Caring for the dentate elderly

The proportional increase of elderly persons in most communities and increasing tooth retention among them betoken considerable change in gerodontic needs. Servicing dentate older patients will occupy progressively more practising time. This committment requires the development of somewhat different skills, knowledge and philosophy from those customarily propounded in dental teaching to date which has concentrated mostly on matters relevant to young and middle-aged persons. Dentists must become proficient in managing clinical entities of prevalence in the elderly. Xerostomia, a frequent, but often neglected symptom can have distressing consequences. Practitioners have a responsibility to detect it, analyse its likely cause or causes and select appropriate therapy. Root caries is re-emerging as a common finding. Its aetiology must be understood in order to institute effective preventive measures and treatment. Dentate elderly persons typically have heavily restored teeth subject to various iatrogenic problems. Some of the restorative work required can be provided exactly as for younger patients. However, optimum care is not necessarily the most elaborate. It is often desirable, when health or financial considerations dictate, to adopt expedients which reduce treatment extent and/or expense. Adhesive materials are extremely useful. The 'sandwich technique' for bonding composite resin to dentine via glass ionomer cement often facilitates the provision of extensive restorations in a minimally invasive fashion. Adhesive procedures can also be applied to treat attrition, mend fatigue fractures, splint teeth deficient in periodontal support, and provide simplified cosmetic treatment for elderly patients.