To lead a quality life in old age, one needs teeth not only for the enjoyment of food but also for proper nutrition and pleasant looks.There is also evidence that oral diseases impact cardiovascular, endocrine and pulmonary health particularly in the elderly, which will certainly provide additional stimuli for the elderly to seek dental care. Three groups of older subjects are identified.Young old (65 – 74) Older old (75 -84) Oldest old (greater than 85). Pain associated with vital pulps (caused by heat, cold, sweets or referred pain) seems to be reduced with age.

1. GERIATRIC
ENDODONTICS
Presented by:
DR. ANUBHUTI
BDS,MDS
Dept. of Conservative
Dentistry & Endodontics
Dental Institute
RIMS

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Comparison among the ages

3. “He, who is born, has to go through childhood, youth
and old age. If aging is inevitable, let's be graceful and
serene about it and lead a disciplined quality life.”
• – Bhagvad Gita.
3

4. To lead a quality
life in old age, one
needs teeth not
only for the
enjoyment of food
but also for
proper nutrition
and pleasant looks.
There is also evidence
that oral diseases
impact cardiovascular,
endocrine and
pulmonary health
particularly in the
elderly, which will
certainly provide
additional stimuli for
the elderly to seek
dental care
J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214.
4

5. There is also evidence that
oral diseases impact
cardiovascular, endocrine
and pulmonary health
particularly in the elderly,
which will certainly provide
additional stimuli for the
elderly to seek dental care
J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214.
5

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J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214.
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Currently the old age population in India -8%-80 million
In 2025-reach 12%-830 million
India alone will contribute to 110 million
One out of every 7 aged persons in the world will be an
Indian
Geriatric Endodontics is Endodontic Consideration
for the Older Adults.

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J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214.
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Unfortunately, geriatric dental care in India is still in its
infancy.
Dental treatment is considered the last priority owing to lack
of awareness and poor socio-economic status
Geriatric Endodontics is Endodontic Consideration
for the Older Adults.

8. Young old
(65 – 74)
Older old
(75 -84)
Oldest old
(greater
than 85).
8
Three groups of older subjects are identified.

9. Allow the patient to explain the problem
in his/her own way.
Pain associated with vital pulps (caused
by heat, cold, sweets or referred pain)
seems to be reduced with age.
J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214. 9
C
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10. More than 50 % of patients over 60 years of age are
medically compromised and are on medication
Most commonly seen medical conditions are diabetes,
hypertension, cardiovascular diseases, arthritis and
neuromuscular problems like Parkinson's disease and
Alzheimer's.
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M
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PULP CHANGES WITH AGE
Continuing Dentin Formation Calcifications increase
<<Sayegh F & Reed A. Oral Surg 1968

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reparative dentine formation, canal & Pulp space decreases in size
Morse D et al. Quint Int 1991
Young tooth
Old tooth

13. Pathologic process related to injury
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Pulpal calcifications
Pulp
stones
Denticles
Coronal
area
Diffuse
(linear
calcifications)
Radicular
area

14. Presence of tori, exostoses& denser bone may require
increased exposure times for contrast for x-ray film
Periapical area must be included in the radiopgraph
Lamina dura should be examined (incidence of cysts
& tumour increase with age)
J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214. 14
R
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RESPONSE OF PERIAPICAL TISSUES
Both older and younger patients have similar patterns of
healing, but with a slight delay in older.

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DIAGNOSTIC PROCEDURES

17. Hence, it will be wrong to assume that the
pulp is non vital and carry out the treatment
without other supporting evidences.
may diminish the response to
traditional vitality testing.
Increased bulk of dentin and increased
pulpal fibrosis
J Conserv Dent. 2011 Jul-Sep; 14(3): 208–214.

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DIFFERENTIAL DIAGNOSIS
Periodontic or Endodontic??

19. In general, treatment approaches do not
differ significantly.
Number of appointments (single vs multiple)
are impacted.
Use a bite block!!!
Adjust the chair in a more upright position.
Place a rolled towel or other type of support
under the patient’s neck.
19
TREATMENT PLANNING CONSIDERATIONS
» Shugars et al. JADA 2000

20. • appointments should be scheduled
considering patients’ normal meal &
insulin schedule
Diabetes
• low stress protocols & shorter
appointments.
cardiovascular
disease

21. There are no specific
contraindications for
different anesthetics or
techniques
Both primary and
supplemental
techniques may be
used.J Conserv Dent. 2011 Jul-Sep;
14(3): 208–214. 21
LOCAL ANESTHESIA
Stabident

22. Bader et al OOOOE 2002 22
• Vasoconstrictors should not be
administered to patients with unstable
angina, uncontrolled hypertension or people
with recent myocardial infarction and
coronary bypass graft.
• Available evidence (large-scale studies are
needed) indicates that epinephrine is safe in
hypertensive, older pts.
cardiovascular
disease

23. 23
CROWN LENGTHENING

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24
ISOLATION
Leakage
Patched or blocked with Cavit,
OraSeal, Rubber base adhesive or
periodontal packing
Replace with
a new one

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Access opening
Endo
Access
bur
Endo Z
bur
C Plus
files
DG 16
explorer
Flaring
should be
performed
to provide
for a
reservoir of
irrigation
Very few
canals have
adequate
diameter to
allow the
safe &
effective use
of broaches

26. The pulp stones
can be visualized
often with
additional light and
magnification.
Ultrasonic
troughing tips are
especially useful in
cutting through
the calcifications
that covers the
canal orifices.

27. An in vitro study
indicates these are
safe to use with
pacemakers
27
WORKING LENGTH
Garofalo et al JOE 2002

28. A working length of 1-2
mm from the apex is
preferred, in order to
confine materials to the
canal space
JWu, Wesselink & Walton. OOOOE 2000
28
CLEANING AND SHAPING

29. Selects Gutta-Percha filling
techniques that do not require
unusually large mid-root tapers
and do not generate pressure in
this area, which could result in
root fracture.
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OBTURATION

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The coronal seal plays an
important role in maintaining the
apically sealed environment, and
it has significant impact on long-
term success.
Double seal

31. These materials are used in combination by
placing layer after layer to make sure that
even if one restorative fails the other
protects the coronal seal and keeps it intact.
This is a technique which involves the use of
two restorative materials together to
overcome the disadvantages caused by the
use of a single restorative material.

32. Materials used in Double seal technique to get Coronal Seal:
Glass Ionomer Type II
over gutta-percha
followed by Light
cure Composite Resin
as the final seal
Cavit over
gutta-percha
followed by IRM
as the final seal
Dycal over gutta-percha
followed by Glass
Ionomer Type II as the
final Seal

33. Materials used in Double seal technique to get Coronal Seal:
MTA – Mineral Trioxide Aggregate
over gutta-percha followed by
Intermediate restorative material as
final seal
MTA – Mineral Trioxide
Aggregate over gutta-percha
followed by Glass Ionomer
Type II as the final seal

34. The need for establishment of drainage and relief
of pain are not common indications for surgery
Less traumatic than an extraction
Tissue is less resilient and resistance to reflection
appears to be diminished.
Lips can more easily be stretched; the apex can
actually be more surgically accessible in older
patients
Ecchymosis is a more common postoperative
finding,
ENDODONTIC SURGERY:

35. • Cusp Protection
• • Restoring the Access
• • Overdenture Abutments
• • Coronal Leakage
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RESTORATIVE
CONSIDERATIONS

36. In conclusion, successful endodontics can be
achieved for the elderly, if proper attention is given
to the diagnosis, good quality radiographs and
adapting techniques that overcome the challenges
posed by calcification of the root canal system. As
long as the tooth has a strategically important role to
play, endodontic therapy is indicated and justified in
any patient.
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37. 37
Geriatric restorative care - the need, the demand and the challenges.J Conserv
Dent. 2011 Jul-Sep; 14(3): 208–214.
Endodontics and the ageing patient. Australian Dental Journal 2015; 60:(1
Suppl): 20–27
Endodontic considerations in the elderly - case series
Antibiotic and Analgesic Prescription Patterns among Dentists or Management of
Dental Pain and Infection during Endodontic Treatment
Endodontic management of patients with systemic complications, Pharm
Bioallied Sci. 2016 Oct; 8(Suppl 1): S32–S35.
Geriatric Oral Health: A Review Article. Journal of International Oral Health 2014;
6(6):110-116
Root canal treatment in elderly patients.Saudi Med J 2019; Vol. 40 (3)
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38. THANK YOU
FOR
ATTENDING