GERODONTOLOGY
problems. Since ageing is not a pathology but a
permanent decrease of the individual faculties, a
practitioner should face the implications of ageing
in the oral cavity. Genetic and biologic factors as
well as social and behavioral issues may play an
important role.
The necessity of a bio-ethic attempt
Despite the fact that the dentist applies the rules
he was taught, he is very disappointed with the
results. Unfortunately there are dogmas which
dragged down to pitfall the prosthetic restoration
for senior patients.
Since geriatric dentistry is not a priority in the basic
educational syllabus, the profession is not able
to face a growing minority of atypical or unusual
persons looking for prosthodontic treatment that
present outstanding features or variations from the
normality. Therefore, these handicapped patients
described as “denture cripples” cannot receive
conventional treatment or often cannot wear the
dentures as completed by the dentists.11
The classical approach is devoted to the treatment
of typical or normal patients, but for the old-old or
atypical patients special diagnostic and solutions
are recommended.
A typical or conventional patient can be categorized
as the one evincing the following characteristics:
1. A patient who comes to the dental office for
prosthodontic treatment after losing or about to
lose his natural teeth.
2. His expectation with respect to the dental care
is to be provided with a set of removable dentures
which will partly replace the functions fulfilled by
his natural teeth.
3. He is agreeable to the treatment and collaborates
with the dentist during the clinical procedures and
the necessary adjustments that follow the delivery
of the dentures.
4. He does not present any severe systemic or
physical limitations for the treatment and for the
self- home care.
5. The masticatory muscles and the tempuramandibular joints are reasonably healthy without
functional limitations.
6. The residual ridged and their adjacent structures
are of normal size and form, and able to provide a
stable functional foundation of the dentures.
7. The soft and hard oral tissues are healthy and
properly lubricated by the salivary flow.
8. The tongue and the tongue attachments are of
normal size and position that allows the insertion
and proper function of the mandibular prosthesis.
9. There is a minimal or non-existing Gagging reflex
at the posterior region of the maxillary during the
treatment and after upper denture insertion.
10. At a physiological vertical dimension at
occlusion there is enough adequate denture
space for the construction of the denture base and
the artificial teeth.
11. The special occlusal relations between the
edentulous ridges do permit setting of the artificial
teeth on the top or close to the residual crests and
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allows harmonious arrangements.
12. The patient shows a reasonable and positive
attitude acceptance and adaptation ability
following the delivery dentures
13. Last but not least; there are NO symmetric
patients as educated in the conventional Textbooks. Since the left and right side are not
symmetric, that means that the teeth arrangement
do not respect the patient physiology
To conclude, with the ageing there is no ideal
patient that presents all the described criteria.12
Here are the most frequent features:
1. Systemic patients
Most patients present one or two systemic
diseases. The most common are hypertension,
cardio-vascular and diabetes problems.
Moreover, there are also neurological systemic
critical situations such as Parkinson, Alzheimer and
different kinds of depression. Different forms of
cancer are also frequent.
2. Psychological behaviors
One of the most difficult obstacles for a successful
treatment is frequent psycho-geriatrics attitudes
and behavi ܘ[\