Geriatric periodontology: how the need to care for the aging population can influence the future of the dental profession

Abstract

The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population will be affected by noncommunicable chronic diseases, including diabetes mellitus, cardiovascular disease and cognitive impairment. This important demographic shift includes a reduction in tooth loss/edentulism, particularly in older adults of the developed countries in North America, western Europe and north-east Asia. Therefore, in the future, dental providers will be required to care for an expanded number of older adults who have retained teeth and are medically complex. As the linkage of oral disease and systemic disease has focused on the relationship of periodontitis and noncommunicable chronic diseases, a broad review of 'geriatric periodontology' is both timely and important. This volume of Periodontology 2000 covers a range of subjects under this heading. Included are the demographics of an aging world; the effect of aging on stem cell function in the periodontium; the periodontal microbiota associated with aging; the host response in the periodontium of aging individuals; an analysis of the prevalence of periodontitis in the USA on a national, state-wide and community basis; differentiation of physiologic oral aging from disease; treatment of periodontal disease in older adults; implant therapy for older patients; oral disease and the frailty syndrome; the relationship of tooth loss to longevity and life expectancy; and the relationship of periodontal disease to noncommunicable chronic diseases. Although 'geriatric dentistry' is not a recognized specialty in dentistry, and 'geriatric periodontology' is a descriptive title, the subject of this volume of Periodontology 2000 is critical to the future of clinical dentistry, dental public health and dental research. Any comprehensive focus on older patients can only be accomplished with an emphasis on interprofessional education and practice. If embraced, this shift will allow the dental profession to be more closely aligned with the larger health-care environment, and can improve both oral health and health outcomes for patients seen in the dental office.

Changes of students’ understanding in the systemic improvement by dental treatment after undergraduate clinical training in Japan

“…Dental patients with systemic diseases that require an accurate knowledge of pathogenesis have been increasing [8,9]. In order to diagnose and treat these patients correctly, dentists need to be familiar with cardiovascular, respiratory, immune, endocrine, metabolic diseases, etc.…”

Age and Periodontal Health—Immunological View

“…The aging process clearly contributes to the incidence and severity of periodontitis [51, 52, 157, 158] and has been related to altered physiologic and pathophysiologic changes enabling a dysregulation of normal development, maturation, replenishment, and response patterns of the immune system to the noxious challenge of the disease-associated oral microbiome [159]. A detailed understanding of the molecular mechanisms and pathways that control normal versus abnormal responses in aging that could contribute to expression of periodontal diseases would be of great benefit within the context of the aging U.S. population.…”

“…Thus, our preliminary recent results derived from NHANES data (1999–2002) suggesting decreased telomere base pairs with periodontitis (Figure 3C), indicates that rather than simply limiting our perspective to aging processes generating an environment enabling a greater prevalence/extent of periodontitis [165], this chronic infection and persistent local and systemic inflammation my help drive an unhealthy aging progression. Despite the challenges of aging and periodontal research, it is crucial to understand the mechanisms responsible for age-related changes in the immune system in order to develop strategies to maintain good health in the aging population, which will clearly have a major impact on influencing the future of prevention, management, and interventional clinical decisions and implementation for the dental profession [52]. …”

“…pharmacopeia of drugs) factors that can adversely impact oral health. Finally, he emphasizes the importance of the field of periodontics evolving over the next decades to better integrate emerging knowledge on aging processes with improved patient oral health wellness and clinical decisions for most effective disease management within the context of systems alterations in aging [52]. …”

“…One interpretation of these findings would be that while overall antibody levels were not affected by aging, the quality of the response at the individual level was not adequate to manage the chronic infection enabling more frequent/extended episodes of active disease. Sorting out this host-microbe relationship and understanding if this feature is being driven by targeted antigenic changes in the pathogen, or altered capacity of the host immune system to control the chronic infection is an important facet of future approaches to improved precision in periodontal diagnosis and therapy [52, 124, 125]. …”