Geriatrics in Endodontics outline
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
- Gingival recession and abrasion
- 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