Dental implants in frail elderly adults: a benefit or a liability?

Long-term follow-up of a patient with Parkinson's disease under nursing care after replacement of fixed implant-supported prostheses with an implant overdenture: a case report

BACKGROUND

In older patients with progressive neurodegeneration, replacing fixed implant-supported prostheses (FIP) with implant overdentures (IOD) has been proposed to prevent future mucosal injury and create an oral environment that is easier for caregivers to clean. However, there have been no reports on the progress after replacing FIP with IOD. In this report, we present the progress of an older patient with Parkinson's disease in whom FIP was replaced with IOD.

CASE PRESENTATION

An 81-year-old male patient with Parkinson's disease presented to our outpatient clinic with bruxism and crossbites. FIPs, with five Brånemark system implants, were placed in the bilateral lower molars. The FIP was replaced with an IOD with two locator attachments to create an oral environment that was easier for caregivers to clean and allow easy recovery of masticatory function if residual teeth were fractured in the care environment. As his systemic condition deteriorated, treatment was changed from outpatient to in-home visits. During dental care visits, professional oral cleaning and denture repair were continued, and good nutritional status was maintained. However, the patient developed cholecystitis and was hospitalized. During hospitalization, gastrostomy was performed because he developed aspiration pneumonia. After discharge from the hospital, the patient remained in bed all day and could not wear an IOD, resulting in buccal mucosa ulceration due to abrasion of the locator abutment. We decided to replace the abutment with cover screws; however, not all the implants could sleep submucosally. Although regular oral cleaning was resumed, new ulcers developed even when cover screws were installed. Additionally, swelling and drainage were observed at the peri-implant mucosal site where peri-implantitis had once occurred during an outpatient visit. The patient was readmitted to the hospital for a urinary tract infection, and subsequent visits were abandoned.

CONCLUSIONS

By replacing FIP with IOD in an older patient with Parkinson's disease, we addressed a barrier to caregiver-provided oral management. The removable prosthesis facilitated smooth oral care by caregivers and functional recovery in the event of trouble with residual teeth. However, it could not completely avoid the recurrence of buccal mucosal ulcers or peri-implantitis.

Dental Care for Older Adults

There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.

Dental implant status in elderly individuals requiring domiciliary dental care in Japan

Background

The presence of implants is a significant burden not only for dentists but also for caregivers and families of elderly individuals requiring nursing and domiciliary dental care. However, few reports have assessed the status of domiciliary dental care or measures employed to deal with related issues. Hence, we aimed to evaluate the dental implant status in elderly patients requiring nursing and domiciliary dental care and to determine the suitable measures for overcoming the associated limitations. A questionnaire was mailed to 1000 dentists who provided domiciliary dental care in the Tokyo metropolitan area of Japan. The questions were classified into three categories: basic information of the dentists, actual implant status of patients requiring domiciliary dental care, and implants in an aging society.

Results

The response rate was 36.5%. Approximately 2% of patients requiring domiciliary dental care were implant patients. Many implant-related problems were associated with insufficiency or difficulty in cleaning around the implant, resulting in peri-implantitis. Prosthetic and more serious complications such as implant body fracture or loss were reported and frequently managed by routine follow-ups, cleaning the area around the implant, scaling and polishing, and/or pharmacological modalities. Oral care mainly involved simple toothbrushing instructions, which was not adequate.

Conclusions

Our findings suggest the necessity of simplifying the oral environment and making oral care a simple task before aging individuals require nursing and domiciliary dental care.

Frailty transitions and health care use in Europe

OBJECTIVE

There is relative consensus that chronic conditions, disability, and time-to-death are key drivers of age-related health care expenditures. In this paper, we analyze the specific impact of frailty transitions on a wide range of health care outcomes comprising hospital, ambulatory care, and dental care use.

DATA SOURCE

Five regular waves of the SHARE survey collected between 2004 and 2015.

STUDY DESIGN

We estimate dynamic panel data models on the balanced panel (N = 6078; NT = 30 390 observations). Our models account for various sources of selection into frailty, that is, observed and unobserved time-varying and time-invariant characteristics.

PRINCIPAL FINDINGS

We confirm previous evidence showing that frailty transitions have a statistically significant and positive impact on hospital use. We find new evidence on ambulatory and dental care use. Becoming frail has greater impact on specialist compared to GP visit, and frail elderly are less likely to access dental care.

CONCLUSIONS

By preventing transitions toward frailty, policy planners could prevent hospital and ambulatory care uses. Further research is needed to investigate the relationship between frailty and dental care by controlling for reverse causation.

Mandibular implant-supported overdentures in (frail) elderly: A prospective study with 20-year follow-up

Purpose

To prospectively assess long‐term (20 year) clinical, radiographic, and patient‐reported outcomes of an elderly population provided with mandibular implant‐supported overdentures.

Materials and Methods

A total of 53 elderly (aged ≥60 years at the time of treatment) were provided with two endosseous implants supporting a mandibular overdenture and a conventional maxillary denture. Outcome parameters—including implant loss, plaque index, gingival index, bleeding index, presence of calculus, probing depth, and satisfaction with implant‐supported overdenture—were scored 1, 5, 10, and 20 years after prosthetic treatment. Radiographic analysis was performed to assess peri‐implant bone changes. At the 20‐year evaluation, frailty (Groningen Frailty Index) and quality of life (EuroQol 5D) were additionally assessed.

Results

A total of 15 patients completed the 20‐year follow‐up. The 20‐year implant survival rate was 92.5%. Plaque index, bleeding index, and probing depth increased slightly over time, while gingival index and presence of calculus remained unchanged. Radiographic analysis revealed minor marginal bone loss during the first 10 years and no further loss thereafter. Participants were very satisfied with their prosthesis and reported a good quality of life. At the 20‐year evaluation, 64.3% of the patients were classified as frail.

Conclusions

The long‐term survival of implants supporting a mandibular overdenture is high. Although most elderly in the study became frail over time, peri‐implant health and marginal bone level remained at a satisfactory level.