Unit Thirty Seven Special Considerations in the Elderly Prosthodontic Patient [3]
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which occur elsewhere in the body. It appears that many periodontal changes associated with aging can be attributed to a diminished blood supply and a corresponding reduction in tissue nourishment and oxygenation. A gradual apical migration of the gingival attachment is common in the aged patient. Nor only does the position of the attachment change, but the total area of attachment also decreases. Since the alveolar bone level is always apical to the gingival attachment, a migration of the attachment through dissolution of gingival fibers is accompanied by loss of bone from the alveolar crest. The remaining fibers are thicker, less elastic and show more calcification within the bundle masse. The frequent occurrence of long clinical crowns and reduced periodontal support are impartial considerations in designing removable partial dentures for the elderly patient.
Treatment of geriatric patients should be based on a desire to permit the patient to grow old gracefully while maintaining his individual identity. We must accept as normal the general decline in metabolic rate, cell function and 'repair, magnitude and acuity of neuromuscular activity, and psychological adaptability.
Before prosthodontic treatment is undertaken, an accurate evaluation of systemic and oral conditions must be obtained. The patient should be made aware of the results he may expect and what his role will be in the establishment and maintenance of a healthy oral environment. Treatment should focus on retention and maintenance of the remaining natural dentition whenever possible. When major changes are necessary, they should be carried out over an extended period of time. Each phase of treatment should involve only minor functional alterations.
The technical procedures involved in the fabrication of prosthetic appliances must be of the highest level. The practitioner must accept the problems of aging and deal with whom to the very best of his ability. He should be sympathetic toward the needs and desires of geriatric patients and he must persevere in his attempts to meet those needs.
VOCABULARY
1. ger 老年的
2. geriatrics 老年医学
3. geriatric medicine 老年医学
4. dental geriatrics 老年牙医学
5. practitioner 开业医生
6. dental practician 开业牙医
7. approach 方法,步骤
8. delivery 戴牙
9. xerostomia 口腔干燥
10. proprioception 本体感觉
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