Tuesday, June 16, 2009
Dentistry a critical aspect of geriatric care
Dr. Michael Camardi
Recent columns
About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi: About two years ago they called you in to see my mother, who was at Carilion Roanoke Memorial Hospital because her blood sugar was so high that she got dizzy, fell and broke her left leg.
At that time you and your student doctors went over her, looked inside her mouth and said her sugar was so high because she had infected teeth and needed to get them pulled.
Frankly I didn't believe you because it didn't make any sense that teeth could do this, but we took her to the dentist and he pulled two teeth and she got a lot better.
Well now the same thing is happening again with her blood sugar and we're getting ready to go to the dentist again. I don't understand any of this. What's going on? What do I tell the new dentist?
-- Smith Mountain Lake
Dental care in the elderly is one of the most misunderstood, unappreciated but critical aspects of geriatric practice.
The body is a closed-loop integrated system where any single part can have an effect on any other part and the body as a whole. Consider the mouth as a key entry point for many kinds of bacteria into the body because of the maze of blood vessels that support the teeth via the gums.
With age, disease and different medications, a decrease in saliva -- the first line of oral defense against tooth decay -- occurs. Also with age, there tends to be a decrease in manual dexterity, making it more difficult to practice good brushing and flossing habits.
Older adults may need to use electric toothbrushes and other special brushes to clean between teeth. People with arthritis or other limitations to movement may need modified toothbrushes with thicker handles to practice good oral care.
It should be noted that people with diabetes are more prone to infections and need to be especially aware of the possibility of having pockets of infections in their gums, which sets off a vicious cycle of high blood sugars and a weakened immune system.
Uncontrolled gum disease has been associated with an increased risk of complications due to heart disease, diabetes and stroke. I have seen loose teeth be a sign of osteoporosis.
A current review of the literature finds that periodontal disease is associated with a 24 percent increase in the risk of heart disease. Interestingly enough, missing teeth raise the risk of heart disease also. While the mechanisms of these findings are not clear at this time, their importance speaks for itself.
To keep the gums free from trauma, new dentures are needed every three to five years. This is because the gums and teeth that support dentures will change shape and position over time. Then the dentures will no longer fit well and cause pain and inflammation.
Continuing to use worn-out dentures that do not fit well can cause a range of problems such as ulcers or sores on the gums and looseness of remaining teeth. Furthermore, chewing will be painful as well as inefficient and lead to a decrease in appetite. Many times a patient's weight loss can be directly linked to poor oral hygiene.
Women should know they are at a notably higher risk for gum disease because of feminine hormone fluctuations.
Finally a word to the smokers: STOP.
Most studies I have accessed for this article show that more than 40 percent of people who smoke daily for more than a decade have lost most, if not all, of their teeth because of calculus (or bacteria-friendly plaque forming on their teeth), pockets of infection that have grown between their teeth (gingivitis) and the thinning of the bone (the irritants in smoke speed this weakening in some way) holding the teeth in their sockets.
I have saved the worst for last: oral cancer. A special warning applies to those of you who use snuff and chew tobacco. Your risk for cancer of the lip, tongue and gums, not to mention gingivitis, should make you think very seriously of stopping immediately. In taking care of these patients over the years, let me assure you, the habit is worth breaking.
All this said, it is important to know that these conditions are preventable. You can be in control of all of this by going to the dentist regularly.
I have seen so many dental professionals make very important contributions to my patients' overall health. Yes, it can be difficult to get up and go to the office and the insurance can be problematic and sometimes it can be uncomfortable, but you need your dentist more than you may know.
Consider all they can do for you: from supporting an attractive physical appearance and positive self-image to the enjoyment of your meals, while maintaining your health and vitality. The profession of dentistry stands at the very foundation of truly aging gracefully.
