Geriatric prosthodontic care

Treatment planning considerations in the older adult with periodontal disease

Periodontal health in the elderly is influenced by numerous factors, including systemic conditions, patient compliance, age-associated changes, and restorative procedures. The numerous comorbidities seen in the elderly necessitate individualized approaches for treatment planning. In this paper, we review how age, comorbidities, oral hygiene, and restorative dental procedures collectively influence the treatment and management of the periodontium in the elderly. The elderly population is predicted to double in 30 years, which will have an economic impact the dental profession needs to plan for. Preventative and noninvasive treatment, supportive periodontal therapy, and patient-specific maintenance plans are imperative to maintaining oral health in the older population. Multiple coexisting changes, including xerostomia, altered wound healing, altered bone physiology, altered microbiome, and diminished plaque control, can add complexity to periodontal management. Considerations of the patient's general health, the selected periodontal treatment plan, and the selected completed restorative procedures need to be considered. The influence of caries, fixed prosthodontics, partial dentures, shortened dental arch, and implant therapy can have unintended impacts on periodontal health in the elderly. Adverse periodontal outcomes in the elderly can be minimized by carefully assessing the patient's medical history, impact of medications, functional needs, properly finishing and contouring restorations to avoid plaque accumulation, and designing restorations to allow access for hygiene. Partial dentures can be a source of plaque accumulation leading to periodontal disease, caries, and recession around abutment teeth. A shortened dental arch should be considered as a functional and cost-effective alternative to partial dentures. With dental implants, the patient's tissue phenotype, keratinized tissue quantity, risk of peri-implantitis, and patient access for maintaining adequate oral hygiene are all important to consider. Implant risk-assessment tools show promise by providing a systematic approach for early diagnosis to avoid future complications.

Effects of mouth rehabilitation with removable complete dentures on stimulus perception and the electromyographic activity of the orbicularis oris muscle

STATEMENT OF PROBLEM

Many elderly individuals are rehabilitated with removable complete dentures, which require an initial adaptation period for both oral perception and the perioral muscles. Studies assessing the changes in stimulus perception and the electromyographic (EMG) activity of the orbicularis oris muscle shortly after conventional complete denture insertion are lacking.

PURPOSE

The purpose of this clinical study was to evaluate the effect of mouth rehabilitation with removable complete dentures on stimulus perception and the EMG activity of the orbicularis oris muscle.

MATERIAL AND METHODS

This study was approved by the Human Research Ethics Committee of the Araçatuba Dental School (São Paulo State University). Fifteen participants who had worn their removable complete dentures for at least 5 years and needed rehabilitation with new prostheses were enrolled in the study. A perception questionnaire was applied, and surface EMG examinations of the orbicularis oris muscle during rest, suction of water with a straw, and pronunciation of the syllables /bah/, /mah/, /pah/, and the word 'Mississippi' were performed before (T0) and 30 (T1) and 100 (T2) days after insertion of the new prostheses. The data were analyzed with the Cochran Q test, McNemar test, 2-way repeated measures ANOVA, and honestly significant difference (HSD) Tukey test (α=.05).

RESULTS

Significant improvement was reported in the perception questionnaire in terms of the oral discomfort sensation in the T2 period. EMG activity decreased during rest and suction after insertion of the new prostheses. A statistical difference between the upper and lower fascicles of the orbicularis oris muscle was detected, with a decrease of EMG activity between the T0 and T1 periods on the lower fascicle, except for when pronouncing the /pah/ syllable.

CONCLUSIONS

Mouth rehabilitation with removable complete dentures decreased oral discomfort and, depending on the oral function, decreased or increased EMG activity of the orbicularis oris muscle. In addition, the lower fascicle was more active than the upper fascicle during rest and most functional activities.