PERIODONTAL CARE FOR COMMUNITY-DWELLING OLDER ADULTS

The prevalence and severity of periodontitis increases with age. Epidemiologic studies have identified several risk variables associated with advancing periodontitis in older adults: namely tobacco smoking, frequency of dental appointments, infection with anaerobic bacteria considered periodontal pathogens, plaque and calculus accumulation, and some socioeconomic variables. Future morbidity from periodontitis might be reduced by minimizing the impact of these risk-associated variables at younger ages. Treatment of periodontal disease in community-dwelling older adults should be aimed at (1) targeting care to their overall health, functional, and esthetic needs; (2) strategic planning for maximal health and patient satisfaction; (3) documentation of past susceptibility and current risk; (4) control of principal risk factors; (4) investing time in patient education and informed consent; and (5) planning ahead for a potentially catastrophic decline in health. Periodontal treatment needs should be met in an integrated treatment plan that considers the overall prognosis for the dentition and individual teeth and the most efficacious prosthodontic options. Frequent recall for supportive periodontal care is essential. Several medical, physical, and societal impediments to provision of optimal care for older adults should be sought and minimized by the practitioner. Population dynamics and health-oriented activism among older adults are increasing the demand for essential and elective periodontal and prosthodontic services, which are met by implant-supported prostheses. Over the next few decades, as the incidence of tooth loss declines and our knowledge of the pathogenesis of periodontitis and biology of tissue regeneration increases, there will likely be a renewed emphasis on the preservation of the natural periodontium.