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Chalmers JM. Minimal intervention dentistry: part 1. Strategies for addressing the new caries challenge in older patients. J Can Dent Assoc. 2006; 72:427-433
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Carbamide peroxide and its use in oral hygiene and health

From Volume 44, Issue 9, October 2017 | Pages 863-869

Authors

Joseph Greenwall-Cohen

Year 5 BDS

University of Manchester School of Dentistry, Higher Cambridge Street, Manchester M15 6FH

Articles by Joseph Greenwall-Cohen

Linda Greenwall

BDS, MGDS RCS, MSc, MRD RCS, FFGDP(UK), FICD BEM

Specialist in Restorative Dentistry and Prosthodontics, Hampstead Dental Specialists, 5 Elm Terrace, Constantine Road, London NW3 2LL, UK

Articles by Linda Greenwall

Abstract

Plaque accumulation, dental caries and periodontal disease are an increasing concern for elderly, special care and orthodontic patients as a result of numerous predisposing factors which make maintenance of adequate oral hygiene difficult, even with traditional oral hygiene practices. This article will propose a technique whereby the anti-bacterial properties of tray-applied carbamide peroxide are used to improve oral health for these patients.

CPD/Clinical Relevance: Traditional oral hygiene practices may be unsatisfactory for elderly, special care and orthodontic patients. This article proposes a technique whereby the anti-bacterial properties of tray-applied carbamide peroxide are used to improve the oral health for these patients.

Article

Whilst it is apparent that, for dental patients with low to moderate caries risk and low to moderate risk of periodontal disease, a low sugar diet, brushing with fluoridated toothpaste and interproximal cleaning should be adequate to maintain oral hygiene and plaque removal,1 there is a group of higher risk patients where, due to predisposing factors, an additional member of the ‘preventive toolkit’ would be beneficial.

Latest population data by the UK Parliament (2016)2 shows that, by 2020, the number of individuals over 85 will rise by 18%. With more patients than ever retaining their teeth, it is evident that older patients will take up a greater proportion of dental clinicians' care. Many elderly patients suffer from oral health challenges. In particular, polypharmacy and side-effects from multiple medications, results in elderly patients suffering from a reduction in salivary flow and a dry mouth. In addition, degenerative and inflammatory changes result in many patients experiencing reduced manual dexterity. This results in difficulties in oral hygiene and plaque removal which may lead to dental caries, especially root surface caries (Figures 1, 2 and 3). This is especially pertinent for elderly patients with heavily restored dentitions and secondary decay adjacent to direct and indirect restorations.3 These patients, who may have had excellent dental treatment and hygiene practices throughout their lives, would be at high risk for dental diseases in their later years.4

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