Caries risk (diet related-SUGAR IN GRAMS):

Increased carbohydrate consumption

For some geriatric patients it can be due to financial concerns or a decreased care in what they are eating (Wilkins, 2017, p.


Often as a side effect of the medications the patient may be taking their taste sense can decline causing the patient to eat more sweet / salty foods to compensate (Ellis, 2019)

If the patient eats cariogenic foods there is an increase in acid production affecting tooth destruction (Wilkins, 2017, p.437)

In an average day, the elderly may eat for breakfast

Coffee – 53,000 mgs (53 grams)

Bagel – 56,000 mgs (56 grams)

Cream Cheese – 9,000 mgs (9 grams)

Decay in geriatrics are often related to recession, lack of salivary flow (possibly due to medications), high carbohydrate diet, and lacking oral care (Wilkins, 2017, p.900)

It is important to evaluate their diet and make sure they decrease their intake of food that causes caries

Especially important to point out the need to change to avoid root caries because they are more at risk due to the reasons mentioned above (Wilkins, 2017, p.914)

Root caries are more common among the elderly due to the recession caused by periodontitis or abrasion as well as an increase in biofilm due to lack of proper oral hygiene (Wilkins, 2017, p.910)

The use of fluoride, chlorhexidine, and xylitol are especially helpful for geriatric patients (Wilkins, 2017, p.914)

Recurrent decay is also of concern when there are open margins because with smooth margins it helps decrease the retention of bacteria in the mouth (Wilkins, 2017, p.443)

Faulty restorations like open margins can cause bacteria to be held in.

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(Wilkins, 2017, p.910)

Systemic conditions/ List specific types (why critical):

• Medications (side effects, oral implications):


For Parkinson’s Disease

May induce Xerostomia


Treat xerostomia

Antidepressants and Antipsychotics

Cause xerostomia


Create a burn if left directly on mucosa

ACE Inhibitors / NSAIDs

Ulcers in the mouth

Phenytoin, Nifedipine, Cyclosporine

Gingival Enlargement

Corticosteroid Inhalers

Fungal infection



Chlorhexidine gluconate rinse

Affect sense of taste (Critchlow, 2017)

How aging affects the body

As the patient gets older their skin often becomes wrinkly and thin

They are unable to withstand certain temperatures (very high or very low)

Organ function also deteriorates (Wilkins, 2017, p.900)

Musculoskeletal system: loss of bone volume and muscle activity; joint stiffness

Cardiovascular system: cardiac output decreases and the blood vessels are more rigid, (Wilkins, 2017, p.901). They become more prone to atherosclerosis

Respiratory System: gas exchange is less efficient, muscles that work to make us breathe weaken and there is a higher chance of contracting an infection affecting the respiratory system

GI system: acid output declines, movement of food is slower, and the body is unable to absorb effectively

CNS: unable to remember recent events, unable to think like normal

PNS: declines in feeling touch and awareness of where the person is in space

Sensory Systems: vision and hearing declines

Endocrine Systems: the thyroid is unable to function properly

Immune System: effectiveness decreases, increase in infections due to this

Causes to consider that may cause disease




Some systemic diseases that are related to periodontitis


Infections affecting the respiratory system

Rheumatoid Arthritis

Atherosclerotic conditions (Wilkins, 2017, p.902)

Alzheimer’s Disease

The most prevalent kind of dementia which is also incurable

Two kinds: early and late onset

There is no cause

Usually lasts 8-10 years (Wilkins, 2017, p.903)

Varying stages of severity

Medications like “antidepressants, anti-anxiety medications, antipsychotics, and anticonvulsants” are taken to control patient’s behavior (Wilkins, 2017, p.904)

As Hygienists

Focus on starting preventative care

Put patients on a shorter recall


Teach caretakers about proper ways to take care of their patient’s oral hygiene (Wilkins, 2017, p.905)

We want to maintain their oral condition to the best of our ability while preventing disease and keeping them comfortable at the same time

A significant fact is that periodontal bacteria from periodontal disease can enter the brain and cause inflammation


Most prevalent type of arthritis

There is a continuous degeneration of cartilage (Wilkins, 2017, p.904)

Symptoms: pain in the joints, crepitus and rigidity

Treatment: physical therapy, medications, exercise, relieve joints of any pressure

As Hygienists: short appointments, choose a time later in the day, and give the patient breaks often for their jaw


Can cause more complications on top of the normal aging process

Highly related to depression


Prevalent among geriatrics

Due to lack of calcium and vitamin D or hormone imbalance

Could be avoided by exercise or proper intake of calcium and vitamin D (Wilkins, 2017, p.905)

Related to periodontal disease in the fact that periodontal bone loss and osteoporosis are both affected by age, smoking, hormone imbalance, lack of proper nutrition.

Often have backaches and easily can get fractures of their bones since it is weaker

Treatment is through different medications taken with both vitamin D and calcium


Biphosphonates, Selective Estrogen Receptor Modulators, Calcitonin – delays breakdown of bone

Parathyroid hormone – increases development of bone

For the Hygienist

Take your time to make sure the patient is comfortable

Talk to the patient about proper diet and quitting smoking and decreasing alcohol intake

Patients using biphosphonate medications are contraindicated for oral surgery (Wilkins, 2017, p.906)


Becoming more common among geriatrics

Most prevalent STD is HIV / AIDS

For the hygienist

Know what medications the patient is taking for their condition

Have good communication

Inform patient about their condition

Respiratory Disease

Geriatrics have an increased chance of contracting a respiratory disease

This can be prevented with proper oral hygiene

Examples: pneumonia, COPD, asthma

For the Hygienist

Pay attention to patient’s vitals

Change the patient’s chair position to better assist with their breathing

Cardiovascular Disease

Very often leads to death for geriatrics (Wilkins, 2017, p.907)

Periodontal disease is a known risk for CHD (Wilkins, 2017, p.1130)

Ex: myocardial infarction, congestive heart failure, Hypertension, Hypotension, Arteriosclerosis, Atherosclerosis


Silent killer: no symptoms

Monitor blood pressure

Risk: smoking, obesity, high sodium diet, older age

Important to emphasize to the patient the need to exercise and change their diet. Also to stop smoking if they are a smoker (Wilkins, 2017, p.1136)

For the hygienist

Pay attention to the patient’s vitals

Keep the patient comfortable (Wilkins, 2017, p.907)

Be aware if the patient needs antibiotic prophylaxis (Wilkins, 2017, p.1132)


Can be due to smoking, alcohol, excessive exposure to the sun, virus

Treated through “surgery, chemotherapy, radiation therapy” and others depending on the type of cancer and where or how large it is (Wilkins, 2017, p.944)

Chemotherapy can cause random bleeding and inflammation. It can also cause xerostomia and excessive breakdown of bone (Wilkins, 2017, p.947)


Diagnosed more commonly as a person gets older

Periodontal disease has a more significant impact on diabetes patients

Unfavorable effect on sugar levels

More serious response to periodontal disease

Can cause xerostomia (risk for caries) and fungal infections (Critchlow, 2017)

Higher death risk for those who have diabetes (Wilkins, 2017, p.1165)

Typical challenges:

• Periodontal risk-Implants & dentures, OHI (implications, cost)

Geriatric patients have an increased risk of needing implants and dentures due to conditions where they have more bone deterioration (Wilkins, 2017, p.906)

Geriatric patients who are edentulous can wear a complete denture or they can get an implant for their overdenture

If they are not fully edentulous they could wear a partial denture they can either remove or one that is fixed

These dentures help with aesthetics, proper function in chewing and speech, as well as providing support for the lips and TMJ (Wilkins, 2017, p.918)

Important to teach the patient how to properly clean their denture

Brush 2x a day

Leave in a new cleaning solution daily (Wilkins, 2017, p.921)

Patients can also get an implant to maintain the bone around the where the missing tooth was (Wilkins, 2017, p.535)

It is important for the patient to get regular maintenance to monitor the implant and to take proper care in keeping the area clean (Wilkins, 2017, p.539)

Choosing between implants and dentures can be decided based upon cost.

• Manual dexterity (age related changes, grasp strength)

As the patient ages they have a decrease in muscle power (Wilkins, 2017, p.901)

It is important for the patient to be able to brush their own teeth even though they may be taken care of by a caretaker for the sake of their own self esteem (Wilkins, 2017, p.963)

To help grasp the toothbrush a patient can use a ball or bottle (Wilkins, 2017, p.964)

• Mobility & Activities of Daily Living-if applicable (ADL)

As a person gets older they are unable to move around and function independently due to physical disabilities (Wilkins, 2017, p.911)


High Function (Level 0)

Able to brush and floss by themselves

Moderate Function (Level 1-2)

Partially able to brush and floss by themselves

Need guidance

Low Function (Level 3)

Not able to take care of themselves

Bedridden or require a wheelchair (Wilkins, 2017, p.962)

Access to dental care (family or personal history with dentistry):

Patients of this age group often do not think highly of dental care because they don’t believe there is a need for it

This mentality is often shaped because of their family history

Some older patients are unable to seek care because their income is unable to spare for dental work or they do not have insurance (Wilkins, 2017, p.911)

Fluoridated water and toothpaste are significantly helpful to these types of people (Wilkins, 2017, p.900)

Community loss/isolation from support (death of friends/spouse/lack of driving):

• Transportation challenges (no longer driving, bus):

Older patients often have physical disabilities that make them unable to travel outside of the home without a caretaker thus they are unable to drive (Wilkins, 2017, p.911)

Due to low income as well (usually only social security benefits) they do not have the money for transportation (Hurd, 1990)

• Elder abuse (signs and symptoms, mandatory reporter status):

Elder abuse can be through literal abuse or neglect

Abusers are usually family

This active or passive abuse can be physical or psychological

Signs to look out for as a Dental Hygienist



Extremely compliant

Lies regarding the cause of injuries

Bruises, scratches, fractures

Lack of personal hygiene (overall and oral)

Lesions indicating STDs (Wilkins, 2017, p.1052)

Death of friends and spouse

Elders who have a deceased spouse or friends can have depression and need social support for their well being (Tambag et al., 2019)

Financial challenges (fixed income, lack of insurance):

• Retirement:

People are starting to retire earlier as the age for social security benefits was lowered

People used to retire at 65 yos or older but now people who are 57-59 yos are starting to retire

More people are now under social security benefits due to this and they are dependent on this money

The elderly do not have fixed incomes and depend on outlets like medicare or pensions from the government

There is a very limited number of elders who have insurance (Hurd, 1990)

• Raising grandchildren/childcare (impact of, stress):

Women are more greatly affected by the burden of caring for their grandchildren

It is an emotional stress that affects their daily lives especially because usually it is out of their control and not by choice (Marken & Howard, 2014)

Key approach to discuss:

• Listen, consider deficits (hearing/sight/dexterity) give breaks

For patients with trouble with their eyesight:

Proper lighting is important

Large fonts when showing them something on a paper or device

Do not use bright colors

Be vigilant as to whether the patient is wearing their glasses or not

For patients who have trouble hearing

Do not speak differently; speak normally

Face the patient so the patient can read lips

If a patient is wearing a hearing aid, be mindful of the background noises like background music (turn it off)

Also ask the patient if they would like to adjust their hearing aid when using the USS or other hand pieces

For patients who have trouble with their memory

Give instructions on paper for the patient to take and for the caretaker to have

For patients with depression

Try to maintain a positive mindset without overwhelming the patient (Wilkins, 2017, p.913)

Also give patient breaks often because it may be difficult to keep the mouth open for a long period of time (Wilkins, 2017, p.912)

• Comfort in chair (pillows, blanket)

Some patients may need extra support in the chair through the use of pillows or blankets for example patients with osteoporosis need extra cushioning (Wilkins, 2017, p.906)

Also the eldery are more sensitive to temperatures so sometimes a blanket may be necessary (Wilkins, 2017, 900)

• Semi-supine (medication, swallowing)

For those with respiratory diseases, they may need to be sat semi-supine to help with breathing (Wilkins, 2017, p.907)

Also important to bring the chair up at a slower pace or ask the patient to sit longer before standing to avoid postural hypotension (Wilkins, 2017, 912)

Cite this page

GERIATRIC SPECIAL PATIENT Caries risk diet relatedSUGAR. (2019, Nov 22). Retrieved from

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