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Author: Charles H Rankin, D.M.D.

1. Geriatrics in Endodontics

  • Advanced age is not a contraindication for endodontics.
  • Endodontics is less traumatic than exodontics.
  • The elderly are usually highly motivated to retain the teeth.

2. Pulpal change due to aging

  • Decrease in size and number of pulpal cells.
  • Increase in number of collagen fibers.
  • Decrease in size of pulpal space due to continued dentin formation.
  • Decrease in number of pulpal blood vessels.
  • Decrease in number of pulpal nerve fibers.

3. Continued dentin formation

  • Secondary dentin formation
    • Anterior teeth - incisal aspect of pulp
    • Posterior teeth - floor of pulp chamber
  • Tertiary dentin formation
    • Caries
    • Restorations
    • Trauma
    • Gingival recession and abrasion
    • Periodontitis
    • Attrition
  • Pulps with a high degree of calcifications may give false negatives to pulp testing.

4. Pulpal vascular changes

  • Pulpal arteries - susceptible to arteriosclerosis
  • Arterioles and precapillaries tend to calcify

5. Pulpal complications in treating the geriatric patient

  • Pulpal spaces and canals may be difficult to locate due to calcifications
  • Heavily restored teeth may hinder diagnosis and treatment
  • Long standing periodontitis may affect pulp
  • Attrition, abrasion and gingival recession may complicate treatment
  • Effective communication may take longer with patient
  • More complex medical histories
  • Increased postural problems and stamina considerations
  • Decreased rubber dam tolerance due to difficulty breathing, gagging and salivary collection

6. Endodontic geriatric considerations

  • Peripical lesions may take longer to heal (up to 2 years)
  • Medical histories are more complex requiring additional attention
  • Patients may have hearing, postural or chronic systemic problems
  • Patients may need more time for explanations
  • Always treat the elderly with dignity and respect
  • Pay attention and focus on their needs and expectations