Mark Allen looks at the impact successful endo can have on elderly patients.
Elderly people value their oral health. They want to retain their teeth, their own smile and avoid an extraction, if they can, for as long as they can. They also want conservative, minimally-invasive dentistry, due to the compound effect of years of wear and tear and, often, restorative work.
If an infection is diagnosed, and a root canal recommended, a systematic review found that a patient’s age had “no influence on the success rate” of treatment, also that age alone is not a prognostic factor. Nevertheless, age-related changes to the dentition and soft tissue do present challenges for the endodontist. Moreover, the clinical team must feel sure that an elderly patient is fully aware of the role they have to play to keep the result stable. If any patient is unable to commit to regular reviews and the practise of good daily hygiene, because of limited dexterity, or cost, or issues with travelling to the practice, or a combination of these reasons or more, the dentist must set out alternatives to a root canal.
Communication is fundamental to quality dentistry; with your older patients, it is imperative that they understand the implications of their diagnosis and of not going ahead with your recommended treatment plan. Just as when you’re talking to any patient, look for non-verbal communication, like lack of eye contact and negative body language. If they’re in pain, yet also fearful about the prospect of a root canal, they may be giving you mixed signals – agreeing in principle but also showing signs of discomfort, or anxiety about the thought of going ahead.
Careful choice of language can help put elderly patients at ease, while explaining what the endodontic process will entail. As part of taking a full medical and dental history, radiographs and X-rays can be useful aids; modern digital imaging systems provide images of amazing quality. Even for individuals who have always taken good care of their teeth and gums, the natural aging process will have affected the soft tissue in the mouth; there will also be pulpal changes that have led to recession in the size of the chambers and canals and it may be possible to see these radiographically.
Age-related changes to the dentition that are not due to disease include tooth wear and stain accumulation, also alterations to the microstructure, such as reduced mineral content. The patient may have noticed these changes themselves. Also, with age comes increased root canal calcification, which can make endodontic treatment difficult – hence the need to be referred to a dentist with the experience, knowledge and skill to deliver a successful result, and a comfortable time in the chair.
As a result of consenting to root canal therapy, an elderly person may see a significant improvement to their quality of life. The end to a painful infection means they will be able to eat and clean better, also enjoy better function – these things combined also support self and social confidence. An endodontically-treated tooth may be strategically valuable for retaining a prosthesis. The dentist’s clinical view might be that the patient would tolerate non-surgical root canal treatment better than an extraction, physically and psychologically. Having a tooth extracted can have a devastating impact on people of all ages, which lasts a long time. If a patient is struggling with the idea of being old, losing a tooth can lead to increased sadness and low mood.
The tools and materials selected by the dentist can help to mitigate some of the challenges with treating elderly patients for root canals. Narrow calcified canals can make the comprehensive elimination of infection tricky, but there are excellent shaping files available that are suitable for even very thin, curved canals. For example, the HyFlex EDM file system allows even narrow files to be prepared efficiently – the Glidepath file 15/.03 was introduced to help dentists successfully face the challenge of complex cases – who often find they can complete the preparation sequence with just one or two files, for value.
With good treatment planning, there is no reason why quality endodontic therapy won’t be a successful, comfortable experience for an elderly patient. The advantages of root canal treatment over an extraction can be numerous, improving their oral-health related quality of life as well as benefits to emotional and social wellbeing. Skill, a systematic approach, plus use of the finest quality materials to negotiate complex anatomy will support the kind of conservative, minimally invasive dentistry that these patients deserve.
References available on request.