Dentistry for Older Adults in Essen-Rüttenscheid

It addresses the particular circumstances that may affect dental care later in life.

There is no fixed age threshold.

A 75-year-old who lives independently, carries out oral hygiene without difficulty and takes few medications may have completely different needs from another person of the same age with multiple medical conditions, limited hand mobility and care needs.

The most important question is therefore not:

“How old is the patient?”

but:

“Which resources, risks and goals need to be considered in this patient's dental care?”

No.

The terms “older patient” and “geriatric patient” are not synonymous.

Geriatric patients are typically characterised by a combination of multiple diseases, functional or cognitive limitations and increased vulnerability. A need for care may be associated with this, but is not present in every older person either.

This distinction matters because age alone does not determine treatment.

One older patient may, for example, be suitable for a more complex fixed restoration, while for another a simpler solution that is easier to maintain may be more appropriate.

Neither decision can be made on chronological age alone.

Depending on the individual situation, several areas may become important for treatment.

These include, for example:

• general medical conditions,
• regular medications,
• blood clotting and wound healing,
• motor abilities,
• visual or hearing impairment,
• dry mouth,
• ability to perform oral care independently,
• need for care,
• cognitive impairment,
• existing dental restorations,
• chewing function,
• and the ability to clean and adapt to a new restoration in the long term.

Not all of these factors apply to every patient.

For that reason, dentistry for older adults should not be confused with a standardised “senior treatment”.

As people age, some take a larger number of regular medications.

This can be relevant to dental treatment because medications or underlying medical conditions may affect:

• bleeding risk,
• wound healing,
• bone metabolism,
• cardiovascular responses,
• dry mouth,
• or possible interactions with medicines used in connection with dental treatment.

The current S2k guideline therefore recommends asking about the medication plan as well as additional medicines and preparations.

This may include products that do not appear on an official medication list, such as regularly taken supplements or other preparations.

What should I bring to the appointment?

If you take several medications, an up-to-date medication list is helpful.

Information about relevant medical conditions and ongoing medical treatment is also important.

Medication should not be stopped or changed independently because of planned dental treatment. If questions arise about a medicine, coordination with the treating physician may be necessary.

Dry mouth should not simply be dismissed as an unavoidable sign of ageing.

Reduced salivary flow can have different causes, including medical conditions, radiation to the head region and medications. The German Dental Association notes, for example, that certain psychotropic or blood-pressure medications can contribute to xerostomia.

Saliva performs important functions in the mouth: it moistens the mucosa, supports cleansing and helps neutralise acids.

When too little saliva is present over a longer period:

• eating and speaking may become less comfortable,
• dentures may be tolerated less well,
• the mucosa may become more sensitive,
• and caries risk may increase.

Persistent dry mouth should therefore be mentioned and its cause clarified as far as possible.

No.

If dry mouth may be related to a medication, the medicine should not be reduced or stopped without medical advice.

It may be necessary for an important underlying condition.

The first step is dental and, where appropriate, medical assessment. Only then can it be decided whether the medication can be changed at all or whether other measures for symptom relief and caries prevention are more appropriate.

Using a toothbrush correctly or cleaning a denture thoroughly requires several abilities.

These include:

• sufficient hand strength,
• fine motor control,
• vision,
• mobility,
• understanding the individual cleaning steps,
• and the ability to carry them out regularly.

The S2k guideline therefore explicitly identifies motor and sensory limitations as factors that should be incorporated into dental care at an early stage.

If arthritis, a stroke, Parkinson's disease or other limitations change hand mobility, oral hygiene that previously worked well can suddenly become much more difficult.

This does not automatically mean that another person must take over care completely.

It is often useful first to assess which abilities remain and how cleaning can be adapted to them.

The choice should be individual.

Depending on mobility, grip strength and the oral situation, useful options may include different:

• manual toothbrushes,
• electric toothbrushes,
• interdental brushes,
• adapted handles,
• and aids for denture cleaning.

The current S2k guideline recommends selecting aids for oral and denture care according to individual need.

A blanket statement such as “an electric toothbrush is always better in old age” would not be justified.

The decisive factor is which solution allows the necessary cleaning to be carried out reliably.

Many people now retain their natural teeth for considerably longer than previous generations.

This means that teeth, root surfaces, crowns, bridges and implants also require maintenance over many years.

When gums recede and root surfaces become exposed, carious lesions can develop there. In vulnerable geriatric patients, the current guideline describes an increased risk particularly of root caries.

At the same time, limited ability to perform oral hygiene or dry mouth can make the situation more difficult.

Prevention may therefore include:

• regular check-ups,
• individual oral-hygiene advice,
• appropriate fluoride measures,
• interdental cleaning,
• monitoring existing dental restorations,
• and professional preventive measures where needed.

Which measures are necessary and at what intervals depends on individual risk.

More about professional teeth cleaning

Periodontitis is not an unavoidable consequence of ageing.

Risk and impact may, however, be influenced by several factors, including oral hygiene, smoking, general medical conditions and individual history.

In older patients, it is particularly important not to accept existing periodontal disease simply because “the teeth are getting older”.

Bleeding gums, newly loose teeth or other changes should be assessed diagnostically.

If periodontitis is already present, systematic treatment and long-term follow-up belong within a dedicated periodontal treatment plan.

More about periodontitis

Many older people have crowns, bridges, implant-supported restorations or removable dentures.

These require their own follow-up checks.

Depending on the design, the assessment may include:

• Is the restoration still stable?
• Can it be cleaned adequately?
• Are there pressure points or mucosal changes?
• Are crown or bridge margins unusual?
• Are there changes to supporting teeth or implants?
• Has the bite changed?
• Is adequate chewing still possible with the restoration?

A denture that has been worn for a long time should therefore not be checked only when it is obviously broken.

It can be — but not automatically.

Planning should not only ask technically which restoration could be made.

For geriatric patients, it is also important to consider:

• Can the patient adapt to a new restoration?
• Can it be cleaned independently?
• Is support with care available?
• How important would the change be for chewing, symptoms and quality of life?
• What burden does treatment involve?
• What would happen if the current situation were initially left unchanged?

The current S2k guideline particularly emphasises the ability to adapt to removable dentures.

Some people manage well with a denture they have worn for many years even if it is not technically ideal in every detail. Comprehensive replacement therefore does not automatically become the best decision simply because the restoration is old.

Conversely, necessary dental restoration should not be withheld merely because a patient is considered “too old”.

More about dental restorations

No. Chronological age alone is not a blanket exclusion criterion.

The usual medical and dental requirements are more important when deciding on implant treatment.

Later in life, additional factors may have greater influence, including:

• general medical conditions,
• medications,
• bone and soft-tissue conditions,
• ability to tolerate treatment,
• ability to maintain oral hygiene,
• and long-term follow-up care.

A more complex restoration is appropriate when it is medically acceptable, fits the treatment goal and can also be maintained over the long term.

Age should be used neither as an automatic argument for nor against a particular therapy.

Where support is needed, it may be useful to involve relatives, carers or other support persons.

For geriatric patients who need assistance, the current guideline recommends involving such people — with the patient's consent — particularly in instruction on oral care.

As much independence as possible should be maintained.

Depending on the situation, support may mean:

• reminding the patient about oral care,
• providing aids,
• cleaning particular areas afterwards,
• cleaning a denture,
• or partially or fully taking over oral care.

The help required should not be determined solely by a formal care level, but by the person's actual abilities.

Cognitive changes can affect how well instructions are understood, oral care is carried out or longer treatments are tolerated.

Pain may also be expressed differently.

In a person with dementia, for example, changed eating behaviour, resistance to oral care or new agitation may indicate that something in the mouth is uncomfortable. Such changes have many possible causes and do not allow dental self-diagnosis.

Calm, situation-appropriate communication and treatment planning that takes existing abilities and individual tolerance into account are important.

The goal is not to carry out as many treatments as possible or as few as possible.

The priorities are instead to:

• identify and treat symptoms,
• preserve natural teeth where reasonably possible,
• maintain or restore chewing function,
• keep existing dental restorations functional and maintainable,
• identify disease as early as possible,
• organise oral hygiene realistically,
• and adapt treatment to personal abilities and wishes.

A good plan therefore needs to work not only medically.

It must also be manageable in the patient's everyday life.

An examination should not depend solely on whether pain is present.

Older and geriatric patients in particular may have relevant changes without noticing severe symptoms early on.

A timely check-up is particularly appropriate with:

• pain or swelling,
• bleeding gums,
• newly loose teeth,
• problems chewing,
• pressure sores from dentures,
• poorly fitting or damaged dental restorations,
• persistent dry mouth,
• new mucosal changes,
• or clearly more difficult oral care.

If general medical conditions, medication or independence change substantially, it can also be useful to adapt dental care again.

Helpful items, where available and relevant, include:

• an up-to-date medication list,
• information about important general medical conditions,
• documents relating to previous dental treatment,
• existing removable dentures,
• and, where support is needed, a trusted accompanying person.

An accompanying person should not automatically make decisions instead of the patient. As long as the patient can make decisions themselves, their wishes and consent remain central.

Dentistry for older adults means individualised dentistry — not automatically less treatment.

Particularly relevant factors may include:

• general medical conditions and medications,
• dry mouth,
• limited hand mobility or vision,
• cognitive changes,
• difficulties with tooth and denture care,
• increased individual caries or periodontitis risk,
• existing dental restorations,
• and the ability to adapt to a new restoration.

Chronological age alone determines neither tooth preservation nor dental restorations or implants.

Appropriate treatment is medically reasonable, reflects the patient's goals and can be maintained and followed up in everyday life over the long term.

Further information:

Treatments at the practice Professional teeth cleaning Periodontitis Dental restorations

The medical assessment is based in particular on the S2k guideline “Dental care for geriatric patients” (AWMF 083-047) led by the German Society for Geriatric Dentistry (DGAZ) and the DGZMK. The guideline was published in 2026 and is currently valid until January 2031.

Current patient information from the KZBV and information from the German Dental Association on medication-related dry mouth were also considered.

The guideline also makes clear that geriatric patients are highly heterogeneous and that research gaps remain in individual areas. General recommendations are therefore not translated into blanket treatment decisions for an individual patient.

Editorial review date: 9 August 2026. This page does not replace an individual dental or medical assessment.