Geriatric Dentistry
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Direct answer
Old age in India begins at sixty — the National Policy on Older Persons 1999 fixed the threshold the UN's 65 was not — and roughly one in ten Indians today is elderly, heading toward about one in five by 2050 per the UNFPA India Ageing Report's projections. Geriatric dentistry manages their mouths in the shadow of four realities: tissues age (thinner mucosa, recessed gingiva, fibrotic pulps with narrowed canals, residual ridge resorption), polypharmacy dominates the oral environment (five or more drugs, with anticholinergic-driven xerostomia fuelling root caries and candidiasis), antiresorptive therapy creates medication-related osteonecrosis of the jaw risk around extractions, and treatment planning shifts from complete dentitions to function — the shortened dental arch of Käyser (1981) and the two-implant mandibular overdenture that the 2002 McGill consensus named the first-choice standard of care for the edentulous mandible.
What you must remember
- Demography and definitions: elderly is 60-plus in Indian policy (young-old 60-69, old-old 70-79, oldest-old 80 and above); about 10 per cent of Indians today, projected near 20 per cent by 2050.
- Ageing changes: attrition and gingival recession exposing root surfaces; pulpal fibrosis, reduced cellularity, dystrophic calcification and canal narrowing complicating endodontics; diminished taste; residual ridge resorption mandibular worse than maxillary; modest true salivary decline that drugs then dwarf.
- Polypharmacy (five or more medications) and the Beers criteria of potentially inappropriate medications; xerostomia culprits — anticholinergics, tricyclics and SSRIs, antihistamines, antihypertensives, diuretics.
- Root caries: the signature lesion of ageing, tracked by Katz's root caries index; managed with high-fluoride (5,000 ppm) toothpastes, fluoride varnish, chlorhexidine and glass ionomer restorations.
- Candidiasis in age: denture stomatitis under ill-fitting acrylic (Candida albicans), angular cheilitis in the folded, dry mouth — hygiene, fit correction and topical antifungals treat it.
- Shortened dental arch (Käyser, 1981): anterior teeth plus premolars — roughly twenty occluding teeth — suffice for function, sparing elders complex full-arch rehabilitation.
- McGill consensus (2002): the two-implant mandibular overdenture is the first-choice standard of care for the edentulous mandible — the most quotable prosthodontic fact in gerodontology.
- MRONJ: antiresorptives (bisphosphonates, denosumab) and antiangiogenics; risk concentrated with high-dose intravenous therapy and dentoalveolar surgery — non-surgical management first, extraction protocols and physician liaison always.
- Cognitive dimension: dementia affects consent (capacity assessment, caregiver-dentistry), and the frail housebound and institutionalised elderly need outreach delivery — mobile and domiciliary dentistry.
Assessing and planning for one elder
An independent 78-year-old on amlodipine, metformin, alendronate weekly and escitalopram wants to "chew properly again". The assessment runs systematic. History and medication review first: the escitalopram flags xerostomia; the alendronate of four years flags MRONJ risk; the metformin flags healing and infection surveillance. Examination next: three root-surface lesions on the remaining premolars and molars, angular cheilitis, thin mandibular ridge, and worn but serviceable anterior teeth with reduced periodontal support. Priorities then order themselves: prevention first — 5,000 ppm fluoride toothpaste, varnish on root surfaces, saliva substitute and denture hygiene; restorative second — glass ionomer restorations toward a shortened dental arch endpoint (canines and premolars preserved, hopeless molars assessed); surgical third — any extraction is weighed against the alendronate: non-surgical alternatives exhausted first and the physician consulted, atraumatic primary closure chosen if extraction is unavoidable. Prosthetic fourth: the mandibular ridge's height argues for a two-implant overdenture if general health and bone permit, per the McGill consensus — the difference between a denture in a drawer and one worn. Recall last: three-monthly, with the caregiver involved as cognition and dexterity change.
How the exam frames it
The factual anchors come as matched pairs: age definition 60 in India against 65 in UN usage; SDA to Käyser, overdenture standard to McGill 2002; denture stomatitis to Candida; MRONJ to bisphosphonates and denosumab. The conceptual trap is the passive phrase "saliva decreases with age" — the honest answer concedes a modest physiological decline and then names drugs as the dominant xerostomia mechanism, because that is where management acts. And the planning question probes judgement: a grade-3 mobile tooth in a bisphosphonate patient is a risk-benefit negotiation, not an extraction reflex — non-surgical options, physician liaison and consent are the answer the examiner set.
Frequently asked questions
At what age is a person elderly in India?
Sixty years and above, per the National Policy on Older Persons 1999, with the young-old, old-old and oldest-old subgroups — distinct from the United Nations' 65-year threshold.
What is the shortened dental arch concept?
Käyser's 1981 finding that anterior teeth and premolars — about twenty occluding teeth — provide adequate function, allowing simplified treatment for elders instead of full-arch restoration.
What did the McGill consensus conclude?
That the two-implant mandibular overdenture should be the first-choice standard of care for edentulous patients — the minimum intervention transforming lower denture quality of life.
Which drug classes cause xerostomia?
Anticholinergics, tricyclic and SSRI antidepressants, antihistamines, antihypertensives and diuretics — polypharmacy multiplies the effect.
Which drugs cause medication-related osteonecrosis of the jaw?
Antiresorptives — bisphosphonates and denosumab — plus antiangiogenic agents, with risk highest for high-dose intravenous use and dentoalveolar surgery.