When should root remnants and unrestorable broken teeth be extracted in frail older adults?

Tooth retention is a key goal in geriatric dentistry, but in frail older adults, the management of root remnants and unrestorable broken teeth requires careful consideration. These patients often have complex medical conditions, polypharmacy, and limited ability to tolerate invasive dental procedures. The decision to extract such teeth must balance the risks and benefits, taking into account oral health, systemic health, quality of life, and overall patient well-being.

Indications for Extraction

1. Presence of Infection or Pain

Root remnants or broken teeth that are associated with active infection, abscesses, or chronic pain should be extracted to prevent systemic complications such as sepsis, pneumonia, or worsening of existing conditions like diabetes and cardiovascular disease. Pain and infection can also negatively impact nutrition and general well-being.

2. Risk of Aspiration and Pneumonia

Frail older adults, especially those with dysphagia or neurodegenerative diseases such as Parkinson’s or Alzheimer’s, are at higher risk of aspiration pneumonia. Severely broken teeth or infected roots can contribute to oral bacterial load, increasing the likelihood of aspiration pneumonia. In such cases, extraction may be warranted to reduce this risk.

3. Periodontal Disease and Bone Loss

Advanced periodontal disease affecting root remnants or broken teeth can contribute to significant alveolar bone loss, impacting adjacent teeth and overall oral function. If the remaining tooth structure is severely compromised, extraction may be the best option to preserve remaining bone and facilitate future prosthetic rehabilitation.

4. Impaired Oral Hygiene and Caregiver Burden

Frail older adults may struggle with maintaining oral hygiene, leading to further decay, infections, and discomfort. If a root remnant or broken tooth cannot be kept clean due to physical or cognitive impairments, extraction may simplify oral care and reduce caregiver burden.

Situations Where Extraction May Not Be Recommended

1. Asymptomatic Root Remnants with No Infection

If root remnants are completely covered by soft tissue and not causing pain, inflammation, or infection, they may be left in place, particularly if extraction poses significant surgical risks.

2. Medical Contraindications

For patients with severe systemic conditions, such as advanced heart disease, uncontrolled diabetes, or coagulopathy, the risks of surgery may outweigh the benefits. In such cases, close monitoring and palliative dental care are preferred.

3. Functional and Prosthetic Considerations

If the root remnant serves as an anchor for an existing denture or is part of a functional occlusion, removal may compromise chewing ability. The decision should involve discussions about future prosthetic planning.

Conclusion

The decision to extract root remnants and unrestorable broken teeth in frail older adults should be individualized, weighing risks such as infection, aspiration pneumonia, and impaired oral hygiene against surgical risks and overall health status. Close collaboration between dental and medical professionals is essential to ensure optimal patient outcomes.