HJAR Jul/Aug 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2020 55 Niki Carter, DMD Dental Director Delta Dental of Arkansas root caries, and the need for periodontal treatment to preserve healthy clinical tissue attachment for teeth. If overzealous hygiene is not the problem, but poor hygiene is the culprit, this is also problematic 6 . Poor oral health leads to numerous associations in the body, as in heart disease, respiratory disease, bacterial pneumonia, diabetes, and many other systemic illnesses 7 . It is approximated that adults over the age of 65 years old take an average of 5 to 12 medications per day 8 .There are an esti- mated 1,800 medications which cause xe- rostomia (dry mouth). Elderly patients often take medications for osteoporosis, either oral or injectable. This class of bisphos- phonates, while excellent for increasing bone density, can have harmful effects for the oral cavity in the event a tooth must be surgically removed 9 . This special popula- tion also takes this bisphosphonate drug for multiple myeloma and breast cancer. There is a huge negative association with these types of drugs in the jaws. Dentists must know if you are taking these, or have ever had an injection or an infusion of this bisphosphonate class of drug. Other therapies, such as radiation and chemotherapies, can have severe outcomes if the oral cavity isn’t healthy and free of dis- ease 10 . These therapies, while not inclusive to the aging population, are used commonly in this age group. Severe mucositis and osteo- necrosis can occur when the jaw is radiated. Psychologic and cognitive issues have a direct correlation in maintaining proper oral hygiene, and therefore affect the den- tition. Depression, Alzheimer’s disease, and dementia can lead to not caring or forgetting to maintain proper oral hygiene, and this neglect leads to poor oral health 11 . In long- term facilities, it is vital that good oral health is maintained if patients are not edentulous. Habitual issues, such as wear and tear, attrition, abrasion, and erosion have direct impacts on oral health. Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth structure, which starts at the incisal edge or occlusal (biting) surface. This tooth wear is a physi- ological process, and a normal part of ag- ing. Abrasion is the progressive loss of hard tooth surface caused by mechanical actions other than mastication or tooth-to-tooth contacts. Abrasion is commonly associated with an incorrect tooth brushing technique, giving rise to notching at the junction of the crown and root of a tooth 12 . Acid erosion is a type of tooth wear, and is the irreversible loss of tooth structure due to chemical dis- solution by acids not of bacterial origin. The most common cause of erosion is by acidic food and drink 13 . Vertical dimension is the space or height between the surfaces of the teeth when the upper and lower jaws are occluded (biting). A loss of vertical dimension occurs in the aging population. After teeth have worn down, this vertical space has decreased, and the smile line is changed. This is a normal physiological occurrence, but can be prob- lematic, depending on the severity of the