Қарлы жастағы адамдардың стоматологиялық күтімі

Geriatric dentistry is the delivery of dental care to older adults involving diagnosis, prevention, management and treatment of problems associated with age related diseases. The mouth is referred to as a mirror of overall health, reinforcing that oral health is an integral part of general health. In the elderly population poor oral health has been considered a risk factor for general health problems. Older adults are more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical/mental disabilities. Thus, the elderly form a distinct group in terms of provision of care.

The world's population is currently ageing with the number and proportion of elderly people growing substantially. Between the years of 2000 2005 to 2010 2015 life expectancy at birth rose from 67.2 to 70.8 years. By 2045 2050 it is projected to continue increase to 77 years. This increasing longevity can be majorly attributed to advances in modern medicine and medical technology. As a result, the population of people aged 60 and over is growing faster than any other younger age group and it is expected to more than double by 2050 globally. As they get older, the retained teeth are at risk of developing and accumulating oral diseases that are more extensive and severe.

In Australia geriatric dentistry is falls under the 'Special needs dentistry' specialty which is recognised by the Dental Board of Australia. This is because often age related problems and medication can make oral health disease and conditions much more serious and complicated to treat. As a result, they require specialized and individualized treatment and considerations. It is however, important to recognize that, contrary to popular belief, ageing is not synonymous with disease and should not be considered pathologic, and rather a natural and inevitable physiological process. The Harvard Dental School of Medicine however, does offer a further two year study for a certificate in geriatric dentistry. This program trains dentist in the specialised care for the population group of older people who often experience disparity. The Royal College of Dentists of Canada does not recognise geriatrics as one of its nine specialties.

The geriatric population are an ever growing section of the community with rapidly changing dental needs. In 2020 it is predicted that more than 25% of the population in developed countries will be over the age of 65. Due to improvements in oral health over the past 60 years, a decrease in the rate of edentulism is evident and therefore an increase in the number of natural teeth present is present

In 1979, 60% of Australians over the age of 65 had no natural teeth. In 1989, 44% had no teeth and it is expected by 2019, this figure will drop to 20%. This prediction was exceeded in 2013, with 19% of those over the age of 65 had no natural teeth. Although there is a decrease in the rate of edentulism, geriatric patients typically have high levels of plaque, calculus and debris, as they are functionally dependent on others or have lost the capacity to complete tasks such as toothbrushing thoroughly. Consequently, this results in an increased caries prevalence. The gastrointestinal, renal, cardiovascular, respiratory, and immune systems often decrease in efficiency, and this impacts upon the entire body, including oral health. Along with physiological changes, physical ones involve reduced bone and muscle mass Other prevalent conditions include dementia, depression, hearing loss, cataracts, back and neck pain, and chronic obstructive pulmonary disease. Geriatric patients may demonstrate a spectrum of cognitive acuity, and dementia is categorised by a progressive deterioration in cognition that eventually affects an individual's capability to function independently. More often than not, this is diagnosed in the elderly population. Unfortunately this disease impacts upon the ability to manage their medications, systemic conditions, and oral hygiene. The elderly usually develop a decrease in appetite, leading to a lower intake of vitamins and minerals. However, many nutrients are recommended at the same amounts as younger people. Another reason why inadequate nutrition levels are more prominent with elders is if their dental status is poor, with missing teeth or ill fitting dentures, it can negatively affect their taste and ability to chew on food. Even well fitted dentures are less efficient than natural teeth in terms of chewing, so changes in diet to softer foods often happen. Such foods often contain more fermentable carbohydrates, which raise individuals' risk to developing dental caries.

Polypharmacy is common in geriatric patients, which can cause a multitude of symptoms. Chronic dry mouth is prevalent in a high proportion of the elderly population, affecting roughly one fifth of the group. There has been a link between dry mouth and comorbid diseases including diabetes, Alzheimer's or Parkinson's disease A dry mouth can be associated with caries, cracked lips, fissured tongue and oral mucositis.

Dentures are prosthetic appliances fabricated to fill the gaps of missing teeth. Conventional style dentures are removable appliances and are designed to be either a complete denture or a partial denture anchoring to adjacent teeth. There are many denture designs, some which rely on chemical bonding or clasping onto teeth or attached via dental implants known as fixed prosthodontics.

People are now living longer and retaining their teeth for longer due to the preventive focused approach to dentistry. Although the rates of edentulism are rapidly declining, this is resulting in the number of natural teeth retained in the dentition. The impact of this is especially apparent in the residential care setting, as Personal Care Assistant staff are often time poor as a high resident to PCA ratio, oral care is often not adequately attended too or not at all. Residential care facilities will continue to encounter residents retaining their own natural teeth as the population is growing and living for longer periods so an oral health intervention will be required to combat this area of care that is severely lacking in many facilities. Utilising Oral Health Therapists in this sector would provide some assistance in closing the gap.