Patient age is no contraindication to endodontic treatment.

C linical decision making in elderly patients is becoming increasingly challenging as our society ages. 1 Edentulism was once considered normal for anyone entering the seventh decade of life, as was so eloquently declaimed by Jaques in Shakespeare's As You Like It : " sans teeth, sans eyes, sans taste, sans everything. " 2 Today, however, preservation of the natural dentition has been so successful that tooth loss is no longer accepted as inevitable. Nonetheless, there is a cohort of elderly individuals who did not benefit from modern preventive practices and who now present a dilemma in terms of maintaining the masticatory apparatus necessary for nutritional intake. 3 Even with excellent dental care, such patients experience abrasion of the natural tooth crowns with age, and embedded roots are left within the alveolar bone (Fig. 1). According to previous concepts of dental care, extraction of these roots would have been recommended, but today's goal of excellence in endodontics dictates otherwise. Our experience of performing endodontic treatment on the retained roots of a 93-year-old patient provides an unusual opportunity to justify and indicate the need for such treatment in elderly people. The retention of roots of excessively worn or destroyed tooth crowns is in fact a highly desirable objective, as it allows the alveolar bone in which the roots are lodged to be maintained. The loss of tooth roots is a well-known cause of alveolar bone resorption and is an example of Wolff 's law of bone architecture, 4 whereby bone structure reflects its function. In the absence of tooth roots, the need for the alveolar bone disappears, which leads to resorption. 4,5 Moreover, loss of teeth alters the material properties of cortical thickness, elastic and shear moduli, anisotropy and stiffness of the cortical mandibular bone, thereby greatly weakening the mandible. 6 A 93-year-old woman was referred to our office for nonsurgical endodontic treatment. A review of her somatic systems and medical history indicated that she was in relatively good health and had no contraindications to use of local anesthetic solution. The oral examination revealed maxillary edentulism and loss of all mandibular teeth except for incisors 31 and 41. The missing teeth had been extracted many years previously. Radiographic examination revealed that root submergence therapy had been previously performed on tooth 42, and that the root had preserved the alveolar bone. The 2 remaining teeth had excessive wear facets, and there was …