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Preparing Patients for Geriatric Oral Healthcare Needs
Discussions can begin as early as age 50
What happened to Mrs. Jones? Some dental teams have had the experience of wondering what has become of an elderly patient who has been in the practice for 25 years or so. Because clinicians are frequently so busy running their practices, there often is no time to follow up with these complex patients who no longer make their recall appointments because of cognitive decline, transportation issues, and other problems that typically accompany older age. Elderly patients may develop poor oral hygiene secondary to declines in manual dexterity and cognition and/or develop a dry mouth and xerostomia because of their medication.
Prepare for the Future: Patient Education
The discussion needs to begin now with 50- to 60-year-old patients regarding the need to prepare their dentitions for the future assault that aging brings. Like their medical counterparts do, dental teams should establish a plan of action at the dental office. There should also be a discussion of current medications by all patients at all routine care visits.
Dental teams should raise a number of issues with preretirement patients so they can be aware of such problems as xerostomia secondary to the use of medications, and make both financial and treatment-planning arrangements in anticipation of future challenges to their dentition. Recommended preretirement planning issues would include a plan that: protects the dentition from xerostomia and resultant root caries; spans the next 5 to 10 years, in which the patient’s dentition would be prepared for the future; works within the parameters of the individual patient’s insurance benefit package/health savings plan while funds are available, because after retirement, discretionary income is likely to be limited.
Dental teams should bring to the operatory the scenario of what the future will hold for their patients. Let them know the importance of regular routine care not only for themselves but also elderly parents. Ask whether their parents are having their teeth cleaned regularly, and let them know about the importance and benefit of a 3- or 4-month routine care schedule. Discuss, too, the use of multiple medications and the use of fluoride products on a daily basis for their parents.
There are a number of commonly held myths in our culture about aging teeth, which dental teams should discuss with their patients, including:
• If there is no tooth pain, there is no tooth problem.
• Teeth become softer with age and are more susceptible to decay.
• Tooth loss is a normal part of aging.
• If bleeding occurs with brushing, stop immediately.
• Teeth are not as important for an older person since they prefer to eat softer foods.
• Dentures, just like real teeth, stay in the mouth 24/7.
• Dentures are a great alternative to real teeth—simpler to clean, more cost-effective, and easier to function.
Be Budget Wary
Assist patients in using their monetary resources wisely. If insurance is in the mix, it should be used for two prophylaxis visits per year; for the recommended 3-month routine care schedule, the patient must agree to pay out-of-pocket for two of the visits. Once the initial treatment plan has been completed, the option of combining a minor restorative need with a 3-month prophylaxis visit is common.
Dental teams must play an active role in the oral healthcare of geriatric patients.