PERIODONTAL CARE FOR COMMUNITY-DWELLING OLDER ADULTS

The prevalence and severity of periodontitis increases with age. Epide miologic studies have identified several risk variables associated wit h advancing periodontitis in older adults: namely tobacco smoking, fre quency of dental appointments, infection with anaerobic bacteria consi dered periodontal pathogens, plaque and calculus accumulation, and som e socioeconomic variables. Future morbidity from periodontitis might b e reduced by minimizing the impact of these risk-associated variables at younger ages. Treatment of periodontal disease in community-dwellin g older adults should be aimed at (1) targeting care to their overall health, functional, and esthetic needs; (2) strategic planning for max imal health and patient satisfaction; (3) documentation of past suscep tibility and current risk; (4) control of principal risk factors; (4) investing time in patient education and informed consent; and (5) plan ning ahead for a potentially catastrophic decline in health. Periodont al treatment needs should be met in an integrated treatment plan that considers the overall prognosis for the dentition and individual teeth and the most efficacious prosthodontic options. Frequent recall for s upportive periodontal care is essential. Several medical, physical, an d societal impediments to provision of optimal care for older adults s hould be sought and minimized by the practitioner. Population dynamics and health-oriented activism among older adults are increasing the de mand for essential and elective periodontal and prosthodontic services , which are met by implant-supported prostheses. Over the next few dec ades, as the incidence of tooth loss declines and our knowledge of the pathogenesis of periodontitis and biology of tissue regeneration incr eases, there will likely be a renewed emphasis on the preservation of the natural periodontium.