China has entered an aging society, and the elderly population has exceeded 10%. According to statistics, 80%-90% of the elderly have missing teeth of different degrees, and the remaining teeth of the elderly are often accompanied by different degrees of loosening, displacement, tilting, elongation, root exposure, residual crowns, residual roots and so on. Older people also treasure teeth and refuse to extract teeth easily, even Ⅲ degree loose teeth and residual roots and crowns are eager to keep, or they cannot extract teeth due to health reasons, all these bring certain difficulties to oral restoration. How to properly restore missing teeth, ensure the oral health of the elderly and improve the quality of life of the elderly is the focus of modern dentistry. The movable denture, fixed denture, combined fixed and movable denture and implant denture currently used in oral prosthetics can be used in the elderly, however, the local characteristics of the oral cavity related to the restoration of the elderly, the whole body physiologically, psychologically and economically have special characteristics.
The following is a comprehensive introduction to the local characteristics of the oral cavity of the elderly, the physiological and psychological characteristics of the whole body, the retention of the remaining teeth of the elderly, and the design and selection of the restoration of the oral cavity of the elderly, and the health care after restoration.
1.Restoration-related oral characteristics of the elderly
(1) teeth: tooth loss is often more, the remaining teeth jaw surface more wear, caries, root caries, wedge-shaped defect often affects more than one tooth, the teeth because of the length of time missing teeth, missing teeth site is different, isolated teeth, tilt and twist, elongation, loosening and other phenomena are very common, which brings great difficulties to the restoration design and production.
(2) Alveolar bone, mucosa and periodontal tissue: alveolar bone is often more resorbed and uneven, and the alveolar ridge at the missing teeth is often edged; the mucosa of the alveolar ridge becomes thin and elastic; periodontal degeneration and gingival recession. All these lead to the denture can not withstand large forces.
(3) Changes of salivary glands: salivary volume is obviously reduced due to the atrophy of glandular vesicles, and the decrease of salivary volume can lead to dry mouth, which makes the self-cleaning effect of the mouth poor and the formation of bacterial class easy, and increases the incidence of caries and periodontal disease. The decrease of saliva volume is also not conducive to the retention of the denture.
(4) Changes of temporomandibular joint: the fibroblasts in the articular disc and condylar joint area are reduced, the collagen fibers are densely arranged, the cortical bone is absorbed and the condylar process becomes smaller, and the joint surface becomes flat. Dislocation and degeneration of joints make the mandibular joint easy to dislocate or temporomandibular joint disorder occurs.
(5) Ageing can cause progressive atrophy of the masticatory muscles, especially the cheek and lip muscles. This process is often accelerated in patients wearing dentures. The atrophy of the masticatory muscles can cause a significant decrease in chewing efficiency, and the atrophy of the buccal muscles can cause the retention of food, especially at the buccal edge of the denture.
(6) If teeth are missing for various reasons and not repaired in time, various bad habits will be formed, such as lateral chewing, forward biting and lifting habits, displacement of remaining teeth and absorption of supporting tissues, which will cause difficulties in repair and affect the wearing of the denture.
2.The systemic characteristics of the elderly
Geriatric patients have declining body functions, degenerative changes in the relevant tissues and poor adaptability. Many elderly people also have some systemic diseases, such as hypertension, coronary heart disease, diabetes, stroke, metabolic disorders, nutritional disorders, etc., which cannot tolerate tooth extraction or cannot be extracted. These all affect the effect of denture restoration to varying degrees.
3.Psychological characteristics of the elderly related to restoration
With the increase of age, the number of missing teeth is increasing, which seriously affects the chewing function and physical health of the elderly. Due to the missing front teeth, it affects the pronunciation and aesthetics, forming a psychological pressure, social activities are affected, and the request for restoration is urgent. On the other hand, the elderly cherish the remaining teeth in the oral cavity and are reluctant to extract teeth or cannot extract teeth due to physical reasons, even if the loosening is obvious or the residual crown or root is required to be retained.
4.The problem of remaining teeth in the elderly
The number of remaining teeth in the mouth of the elderly is limited and the quality is poor. The retention of remaining teeth in the mouth of the elderly is really an important issue in clinical practice. There are no uniform indicators and objective criteria. In general, the indications for tooth extraction are reduced, especially since many loose teeth as well as remnant roots and crowns are preserved with treatment. Generally speaking, the less teeth are missing the better the restoration results.
Therefore, some remaining teeth should be preserved as much as possible when conditions permit. With a mucosa-supported denture, the force on the bone tissue is non-physiological because it puts the bone tissue under direct pressure, which can accelerate bone atrophy after extraction. The force on bone tissue is different for natural teeth. Even if some affected teeth cannot be used as abutment teeth because of occlusal relationship or other reasons, but the roots are still good, after treatment and adjustment of crown to root ratio, overdenture restoration can be used, which can preserve bone tissue and improve denture effect.
5.Oral prosthetic treatment options for the elderly
(1) movable denture restoration
It is a restoration that uses rings and abutments to obtain retention, stability and support, which can be removed and worn, and is usually suitable for cases with more missing teeth. Because of its cheap, relatively simple production, easy to repair and other characteristics, at this stage in China is still a more common choice of restoration options for the elderly. However, removable dentures have a strong sense of foreign body, are uncomfortable to wear, and have poor chewing function and aesthetics. In addition, it is also easy to cause oral mucosal damage, such as acute and chronic inflammation caused by plaque on the denture, inflammation caused by the denture base material, mechanical damage caused by the denture, etc.
(2) Fixed dentures
The traditional view is that the periodontium of elderly patients is mostly atrophied, the clinical crown grows, the teeth are often loose, the compensatory function of periodontal tissue is reduced, the ability to bear the joint force is reduced, the fixed denture restoration is easy to cause periodontal tissue damage of the abutment teeth, so it is not suitable to choose fixed restoration. However, with the continuous improvement of economic and health care conditions, the loss of teeth in the elderly has been significantly reduced, and the preservation and restoration of the teeth and roots of the elderly, fixed denture restoration is becoming more and more common.
Compared with movable dentures, fixed dentures are small, non-foreign body, comfortable, do not hinder pronunciation, chewing and aesthetic performance is good, patients do not need to take wear, easy to use. The elderly should try to use fixed prosthesis if the economic condition allows and the oral hygiene can be maintained well, which can help to remove the trauma and adjust the occlusion, prevent food embedding, protect the abutment teeth and restore the chewing function. As fixed prostheses tend to be more abrasive, complicated and time-consuming to operate. It should be used with caution for those who have serious systemic diseases, are physically weak and cannot support long time dental preparation procedures.
(3) Combined fixed-active restoration
It combines the advantages of fixed and movable dentures, and is a good choice for patients with more missing teeth who cannot do fixed dentures and want to get better restoration results.
(4) Dental implants
Artificial implants in the elderly is not an absolute contraindication, but should be considered according to the overall situation of the elderly, due to systemic diseases and local osteoporosis in the elderly have a higher incidence, it is generally advisable to carry out fewer implants, the scope of larger should not be advocated to avoid causing excessive trauma. For example, for elderly people with severe atrophy of the alveolar canal, 2-3 implants can be planted, with magnetic attachments, rod and card retainers, ball and cap retainers to assist the retention of their denture, which can also obtain good results.
In summary, elderly patients should consider the patient’s general condition, oral hygiene, the condition of the remaining teeth and other factors when choosing a restoration method.
6, the elderly after the oral restoration of health care:
The health care of the elderly after oral restoration is very important, and it is related to the success and service life of the elderly restoration. After the oral restoration should pay attention to maintain oral hygiene, regular review, to half a year to a year review is appropriate, full denture should be about 5 years for comprehensive repair such as pad or remake. Due to the change of the oral environment of the elderly, special attention should be paid to the prevention and treatment of the secondary caries and root caries, the residual roots should be cleaned, and the periodontal condition of the residual roots should be checked regularly to prevent the residual teeth and roots from being damaged by further caries and periodontal destruction.