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 Table of Contents  
REVIEW ARTICLE
Year : 2014  |  Volume : 26  |  Issue : 3  |  Page : 298-301

Geriatric dentistry in India: An oral medicine perspective


1 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad, India
2 Department of Oral Medicine and Radiology, Maharashtra Institute of Dental Science and Research, Latur, Maharashtra, India
3 Department of Oral Medicine and Radiology, Vaidik Dental College and Research Centre, Daman, Daman and Diu, India

Date of Submission05-Jul-2014
Date of Acceptance02-Nov-2014
Date of Web Publication19-Nov-2014

Correspondence Address:
Abhijeet R Sande
Senior Lecturer, Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed University, Karad - 415 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.145010

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   Abstract 

The fastest emerging component of the general population comprises geriatric people, which, in future, will have an impact on oral and systemic health considerations. As there is an increase in the elderly population, it has given rise to new challenges, of which the foremost and important challenge is to provide health care that is cost-effective, accessible, and of fine eminence. Oral health, which forms a major fraction of the general health, has its impact on the physical and mental status, which affects the quality of life of geriatric population. In order to provide excellent oral health care, it is mandatory to focus on the knowledge and education in the field of geriatric dentistry, which will aid in providing optimum health care. Geriatric dentistry has failed to evolve as a distinct, independent specialty at the postgraduate level of dental education. Even at the undergraduate level, there is a lack of training and the constituent aspects of geriatric dentistry are not included in the curriculum. Young graduates need to understand the socio-economic, physical, and psychological problems, and the complexity in treating the elderly patients suffering from chronic diseases and long-term medication, as part of their training in oral medicine. Also, specialized courses in the field of geriatric dentistry, such as "oral medicine advanced education program" and "fellowship in geriatric dentistry," must be developed for the oral medicine specialists to address and meet the needs of elderly population in India.

Keywords: Dental education, geriatric dentistry, India


How to cite this article:
Sande AR, Suragimath A, Bijjaragi S, Mathur A. Geriatric dentistry in India: An oral medicine perspective . J Indian Acad Oral Med Radiol 2014;26:298-301

How to cite this URL:
Sande AR, Suragimath A, Bijjaragi S, Mathur A. Geriatric dentistry in India: An oral medicine perspective . J Indian Acad Oral Med Radiol [serial online] 2014 [cited 2022 May 22];26:298-301. Available from: https://www.jiaomr.in/text.asp?2014/26/3/298/145010


   Introduction Top


Ademographic revolution has already started throughout the world. The proportion of older people is rising tremendously when compared to the other age groups. Approximately 600 million people in the world are aged 60 years and above, and this number will double by the year 2025. This number will rise to 2 billion by the year 2050, with almost 80% living in the developing countries. [1] The geriatric population which comprises 7.7% of the total population suggests that India is in a phase of demographic transition. By 2050, as estimated by the UN Population Division, geriatric population will double in Africa and treble in Asia with one-sixth population residing in developing countries. [2]

A tremendous challenge is being faced by the health and social policy planners because of changing disease patterns. [1] The advances in medical technology, better access to medical facilities, and socio-economic conditions have increased the life expectancy in many parts of the world. [3] As the life expectancy and the number of elderly people increase, there will be a rise in the chronic conditions and illnesses which will affect not only oral, but also the systemic health of an individual. [4] Alteration in oral health and function is commonly seen in older people. [5] However, it is not only the age but also multiple medical problems and medication that contribute to the impairments and adverse effects on oral health and functions. [4]

Some of the distinctive features regarding the geriatric population in India are:

  1. As compared to the general population, the growth rate of elderly population is very high.
  2. Women constitute a larger proportion of the elderly (52% of them are >60 years and 55% of them are >80 years of age). [6]
  3. About 80% of the geriatric population are from rural areas. [7]
  4. Three-fourth proportion comprises the dependent geriatric population who are supported by their own family members. [8]
  5. Economically dependent portion constitutes 75% of the geriatric population. [8]
  6. The portion of geriatric population that lives alone or with their relatives is about 9%. [8]
  7. The literate portion is only 28% (which is low compared to the national average). [9]



   National Policy for Elderly Persons Top


The National Policy for Older Persons (NPOP) was announced by the Government of India in January 1999 with the intention to provide food, health, shelter, finance, and security to the elderly. However, for workers in unorganized sectors, such as farm laborers and daily wage earners, there is no social and financial security plan which has been established. Only 1% of the elderly population is covered under the National Old Age Pension Scheme and the amount given is a paltry Rs. 75-150 per month. [6],[8],[10]


   Oral Health Problems in Elderly Top


Tooth loss, dental caries, rise in prevalence of periodontal diseases, xerostomia, altered taste sensation, and potentially malignant disorders are seen most frequently in the elderly people with poor oral hygiene. [11]

Changes in the oral mucosa

Clinically, the oral mucosa in many healthy older persons is identical to that of younger ones. Constant irritation to the oral mucosa in the form of trauma like cheek biting, diseases like lichen planus, habits like smoking, and salivary disorders can bring about alteration in the clinical appearance of oral mucosa. Age-related oral mucosal immunity changes are bound to occur. [12] As the age advances, wound healing and regeneration capacity of the tissues is delayed. [13] Thus, the communal effects of age-related immunity changes and other factors like trauma, systemic diseases, medication, and poor nutrition lead to considerable oral mucosal changes in the geriatrics.

Edentulism

Edentulism, which is a loss of teeth, is seen in the elderly population worldwide and is related to the socio-economic status. [14] Surveys of old age people document the social gradient for incremental tooth loss. The elders with high socio-economic status have functional dentition (at least 20 natural teeth are present). [15] Tooth extraction, which is the cause of edentulism, is due to the increase in prevalence of dental caries and periodontal diseases. [11],[16],[17]

Problems with dentures

One of the significant clinical findings seen in the elderly people using dentures is denture stomatitis, with the prevalence rate in the range of 11-67%. [18] Use of ill-fitting dentures, improper denture hygiene, denture use at night, and xerostomia are some of the causes for denture stomatitis. Chewing tobacco and consumption of alcohol are some of the other factors causing denture stomatitis. [19],[20],[21] Traumatic ulcers and denture-induced mucosal hyperplasia, which have a prevalence of 4-26%, are the other lesions associated with denture use. [22],[23]

Dental caries

Root surface caries and coronal caries have increased prevalence in the old-age population. [11] The mean numbers of decayed and filled coronal surfaces range from 22 to 35 in developed countries, as indicated by different surveys. [24],[25] The mean number of decayed and filled root surfaces in older people lies between 2.2 and 5.3 in developed countries, and in meta-analyses the root caries increment has been estimated at 0.47 surfaces per year. [1],[26] Thus, dental caries, which is linked to the social and behavioral factors, forms the major health problem in older people. [11],[12],[13],[14],[15]

Periodontal diseases

Globally, approximately 5-70% of the elderly population has a Community Periodontal Index score of 4 (deep pockets). [27] Low education, no dental checkups, few teeth present, and consistent smoking habit have independent effects on the advancement and progression of periodontal diseases in older adults. [28],[29] Also, evidence supports that bone mineral content is reduced due to severe osteoporosis which causes periodontal attachment loss resulting in tooth loss. [30]

Taste and smell

As the age advances, there occurs an alteration in smell and taste function, which results in diminished taste recognition and enjoyment. [31] Olfaction undergoes age-related changes, while gustatory function remains intact in healthy older adults. [32]

Xerostomia

Dry mouth, which is reported in approximately 30% of population aged 65 years and above, is the most common complaint in older people. Persons suffering from dryness of mouth are likely to experience several oral problems, including higher incidence of dental caries, [33] in addition to difficulties in chewing, eating, and communicating, [15] burning sensation to spicy foods, and candidasis. Most of the older adults take at least one medication that causes salivary dysfunction resulting in drug-induced xerostomia. The drugs mostly responsible for dry mouth are tricyclic antidepressants, antipsychotics, atropines, beta-blockers, and antihistamines. Smoking is another major risk factor for dry mouth. [34]

Potentially malignant disorders

The rate of cancer occurrence increases gradually with advancing age, with most of the cases seen above 60 years. Potentially malignant conditions like leukoplakia and erosive lichen planus are found most commonly in older age group with a prevalence of 1.0-4.8% and 1.1-6.6%, respectively. [35]


   Oral Health, General Health, and Quality of Life Top


In recent years, the impact of oral health on the quality of life and general health has been demonstrated in research. General health is compromised due to poor oral health, and improper eating abilities can affect the nourishment of the elderly. Also, the systemic diseases and their medication can lead to xerostomia, alteration of taste and smell, or can be a causative factor for oral diseases like lichen planus. [36]


   Provision to Maintain Oral Health Care in India Top


In the past few years, the Government of India put forth certain rules and regulations for opening new medical and dental colleges. The consent is given to only those colleges which are in rural or peri-urban areas. This, in turn, serves the dual purpose of providing oral health care to the rural population and decreasing overcrowding in cities. These colleges provide clinical training to the dental students as well as provide appropriate treatment in the rural areas at a low cost. As approximately 80% of elderly people reside in the rural areas, this provision made by the government is beneficial and can help to fulfill the demands of geriatric oral health care. However, due to inadequate funds, the district hospitals and health care centers have deficient supply of dental materials and poor maintenance of the equipment, which results in poor dental treatments. The medical colleges do not have a complete dental clinical setup and, hence, provide only few treatments. Due to lack of a complete dental setup, some treatments such as fabrication of dentures, endodontic and orthodontic work cannot be provided by the medical colleges. Government dental colleges having all the facilities are few in number and have a long waiting period of treatment. In addition, no special provisions to treat the elderly have been undertaken. Thus, the elderly population competes to share the available dental resources with the general population and remains neglected.

In the elderly population, poor oral health is one of the risk factors for general health problems and simultaneously, they are also more susceptible to oral conditions or diseases due to an increase in chronic conditions and physical/mental disabilities. The oral health problems increase due to decreased immunity in old age and coexisting medical conditions. In addition, long-term use of medications like tricyclic antidepressants, antipsychotics, anxiolytics, atropines, beta-blockers, antihistamines, etc., leads to xerostomia, and the absence of the protective function of saliva increases the predisposition to oral disease. Thus, management of oral diseases in an elderly patient requires a thorough knowledge of dentistry, medicine, psychology, and pharmacology. An oral medicine specialist provides an essential link between dentistry and medicine and possesses a thorough knowledge of the basic physiological and pathological mechanisms that contribute to health and disease. Hence, oral medicine specialists specially trained in geriatric dentistry can provide optimum care to this distinct group of population and possess the experience, skill, and knowledge needed to advance geriatric dentistry in institutional, academic, community, and private practice settings. Specialized courses in the field of geriatric dentistry such as "oral medicine advanced education program" and "fellowship in geriatric dentistry" must be developed for the oral medicine specialists to address and meet the needs of the elderly population in India. Also, young graduates need to understand the socio-economic, physical, and psychological problems, and the complexity in treating the elderly patients suffering from chronic diseases and on long-term medication right from their undergraduation as part of their training in oral medicine.


   Conclusion Top


As the proportion of elderly people and prevalence of oral and systemic diseases is increasing, it has led to a considerable challenge in providing oral health care to the geriatric population. In order to provide beneficial oral health care, it is essential to understand the mental, physical, and socio-economic state of the elders. Although the dental curriculum of the undergraduates just mentions geriatric dentistry, revised and restructured curriculum along with special training needs to be pursued. Geriatric dentistry needs to be developed in the form of specialized courses such as an advanced education program or fellowship for the oral medicine specialists, who are already trained to handle the diseases occurring in this distinct group of population. Now is the time to gear up and create a committed workforce that can plan and govern oral health care delivery, education, and research in India.

 
   References Top

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