Table 3.50.
Key considerations for dental management in the elderly (see text)
| Management modifications* | Comments/possible complications | |
|---|---|---|
| Risk assessment | 2 | Poor compliance; adverse reactions; arrhythmias |
| Appropriate dental care | 2 | Systemic diseases condition dental treatment; dependent persons may need domiciliary dental care |
| Pain and anxiety control | ||
| – Local anaesthesia | 0 | |
| – Conscious sedation | 1 | Oral benzodiazepines |
| – General anaesthesia | 3/4 | Avoid opioids, vascular and pulmonary complications |
| Patient access and positioning | ||
| – Access to dental office | 1 | Evaluate need for domiciliary care |
| – Timing of treatment | 0 | |
| – Patient positioning | 1 | Upright position |
| Treatment modification | ||
| – Preventive dentistry | 1 | Adapted and electric toothbrushes; chlorhexidine; fluoride varnish; salivary stimulants |
| – Oral surgery | 1 | Hypercementosis; low bone elasticity; impaired tissue healing |
| – Implantology | 1 | |
| – Conservative/Endodontics | 1 | Attrition; brittle dentine |
| – Fixed prosthetics | 1 | Material selection |
| – Removable prosthetics | 1 | Do not alter shape and occlusion; label appliance |
| – Non-surgical periodontology | 1 | Poor compliance |
| – Surgical periodontology | 1 | Impaired wound healing |
| Hazardous and contraindicated drugs | 2 | Avoid polypharmacy; possibly dosage reduction |
*
0 = No special considerations. 1 = Caution advised. 2 = Specialised medical advice recommended in some cases. 3 = Specialised medical advice mandatory. 4 = Only to be performed in hospital environment. 5 = Should be avoided.