Management of Caries in Older Adults

Changing attitudes, improved access to dental care, emerging treatment modalities and effective preventive programs have meant that large numbers of patients are now retaining natural teeth into old age. However, the prevalence of caries is predicted to continue increasing within this partially dentate older population as patients struggle to control a range of etiological factors including high sugar diets, limited manual dexterity, xerostomia as a result of polypharmacy and plaque retentive intra-oral prostheses. Whilst evidence for management of caries in older adults is scarce compared to that in children, similar principles of risk assessment, prevention and minimal intervention should be applied to operative management. This includes the use of atraumatic restorative treatment (ART) as a means of managing coronal and root caries for patients in the dental surgery or those treated in a domiciliary setting, including long-term care facilities (LTCFs). Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, including prescription of topical fluoride regimes, dietary advice and instructions for carers. In addition to managing caries, dental professionals should also consider how older adults maintain prosthodontic interventions to replace missing teeth with prevention and future maintenance an essential element of any treatment plan in this population.