Dental geriatrics and periodontitis

The present literature review is focused on two main areas: (i) periodontal conditions in older individuals; and (ii) the scientific data available on periodontal treatment outcomes in individuals ≥ 75 years of age. The population of older people is increasing but the data on periodontal therapies and their efficacy in this population are limited and need to be carefully reviewed. Although life expectancy has increased, this does not mean that older people are medically healthy. Several chronic systemic diseases are associated with periodontitis, and the prevalence of most chronic diseases increases with age. Furthermore, older people are challenged by impaired immunity (immune senescence) with a decline in the numbers of naïve T-cells in peripheral blood and lymphoid tissues. The most frequent significant correlates with successful ageing include not smoking and the absence of disability, arthritis and diabetes mellitus. Periodontal diseases in older individuals may have specific features that are not consistent with periodontal diseases. In this respect, data suggest that gingival lesions in older individuals develop differently from gingival lesions in younger adults. The progression of periodontitis may be slower in older individuals, and older individuals with periodontitis may benefit from more conservative treatment approaches. Diagnostic criteria used for the assessment and diagnosis of periodontitis in younger adults may not be fully applicable in older individuals. In summary, declining health, perception of treatment needs, dietary changes, comorbidity with other diseases and immune senescence are challenging factors to clinicians and researchers, in terms of therapies and in understanding periodontitis etiology in older individuals.