Walsh L J
Special Needs Dentistry, The University of Queensland School of Dentistry, UQ Oral Health Centre, 288 Herston Road, Herston, QLD 4006, Australia.
Br Dent J. 2017 Aug 11;223(3):151-161. doi: 10.1038/sj.bdj.2017.660.
With an aging population, dentists need to be aware of the risks which come to their elderly patients from retained teeth and exposed root surfaces. Oral health problems in the later years of life are multifactorial, with lifestyle, plaque and salivary factors remaining paramount. Root surface caries is likely to present a challenge in patients with a strong history of past coronal caries (and who have the attendant lifestyle risk factors) as well as in elderly patients who suddenly develop salivary hypofunction. Following a maximum interception approach means that specific efforts are needed to profile salivary, plaque and lifestyle risk factors and ensure that the dentition can be cleaned by the patient and maintained in a way which gives comfort and function as well as aesthetics. Discussions around long-term objectives for oral health are important when there is a sudden decline in general health in the later years of life. It may be appropriate to use tooth surface protection for strategic anterior teeth and apply the shortened dental arch concept where patients cannot readily maintain their own oral health because of frailty or medical conditions. Glass ionomer materials can be used both for root surface protection and for conservative restoration where a minimally invasive preparation has been undertaken. In other cases, arrest of lesions using silver fluoride or CPP-ACP topical treatments can delay or obviate the need for restorative interventions, and forms part of the management of patients in high care units in nursing homes. Involving all members of the healthcare team in supporting oral health is an important strategy to ensure that oral health issues are not overlooked. The challenge is to promote evidence-based self-care. A key message is to promote oral health as part of overall health.
随着人口老龄化，牙医需要意识到留存牙齿和暴露牙根表面给老年患者带来的风险。晚年的口腔健康问题是多因素的，生活方式、牙菌斑和唾液因素仍然至关重要。根面龋在有严重冠龋病史（以及伴有相关生活方式风险因素）的患者以及突然出现唾液功能减退的老年患者中可能构成挑战。采取最大程度的预防措施意味着需要做出具体努力来分析唾液、牙菌斑和生活方式风险因素，并确保患者能够清洁牙列，并以提供舒适、功能和美观的方式进行维护。当晚年总体健康突然下降时，围绕口腔健康长期目标的讨论很重要。对于因身体虚弱或健康状况而难以自行保持口腔健康的患者，对关键前牙使用牙面保护措施并应用短牙弓概念可能是合适的。玻璃离子材料可用于牙根表面保护以及在进行微创预备后的保守修复。在其他情况下，使用氟化银或酪蛋白磷酸肽-无定形磷酸钙局部治疗来阻止病变发展，可以延迟或避免进行修复干预，这也是疗养院高护理病房患者管理的一部分。让医疗团队的所有成员参与支持口腔健康是确保口腔健康问题不被忽视的重要策略。挑战在于促进基于证据的自我护理。一个关键信息是将口腔健康作为整体健康的一部分来促进。
