Care Needs of the Elderly Treated at a Dental School1

Increased longevity and recently intensified emphasis on gerodontology mandate that dental students'exposure to clinical care of the elderly be enhanced. The extent to which individual students can be exposed to geriatric dental care depends on the availability of elderly patients to dental school clinics and the treatment needs of these patients. The purposes of this study were (1) to determine the dental treatment needs of geriatric patients who seek care at a dental school, and (2) to ascertain if differences exist between the needs of older versus relatively young geriatric patients. Data collected on 128 elderly patients during a three month period indicate that 57% of the aged were either edentulous at examination or treatment planned to become edentulous and receive two full dentures. The remaining 43% were treatment planned to remain dentulous and receive therapies other than full upper and lower dentures. More older geriatric patients required full dentures than their younger cohorts. More young elderly required prophylaxes, scalings, root planing therapy, dental restorations, and partial dentures. Additional to their denture requirements, aged patients appear to have sufficient non-prosthetic needs to allow for meaningful gerodontic experience by students.     

Perspectives on providing good access to dental services for elderly people: patient selection,dentists’ responsibility and budget management

doi: 10.1111/j.1741‐2358.2012.00646.x Perspectives on providing good access to dental services for elderly people: patient selection, dentists’ responsibility and budget management Objectives: To suggest a model for organizing and financing dental services for elderly people so that they have good access to services. Background: There are few studies on how dental services for elderly people should be organized and financed. This is surprising if we take into consideration the fact that the proportion of elderly people is growing faster than any other group in the population, and that elderly people have more dental diseases and poorer access to dental services than the rest of the adult population. In several countries, dental services are characterized by private providers who often operate in a market with competition and free price‐setting. Private dentists have no community responsibility, and they are free to choose which patients they treat. Material and methods: Literature review and critical reasoning. Results: In order to avoid patient selection, a patient list system for elderly people is recommended, with per capita remuneration for the patients that the dentist is given responsibility for. The patient list system means that the dentist assumes responsibility for a well‐defined list of elderly people. Conclusion: Our model will lead to greater security in the dentist/patient relationship, and patients with great treatment needs will be ensured access to dental services.     

Success of dental implants in elderly people--a literature review

Implant-supported dentures seem particularly appropriate for the predicament of being elderly and becoming edentulous. The aim of this article was to review the literature on success of dental implants in elderly people. The results of two studies suggested that the treatment with implants can be considered safe and predictable for older as well as for younger patients. Three studies found no increased implant failure-rate in patients with a compromised medical status. Four studies revealed high success-rates of dental implants among groups of elderly people. Within the limitations of this review of the literature it can be concluded that old age does not seem to represent a factor of major prognostic significance in treatment with dental implants.     

Anaesthesiological risk assessment in young/adult and elderly dental patients

Objective: Analysing the differences in number of diseases reported, medicines taken and American Society of Anaesthesiologists (ASA) scores in young/adult and elderly dental patients. Subject: Forty‐seven young/adult and 47 elderly dental patients living in the community. Setting: Private dental practice. Main outcome measures: Age, number of systemic diseases reported during anamnesis, number of medicines taken, seriousness of pre‐existent diseases measured according to the ASA (American Society of Anaesthesiologist) scale. Study design: Analytical study. Results: The differences between young/adult and elderly dental patients as far as self‐reported medical conditions, medicines taken and ASA scores were statistically significant (p < 0.001). Conclusion: The number of elderly patients’ medical conditions are greater than young/adults’. It is therefore necessary to adequately assess the elderly patient before starting any dental treatment.     

Clinical Decision Making in the Dental Treatment of the Elderly1

Dental care of elderly persons is similar to that of younger persons but is modified by a variety of age-related and age-associated changes, as well as diseases and drugs. Clinical decision-making for the dental care of elderly persons is therefore more complex. The dental disease patterns in the elderly population seem to be changing and they seem to be expressed differently, which will require actual diagnosis and more complicated treatment planning. This paper evaluates the principles of problem solving and decision making in general, and applies them to dental diagnosis and treatment planning. A model of the different types of decision making in dentistry is presented, and its component parts discussed, with emphasis on the care of the elderly patient. The conclusions of this paper are that dental care for the elderly patient is becoming extremely complex, especially as more elderly patients will be dentate and more will be demanding care. Research is needed in the area of how dentists make decisions, and in methods of teaching decision-making skills. Longitudinal studies are required to evaluate the outcomes of treatment.     

Dental Care for the Elderly

The geriatric population in many parts of the United States is underserved by dentistry. Socioeconomic problems, difficult access to dental facilities, and confusion about the need for dental care often prevent the elderly from seeking dental service. Because dental diseases are not life threatening or outwardly disabling, administrators of institutions for the elderly and health legislators place a low priority on dental care for the elderly. These factors working in concert with the insidious, progressive, and cummulative nature of denture diseases contribute to the poor dental health experienced by some segments of the geriatric population. Dentistry has the manpower and the technology to improve the oral health of the elderly, but society must be made aware of the importance of dental health in the total health of elderly persons in order that dentistry be given a chance to achieve that goal.     

The Yad Sarah geriatric dental clinic, a different model

Introduction: There are not sufficient dental services for elderly people around the world. Yad Sarah is an Israel‐wide network of volunteers aiding sick, elderly, isolated and housebound people with an array of services aimed at making home care possible. It provides medical and social services to more than 380 000 elderly persons per year and in addition, lends medical equipment free of charge, has day rehabilitation centres, legal aid council for seniors, provides transportation for the disabled, meal deliveries and geriatric dental services. Materials and methods: The latter are equipped with five dental units (one mobile unit) and a dental laboratory. During the 5 years from 2000 to 2004 the dental services provided dental care for 3890 elderly patients with the main clinic located in Jerusalem. Patients pay an average of 70% of the cost price of their dental care, with the difference being subsidised by Yad Sarah. Of the 515 patients who applied for treatment in 2004, 54% possessed natural teeth in both jaws, 28% were fully edentulous, 12% were edentulous in the maxilla and 6% were edentulous in the mandible. Females applied for dental treatment more often than the male population. Older patients (75–101 years old) required oral care at their homes or at old age residences, more frequently than the younger age groups (60–74 years old). Conclusion: Dental treatment was administered by 70 volunteer dental surgeons, two certified dental hygienists and dental hygienist students. The clinical staff was provided with a comprehensive in‐service training in geriatric dentistry during the 3‐year service learning period. A survey in 2004 showed that 83% of the selected patients were satisfied, compared with 14% who were not. The reasons for satisfaction were, mainly, the personal relationship with the attending staff (41%) and the professional ability of the dental team (46%).     

Geriatric dentistry--meet the need

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an inter-disciplinary team with other health care professionals. Geriatric health is an ignored and under-explored area worldwide. Oral health reflects overall well being for the elderly population. Conversely, elderly patients are more predisposed to oral conditions due to age-related systemic diseases and functional changes. The major barriers to practising geriatric dentistry are the lack of trained faculty members, a crowded curriculum and monetary concerns. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the elderly. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, dental professionals must have a proper understanding of the magnitude of the services to be provided to the elderly. This could only be realised through an education programme in geriatric dentistry, which should be started without further delay. This article hence sets out the objectives, needs, present scenario, strategies and types of dental treatment required by the elderly population.     

Knowledge and attitude of elderly persons towards dental implants

doi: 10.1111/j.1741‐2358.2011.00586.x Knowledge and attitude of elderly persons towards dental implants Background: Despite their unrivalled place in restorative treatment, dental implants are still scarcely used in elderly patients. Introduction: The aim of this survey was therefore to identify potential barriers for accepting an implant treatment. Materials and methods: Participants were recruited from a geriatric hospital, two long‐term‐care facilities and a private clinic. The final study sample comprised 92 persons, 61 women and 31 men with an average age of 81.2 ± 8.0 years. In a semi‐structured interview, the participants’ knowledge of implants and attitude towards a hypothetical treatment with dental implants were evaluated. Results: Twenty‐seven participants had never heard of dental implants, and another 13 participants could not describe them. The strongest apprehensions against implants were cost, lack of perceived necessity and old age. Univariate and multiple linear regression analysis identified being women, type and quality of denture, having little knowledge on implants and being hospitalised as the risk factors for refusing implants. However, old age as such was not associated with a negative attitude. Conclusion: The acceptance of dental implants in the elderly population might be increased by providing further information and promoting oral health in general. Regardless of the age, dental implants should be placed when patients are still in good health and live independently.     

Association between dental health behaviours, mental/physical function and self-feeding ability among the elderly: a cross-sectional survey

Objectives : The aim of this study was to determine the association between dental health behaviour, mental/physical function and self‐feeding ability among the elderly. Subjects : A total of 414 elderly dental patients aged 65 years and older participated in this study. Methods : A survey was carried out for three years and seven months starting in January 1998 at the Chubu National Hospital. The patients or their carers were examined/interviewed about the severity of senile dementia, dental health behaviour, ability to rinse their mouths, ability to manage dentures, and ability to sit at a table during meals. To assess the association with self‐feeding ability among the elderly, cut‐offs were given for these variables, and then the odds ratios were calculated. Results : The strongest association to self‐feeding ability was marked by inability to rinse their own mouth, followed by inability to manage dentures, inability to sit at a table during meals, severe senile dementia and less frequency of toothbrushing. Conclusion : Elderly who have lost the feeding ability often could not maintain their dental health by themselves. Carers must provide not only a feeding service with acknowledgement of aspiration but oral care to prevent dental disease and fatal pneumonia in the elderly.     

Oral health status of elderly hospitalised psychiatric patients

doi: 10.1111/j.1741‐2358.2012.00633.x Oral health status of elderly hospitalised psychiatric patients Objectives: This study investigated the oral health status of an elderly mentally ill population hospitalised in a psychogeriatric ward in Athens. Materials and methods: A structured interview recorded sociodemographic and dental data, and an oral examination recorded the status of oral tissues and the existing dentures. The patients’ medical records were examined by a hospital’s physician. Results: One hundred and eleven patients with a mean age of 73 years participated in the study. Almost half of them suffered from schizophrenia. Forty percent were completely edentulous but only 38.6% of them used a pair of dentures. The dentate had an average of 12.9 teeth, 50.7% of them had at least one decayed tooth, 44.8% needed at least one extraction, and only 26.7% had filled teeth. The dental hygiene was poor in 83.6% of the patients. More than 60% of the dentures had a defect. Multiple regression analyses showed that increasing age and dementia were significantly related to fewer remaining teeth, and the use of atypical antipsychotics was related to fewer caried teeth. Conclusion: The oral health of the elderly psychiatric patients was very poor. Access to dental care should improve, and the health care staff should be trained to identify oral problems.     

First-time dental care and the most recent dental treatment in relation to utilisation of dental services among dentate elderly patients in Lithuania

Objectives: To describe the initial dental treatments of Lithuanian dentate elderly patients and the content of the most recent treatment in relation to their dentist‐visiting behaviour. Materials and methods: A cross‐sectional questionnaire study was carried out at two public dental offices in Kédainiai, Lithuania, among dentate patients aged 60+ years. A self‐administered questionnaire covered first‐time dental care, the most recent dental treatment, check‐up behaviour, interval since the most recent dental visit, and number of teeth. Age, gender and education served as background information. Statistical evaluation was by chi‐squared test, anova and logistic regression for odds ratio (OR). Results: In all, 174 dentate elderly responded, mean age being 69.2 (SD = 6.6) years. The mean age at the first visit was 16.3 years [95% confidence interval (CI) 14.9–17.6]. Regular dental check‐ups were reported by 30%, and 36% had visited a dentist within the past 12 months. As to the content of the most recent treatment, 78% of the elderly reported filling therapy, 50% endodontics, 48% tooth extraction, 21% radiography, 10% cleaning or scaling and 6% polishing of fillings. Those going for check‐ups were more likely to report diagnostic (OR 1.9; 95% CI 1.1–2.8; p = 0.01) and preventive (OR 4.8; 95% CI 2.5–9.0; p = 0.002) treatment when analysed by a logistic regression model, controlling for age, gender, education and number of teeth. Conclusions: Check‐up‐orientated utilisation of dental services should be encouraged among the Lithuanian elderly. Dentists and health officials should place greater emphasis on prevention.     

Orthodontic treatment in an elderly patient with extraction of upper premolar

In the past few years, life expectancy of the world's population has gradually increased and as a result the number of elderly patients seeking orthodontic treatment is becoming higher. The objective of this work is to report a clinical case of orthodontic treatment of an elderly patient in which a dental extraction was performed to correct the relationship between upper and lower arches. The results favoured an improved dental arch relationship and promoted adequate aesthetics and function.     

老年患者拔牙的安全性探讨

老年人在患有口腔疾患的同时,可患有多种疾病。老年人拔牙的危险因素主要是精神紧张。接受拔牙手术的恐惧、焦虑致其在术前术中都处于高度紧张状态,拔牙时间长及麻醉效果差引起血压升高和心率加快等,故消除这些危险因素是获得拔牙成功的关键。一方面取决于病人是否有足够的心理承受能力,另一方面取决于医生能否快速、准确、无痛的拔牙。而术中的任何刺激都可诱发心血管意外及其他并发症的出现。本文通过对国内外文献的归纳、总结,从严格掌握适应症、禁忌症、麻醉药物的选择、充分的术前准备、术中意外的处理以及完善的术后等多方面进行阐述,将心理治疗用于手术全过程,确保老年患者拔牙的安全性。     

Need for gerodontology education in India

Objectives: To evaluate the status and need for education in Geriatric Dentistry in India. Materials and methods: The status of dental education in India was studied. India has 185 dental schools producing 12 000 dental graduates every year. At postgraduate level, there are nine recognised specialities in Dentistry, and approximately 58 institutions offer 1160 places for postgraduate degree courses. Dental education is shaped and administered by the Dental Council of India. Results: So far, Geriatric dentistry has not developed as a separate, independent speciality at postgraduate level. The undergraduate curriculum does not have any significant component of geriatric dentistry. The lack of training results in poor understanding of special needs of older adults in young graduates. Without adequate training and personal experience of growing old, young graduates may not be able to understand the physical, socio‐economic and psychological problems of the elderly and the complexities involved in treatment planning for patients with multiple chronic diseases and medication. Conclusions: It is emphasized that geriatric dentistry should be included in each of the pre‐clinical, para‐clinical and clinical subjects at the undergraduate level. Graduate students should be encouraged to treat elderly patients in clinics under supervision using a multi‐disciplinary approach. Also, postgraduate diploma and degree courses in geriatric dentistry should be developed to address the needs of the vast elderly population in India.     

Alzheimer's disease,oral function and nutritional status

Objectives: To study differences in nutritional, dental status and oral function between institutionalised patients with Alzheimer's disease and cognitively healthy elderly people living in the community. Design: Comparison was made between two groups, Alzheimer's disease sufferers and healthy controls, using established criteria for anthropometric, mental and dental state. Setting: An institution and residential area in Stockholm, Sweden. Subjects: Forty patients with Alzheimer's disease living in a nursing home and 40 age-and gender-matched control subjects living independently. Intervention: Dental status and anthropometric variables. Results: Overnutrition was less frequent among the demented than the controls and more demented were undernourished. Dental status was similar in the two groups with few edentulous subjects but only 2 of 7 edentulous subjects with Alzheimer's disease wore dentures. Having natural teeth and many functional oral zones is important for food consistency choice, but not for nutritional status. In the Alzheimer group, the stage of dementia has a strong association to the ability to eat unaided and an association with dental status. Conclusion: There are differences in nutritional status between Alzheimer's patients in institutions and cognitively healthy elderly living at home. The choice of food consistency is correlated to dental status but nutritional status is not shown to be influenced by dental status. However, the ability to eat unaided is strongly correlated to cognitive status.     

Alzheimer's disease,oral function and nutritional status

Objectives: To study differences in nutritional, dental status and oral function between institutionalised patients with Alzheimer's disease and cognitively healthy elderly people living in the community. Design: Comparison was made between two groups, Alzheimer's disease sufferers and healthy controls, using established criteria for anthropometric, mental and dental state. Setting: An institution and residential area in Stockholm, Sweden. Subjects: Forty patients with Alzheimer's disease living in a nursing home and 40 age-and gender-matched control subjects living independently. Intervention: Dental status and anthropometric variables. Results: Overnutrition was less frequent among the demented than the controls and more demented were undernourished. Dental status was similar in the two groups with few edentulous subjects but only 2 of 7 edentulous subjects with Alzheimer's disease wore dentures. Having natural teeth and many functional oral zones is important for food consistency choice, but not for nutritional status. In the Alzheimer group, the stage of dementia has a strong association to the ability to eat unaided and an association with dental status. Conclusion: There are differences in nutritional status between Alzheimer patients in institutions and cognitively healthy elderly living at home. The choice of food consistency is correlated to dental status but nutritional status is not shown to be influenced by dental status. However, the ability to eat unaided is strongly correlated to cognitive status.     

An Introduction to a Symposium in Geriatric Dentistry: Issues in Gerontology

The papers in this collection address geriatric dentistry at a time when society is rapidly becoming older. More than ever before, all dental care providers must understand the special needs of elderly patients and the unique biological features of the aged person that affect the diagnosis and prognosis of oral pathology. Attitudes about aging in the elderly must be discussed within the context of the health care setting so we can address the needs for social change, particularly in the dental and medical professions. This symposium brings together a series of papers on topics that are being researched in geriatric dentistry. The topics are diverse, including methods to finance dental care, psychiatric considerations, temporomandibular joint dysfunction, prosthodontics, artificial saliva and nutritional factors, immunology and the new frontiers in dental science, periodontal disease and oral cancer. And as an epilogue to our theme, a dentist with a primarily geriatric practice reflects on the difficulties and the rewards of the elderly patient. Improving the quality of life is the goal of aging research and to investigate aging legitimately we must ask in a systematic manner, what is aging? In this introduction, we discuss briefly the several theories of aging that are guiding research efforts.     

The orodental status of a group of elderly in-patients: a preliminary assessment

Objective: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. Design: Cross-sectional. Setting: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. Subject: 150 patients aged 58 to 94 years, in which a history could be validated at interview. Intervention: Questionnaire administered by dentist and clinical examination. Main outcome measures: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. Results: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61 % had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. Conclusions: The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.