Dental caries: risk assessment and treatment solutions for an elderly population

Caries remains one of the top three most common infectious diseases in the world today. Although caries prevalence decreased markedly in children and in adults up to age 40 between 1975 and 2000, the overall risk for caries in older age groups (45 to 64, 65 to 84, and > 85 years of age) has not decreased appreciably. In fact, the risk for caries in individuals 70 years of age and older has increased. The increase in restorative work needed between 1990 and 2030 will be highest in adults over the age of 44 years. Root caries prevalence and the number of restored teeth will be greatest in the elderly population. Approximately 30% of individuals over the age of 65 will have no permanent teeth. It is also apparent that additional caries risk factors are associated with a significant proportion of the older population, including reduced saliva flow, inadequate oral hygiene, frequent sugar intake, Asian ethnicity, and the presence of partial dentures. The principles of modern caries management focus on risk assessment, risk reduction, monitoring noncavitated carious lesions, and the assignment of specific treatment options according to risk. Because a relatively high proportion of elderly patients will remain at high risk for caries, therapeutic regimens for managing caries as an infectious disease must focus on the use of antibacterial treatment; high-fluoride dentifrices; supplementary low-dose, high-frequency fluoride rinses; patient education; and shorter recall intervals.