Dental pain in the elderly

Dental pain is a primary precipitator of dental treatment in the elderly population. Yet the pain in an older person is likely to represent a more severe pathosis than in a younger individual. Increased internal mineralization of the teeth with time results in increased brittleness and susceptibility to fracture. Gingival recession exposes softer, more caries-prone areas of teeth to the oral environment. Alteration in salivary volume and composition is a common side effect of many medications; this further compromises the dentition. The sense organs of older teeth are relatively insulated from the oral environment; there is diminished vascular and nervous support of the pulps of older teeth; and incipient dental caries becomes less likely to cause any discomfort. Dental caries in an older individual therefore often presents as an advanced, cavitated lesion, a fractured tooth, or a soft tissue ulceration secondary to either. Soft tissue trauma similarly may be missed until extensive damage has occurred. Innervation of intraoral soft tissue is diminished in elderly subjects, and the healing potential of mucosa may be less as well. Dentures are often responsible for intreoral trauma due to progressive maladaptation, diminished patient coordination, or salivary modification. Inasmuch as both incipient dental caries and incipient soft tissue trauma may fall to signal their presence, regular intrsoral examinations become the most effective means for avoiding advanced dental pathoses and subsequent dental pain in the elderly.