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Periodontal disease in the older patient Chris R Irwin Dental Update 2025 38:2, 94-100.
Authors
Chris RIrwin
BSc, BDS, PhD, FDS RCPS(Rest Dent)
Consultant/Reader in Restorative Dentistry, Department of Restorative Dentistry, School of Medicine, Dentistry and Biomedical Science, Queen's University, Belfast
Population projections predict an increasing number of dentate older people who will require assessment and treatment of periodontal disease. Studies show that healthy, older patients show no increased risk of periodontal disease progression compared to younger individuals, while periodontal treatment can be equally successful in the older age group. However, co-morbidity can impact negatively on both the periodontal tissues and the dentition. These effects range from a reduced ability to maintain adequate plaque control, to the use of drug and other therapies directly affecting the periodontal tissues and salivary flow.
Clinical Relevance: An individualized treatment plan is required for older patients, taking account of all factors impacting on the periodontal tissues.
Article
Improvements in healthcare and the standard of living continue to result in an increase in the expected lifespan. At the same time people are retaining more teeth into later life. Predictions for future levels of total tooth loss indicate that the percentage of people in the older age group without natural teeth will reduce significantly, with a trend towards retaining a functional dentition into later life (Figure 1). This increasing incidence of tooth retention will impact on all areas of dentistry, including periodontal management.
Data reported in the 1998 Adult Dental Health Survey1 show increasing levels of attachment loss with age (Figure 2). In the 65+ age group, 85% of subjects exhibited attachment loss (ALOSS) of ≥4 mm, with 35% of dentate subjects exhibiting ALOSS ≥6 mm. Data on probing pocket depths (ppd) showed a lower prevalence of periodontal pockets of equivalent magnitude in this age group (67% exhibiting ppd ≥4 mm; 31% with ppd ≥6 mm), reflecting the level of recession seen in older subjects. Similar studies in the US, Canada and Australia have reported similar prevalence data of between 15–30% of older subjects having ALOSS or ppd ≥6 mm.2–4 Past interpretation of these data concluded that age was a risk factor for periodontal disease. The current view is that the greater level of periodontal destruction seen in older populations reflects the accumulation of disease over a lifetime and not an age-specific condition.
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