Are there any approaches to caries prevention and therapy for the elderly?
This summary is based on the article published in Advances in Dental Research: Approaches to Caries Prevention and Therapy in the Elderly (September 2013)
The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries.
Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population.
Purpose of the Article
This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.
- There are few data available to allow for evidence-based advice on strategies for personal oral health care.
- Fluoride is an effective agent in helping to prevent caries in the older person, with evidence that an increased concentration of fluoride and/or use of multiple methods of fluoride delivery is of increasing benefit.
- There is very limited evidence for the use of calcium phosphate preparations as an adjunct to a fluoride-containing toothpaste in this population, and that which is available comes from high-risk populations with xerostomia. The evidence that is available suggests significant clinical benefit.
- The use of chlorhexidine as a varnish or rinse, again as an adjunct to a fluoride-containing toothpaste, also appears to have some clinical benefit in high-risk populations.
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