Ed i to r ia l

Oral satisfaction – or getting to the root of the problem of theoldest old?

This issue of Gerodontology marks the reintroduction

of review articles that will cover a wide range of

subjects and, hopefully, provide readers with key

information as well as clinical input into patient

care. This review article gives consideration to

endodontics in the elderly and deals with the par-

ticular problems and potential solutions associated

with this area of dentistry. Often this aspect of a

treatment plan is critical to the adequate function-

ing of any removable appliance, particularly when

the number of remaining natural teeth is small.

Previous studies have shown that there is a high

non-compliance rate with bilateral free-end saddle

partial dentures and many older adults may reject

or be judged unsuitable for implant therapy. How-

ever, root canal treatment can also be one of the

most difficult aspects of treatment in view of the

degrees of difficulty in achieving a satisfactory end

result. This may be because of the access to the

tooth or within it, sclerosis of the root canal or

placement of a rubber dam to isolate the tooth. Also,

many older patients do not take kindly to lying

supine or are not in a position to remain still for the

length of the procedure. Unfortunately some are

housebound or live in residential care where such

treatment modalities present significant problems

for the operator. In addition medical problems, such

as Alzheimer’s disease present a serious restriction

on what might be achieved. There is also the

dilemma as to whether attempting this form of

treatment is appropriate where there could be

concerns regarding the level of oral hygiene and the

support required to maintain it. Attempting to bal-

ance this against the removal of the last remaining

teeth and the known difficulties for everyday

patients in controlling and functioning with com-

plete dentures is essential. Consideration has also to

be given to the patients’ quality of life where eating

may be one of their few remaining pleasures.

The overall theme of further papers included in

this issue, relate to oral hygiene, oral health pro-

motion and nutrition, and communication, all of

which impact on to the quality of life of older

adults. Often attempting to motivate denture

wearers is very difficult and it is important that

dentists have an accurate view of the patients’

subjective experience of their dentures and the

impact on their daily lives. The use of a semi-

structured interview in this area is suggested as a

means of achieving good repeatability for qualita-

tively assessing satisfaction with complete den-

tures. Patients also report that mechanical cleaning

is still the most prevalent method of hygiene and

that there is still a lack of guidance in this area

which has impact on conditions of the underlying

oral mucosa such as denture stomatitis and

hyperplasia. Also, periodontal conditions and lack

of denture hygiene may impact on the health of

older patients. Therefore, oral health knowledge

and understanding are always considered key fac-

tors to successful ongoing treatment, not only

amongst patients but also with regards to their

nurses and carers. A group of researchers decided to

take their oral health promotion to older adult’s

social clubs and this proved to be a successful

innovation and as a result provided oral health care

products as well as information sheets to this group

of patients. Often it is useful to be able to measure

the level of moisture within the oral cavity as this

could provide important additional information as

to the likely success of a line of treatment. A useful

and simple tool for this task has been piloted and

appears to satisfy key criteria for dentists as well as

non-dental health care workers to rapidly evaluate

levels of dryness of their patients’ mouths.

At one time it was thought that many people in

their 90s or older would be amongst the most

debilitated or unhealthy of the population and

would require the most support from the health

care services or their family. Although unfortu-

nately this is still true for a proportion of this group,

it is becoming increasingly obvious to professionals

working with these oldest old that many enjoy

good health, are fit to take part in outdoor activi-

ties, have an agile intellect and are sexually active,

much to the surprise of their younger relatives. It

would therefore appear that the general view that

advancing age leads to a deterioration in lifestyle

needs to be rethought. An interesting study has

shown that cognitive abilities in men over 90 years

are higher than that of men in their 60s, 70s and

80s. It has been suggested that men who reach

their 90s consist almost exclusively of those who

are not susceptible to Alzheimer’s disease and

therefore their cognitive ability remains intact.

Similarly as men in their 60s and 70s are more

susceptible to cardiovascular disorders, those that

survive into older age remain physically fit.

� 2004 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2004; 21: 183–184 183

In addition, evidence would suggest that men do

better than women in this oldest age group. It

appears that women with dementia survive with

the illness rather than die from it, and therefore

have a lower level of overall mental ability.

Unfortunately women are less physically fit than

men although many are still alive in their 90s. An

interesting statistic in the United States indicates

that although men only form 15% of centenarians,

they are 40% of those over 105 years old. This may

go some way towards explaining why data from

studies of hand and jaw muscle function of these

oldest old have some diverse results as a proportion

of them exhibit functional characteristics often

seen in their younger counterparts. Could it be that

in some way these individuals are special? Some

have suggested that longevity genes may be can-

didates as they protect against the development of

disorders and allow this group to survive poten-

tially life-threatening ailments and conditions.

Genes also help to determine other important

properties: adaptive capacity and functional

reserve. Adaptive capacity is a person’s ability to

overcome disease or injury and deal with the

related stresses; functional reserve is defined as

how much of an organ is required for it to function

effectively. These are mutually dependent as the

ability to deal effectively with disease depends on

the adequate functioning of a person’s organs and

hence their continued survival. Although limited,

recent evidence would suggest that these oldest old

resist long standing lethal diseases but often have a

relatively short period of illness and succumb to

acute disorders such as pneumonia. Studying this

group in greater detail may offer ways in which

larger numbers of the population could benefit, but

… they are in you and me; they created us, body and mind

… they go by the name of genes, and we are their survival

machines (Richard Dawkins, The Selfish Gene, 1976).

James P. Newton

Editor

� 2004 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2004; 21: 183–184

184 Editorial