug.
Oral side-effect
Drug/class
Bleeding
Increased infection risk
Erythema multiforme
Gingival hyperplasia
Lichenoid reactions
Oral ulceration
Altered taste
Dry mouth (xerostomia)
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Tooth loss
One in four of the over-65 age group have lost all of their
teeth. Despite this more patients are retaining some or all
of their teeth into old age and therefore require more
complex restorative treatment. Teeth that require extraction are likely to be heavily restored and more likely to
require a surgical approach.
Periodontal disease
The incidence of periodontal disease increases with age;
half of those over 55 have periodontal disease.
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Extremes of age
Oral cancer
There is an increased incidence of oral cancer with age,
especially if there is a past history of smoking and excess
alcohol consumption.
Dry mouth
This is most commonly due to side-effects of medications
taken (see Table 15.1). Other causes include:
salivary gland disease, e.g. secondary Sjgrens
syndrome
jaw irradiation for treatment of malignant disease
dehydration.
Management
In order to treat elderly patients in an appropriate and safe
manner it is important to:
Appreciate the specic needs of this group of
patients.
Assess each individual in terms of their physical,
social and psychological capability.
Be aware of the oral manifestations of systemic
diseases and the impact they may have on the
treatment plan.
Avoid interactions with and look for the oral
side-effects of drugs taken. Remember that patients
may have difculty in swallowing tablets so be
prepared to prescribe medicines in elixir forms.
Take a multidisciplinary approach and liaise with
other individuals responsible for each patients care,
e.g. general medical practitioner, carer,
physiotherapist, occupational therapist, family, etc.
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Autism
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The young
Children under the age of 16 make up 20% of the UK population and they present a number of unique management
issues, from behavioural problems to suspected abuse,
which a practising dentist will have to deal with on a daily
basis.
Most children have erupted teeth from the age of 6
months and may present for dental treatment.
Behaviour management is the main issue for dentists in
the treatment of children; there are, however, specic
childhood conditions and illnesses that should be understood in order to deliver safe, effective treatment and
advice.
The presentation of illness in children differs to that in
adults and depends on:
age
understanding
communication skills.
In babies, for example, there may be inconsolable crying,
fever, convulsions, refusal to feed or failure to thrive.
Childhood illnesses
These are common and often the result of self-limiting
viral infections. In modern western society, with the aid of
mass vaccination (Table 15.2), most of the serious infectious diseases are rare (see infection chapter). There are,
however, cases where vaccination has been omitted or
refused, putting the individual child at increased risk.
Autism
It is estimated that up to 1 in 100 children are affected by
autism spectrum disorders in the UK. It is a developmental
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Extremes of age
Table 15.2
The recommended UK vaccination schedule (2004).
Age
Vaccination
2, 3 and 4 months
13 months
Pre-school
1014 years old
1318 years old
Cerebral palsy
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Downs syndrome
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Downs syndrome
Downs syndrome is most commonly due to trisomy of
chromosome 21 (95%). There is an incidence of 1 in 1000
births which increases with maternal age to 9 : 1000 by the
age of 40.
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Extremes of age
Safeguarding children
Dental practitioners have a duty to safeguard and promote
the welfare of children.
Child abuse can take a number of forms:
physical
emotional
sexual
neglect.
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Safeguarding children
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Clinical features
The investigation of abuse has huge implications for the
child and parents and is a sensitive and emotional issue.
Children often suffer traumatic injury in an accidental
manner; features that increase the likelihood of abuse
are:
delayed presentation
inconsistent history
unexplained injury
unusual injury pattern
repeated injury
abnormal child and parent relationship
information from a third party
child on the protection register.
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Extremes of age
Table 15.3
Drugs commonly prescribed during dentistry to be avoided or
altered during the treatment of children.
Drug name/type
Paracetamol
NSAIDs
Reduce dose
Do not use aspirin in under 12s due to
risk of Reyes syndrome
Reduce dose
Reduce dose
Reduce dose
Do not use in under-12s due to risk of
tooth staining and enamel hypoplasia
Reduce dose
No change
Reduce maximum quantity
Avoid in under-16s or emotionally
immature due to unpredictable reaction
Maximum of 5-day course
Amoxycillin
Metronidazole
Clindamycin
Tetracycline
Miconazole
Nystatin
Local anaesthetic
Midazolam
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Adcortyl/Corlan
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