Aging and oral health: effects in hard and soft tissues.

Changing demographics, including an increase in life expectancy and the growing numbers of elderly has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health; indeed, oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balanced diet, not to mention aesthetical considerations and facial alterations leading to anxiety and depression. The World Health Organization recommends the adoption of certain strategies for improving the oral health of the elderly, including the management and maintenance of oral conditions which are necessary for re-establishing effective masticatory function. Oral health is often neglected in the elderly, and oral diseases associated with aging are complex, adversely affecting the quality of life. Although oral health problems are not usually associated with death, oral cancers result in nearly 8,000 deaths each year, and more than half of these occur at an age of 65 years plus. This report, which is dedicated to geriatric physicians, geriatric dentistry and specialists in oral medicine reviews age-related oral changes in elderly patients and efforts to summarize the effects of aging in hard and soft oral tissues.

Halitosis: a stomatological and psychological issue.

It can be stated that halitosis is located on the ridge connecting dentistry, oral medicine, parodontology and psychology. It represents, at the same time, the manifestation of an organic malfunctioning of the oral apparatus, and a problematic element for the individual and his/her relational life. A smelly emanation comes into conflict with the wish to attract, to please, to seduce. The attitudes towards the possibility to suffer from bad breath have two typical opposite expressions, which share the common characteristic that many are bad judges of one's own breath. The dentist, in fact, is frequently involved in the management of patients who believe they have bad breath problems, which in reality are non-existent (pseudo-halitosis), and, more often, of patients who are not aware they have an halitosis condition, and who are not inclined to accept it (denied halitosis). Generally, the most adequate and suitable option is that of communicating to the unaware patient the existence and the nature of the problem. What is said, and especially the way of saying it, may play an important role in patient's acceptance of the information without producing, or reducing to a minimum, the undesirable side effects on the patient-professional relationship, and on the personal dynamics of the patient him/herself. A useful procedure is provided by employing a pre-visit questionnaire, that may suitably ask many different questions about relevant dental and mucosal aspects, for instance, dental complaints, the frequency of toothbrushing and flossing, gum bleeding, and about psychological aspects, such as dental anxiety, and degree of satisfaction as regards one's oral condition, in order to solve or alleviate the patient's problem, avoiding unnecessary personal discomfort and, at the same time, providing competent and effective professional help. Strategies for communicating in an effective way, in order to properly face both the somatic and the psychological aspects, are proposed. A questionnaire (Halitosis Questionnaire - HQ) is also provided, to facilitate the assessment and the management of the halitosis issue.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ): run dental management designs and issues in diagnosis.

Recently, jawbone osteonecrosis has been largely reported as a potential adverse effect of bisphosphonate (BP) administration. Because of the peculiar pharmacokinetic and pharmacodynamic features of the BF (mainly for i.v. administration), their efficacy and large use, some major issues have to be taken into account extendedly both by oncologists and by dentists: 1) therapeutic dental protocol for patients with diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ); 2) dental strategies for patients in former or current i.v. BF treatment and in absence of BRONJ signs; 3) strategies for patients before i.v. BF treatment. Clinical features and guidelines for the management of this condition have been investigated and reported, sometimes with unclear indications; hence, on the basis of the literature and our clinical experience, major end points of this paper are providing our run protocols for the issues above described and, finally, focusing on a crucial, but not extensively investigated point: the early and correct diagnosis of BRONJ versus metastatic jaw lesions in cancer patients.