Introduction

The elderly are increasing in numbers and have a longer life expectancy in most parts of the world.  In addition, older adults are now visiting their dentist more frequently than in the past.  Thus, dentists will be treating more elderly patients in the future.  It is important dentists be aware of the common medical conditions and medications taken by the elderly.  Dentists must be aware of complications or danger to life that may occur during dental treatment.  A thorough medical history is basic to understanding a patient’s total health.¹  Therefore, taking a careful medical history before undertaking any dental procedure is mandatory in order to provide appropriate care for these older patients. Some systemic diseases may influence oral health and/or dental treatment to some degree, and conversely dental treatment may have an influence on some systemic conditions.  Loesche et al.² stated medical health and oral health are linked.  Several recent studies have shown a correlation between dental or periodontal infections and cardiovascular or cerebrovascular disease.^3-6

Surveys indicate a high prevalence rate of medical conditions in the elderly and age appeared to be a significant factor.^7-9  Cardiovascular disease was the most prevalent group of disorders reported in the elderly.^7,9,10  Other common disorders include endocrine problems, arthritis, respiratory diseases, gastrointestinal diseases, blood diseases, neurological disorders, vision defects, and impaired hearing.^10-13  Among cardiovascular diseases, hypertension is the most frequent disorder experienced by the elderly.^9,10  With reference to endocrine disorders, diabetes mellitus and thyroid disease are the most common ailments. Vision defects and impaired hearing have been associated with advancing age.  The three most common conditions causing vision loss in the elderly are senile macular degeneration, glaucoma, and cataracts.¹⁴  Sensory neural hearing loss is a common phenomenon, which may lead to significant communication problems in older people.¹⁵

Elderly patients tended to have more chronic health problems and consume more medications than other age groups.^16,17  Steen¹⁵ stated most chronic diseases are age-dependent, and the prevalence of related drug treatment increases with advancing age.  Also, multiple drug use increases significantly with advancing age.^1,16,18,19  Galan et al.¹¹ reported 90% of older Canadian dental patients were taking at least one medication, most of which were analgesics, diuretics, and gastrointestinal agents.  Landahl²⁰ reported the most common medications at age 70 were anxiolytics, diuretics, analgesics, and digitalis; at age 82 common drugs included analgesics, anxiolytics, diuretics, and laxatives.  Hale et al.²¹ reported the average number of drug categories used simultaneously increased with age; the most common drugs reported were antihypertensive agents, cardiovascular drugs, vitamins, and analgesics.  The elderly were almost always on long-term drug therapy, frequently involving multiple drugs.  Therefore, they were more likely to have adverse drug reactions.^16,19,22,23  These adverse drug reactions can affect the oral cavity.  For example, psychotropic agents, antihistamines, and diuretics dry the oral mucosa and cause xerostomia.  It has been shown the use of cardiovascular agents and psychotropic medications reduced salivary flow with statistical significance.²⁴ Lichenoid reactions may be induced by antihypertensives, hypoglycemics, and non-steroidal anti-inflammatory drugs.  Table 1 lists the most common adverse effects of dental significance associated with the most frequently taken drugs by dental patients.^16,19,25

Table 1.  List of medications with possible adverse effect of dental significance.^16,19,25

Because of the reported high prevalence of medical conditions and medications used in the elderly, understanding the most common conditions is important for dental management.  The objectives of this study were to obtain information on the medical conditions and medications used among elderly Thai dental patients and to investigate the relationship between the medical conditions and medications used in relation to age and sex.

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Citation Number: Vol. 5, No. 1, Page 032