Oral health care in older adults

Abstract

The global older adult population is expected to surge to 1.5 billion, 1 in 6 among the population, by 2050. Current literature shows that oral and general health are interrelated. Many medical conditions and diseases such as diabetes, hypertension, rheumatoid arthritis, Alzheimer’s disease, Parkinson’s disease and depression pose older adults vulnerable to oral diseases such as dental caries and periodontal diseases. Poor oral health has been associated with malnutrition, the presence of several systematic diseases, and increased morbidity and mortality. Improving oral health of older adults will be the foremost public health issue in the coming decade. This PhD study included a systematic review to examine the caries status of older adults. Based on the 39 included studies, the global prevalence of dental caries was high in older adults and half of them had untreated caries. Fluoride is well-known for its efficacy in caries management. Another systematic review was conducted to assess the clinical efficacy of professionally applied fluoride therapy to prevent and arrest caries in older adults. Based on the findings of seven included clinical trials, 5% sodium fluoride varnish and 1.23% acidulated phosphate fluoride gel can prevent root caries whereas 38% silver diamine fluoride solution can prevent and arrest root caries in older adults. The meta-analysis found a decrease in incidence (number of new root caries) by 55% (95% CI: 32%-78%; p<0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33%-49%; p<0.001) after 38% silver diamine fluoride application at the 24-month follow-up. Exposed root surfaces and the presence of dental biofilm are the risk factors for root caries. Dentine hypersensitivity resulting from exposed root surfaces is a common symptom affecting oral hygiene practice. Silver diamine fluoride has been cleared as a desensitizing agent by the United States Food and Drug Administration, however, the evidence on its clinical use in managing dentine hypersensitivity is insufficient. A randomized double-blind clinical trial was conducted to evaluate the desensitizing effect of the application of 38% silver diamine fluoride solution on hypersensitive teeth with exposed root surfaces in older adults. The study recruited healthy older adults with dentine hypersensitivity. The most hypersensitive tooth-root surface of each older adult was tested with compressed cold air from a three-in-one syringe. The older adult gave a sensitivity score on a visual analogue scale from 0 (no pain) to 10 (agonizing pain) at the baseline visit. The older adult received 38% silver diamine fluoride or 5% potassium nitrate (control) solution on the most hypersensitive tooth-root surface according to his/her intervention group assignment every 4 weeks. The sensitivity score was collected immediately after intervention at baseline and at 4-week and 8-week follow-ups before intervention. The primary outcome was the reduction in sensitivity score at 8-week follow-up compared to the sensitivity score before intervention at baseline. Mann–Whitney U tests showed that 38% silver diamine fluoride solution reduced hypersensitivity on the exposed root surface of older adults. (Word count: 482)