Abstract

Elderly patients and dental treatment

Christian Bär, Thomas Reiber, Ina Nitschke
Introduction
With increasing fragility of the old and very old, treatment at dental clinics should give way to comprehensive dental care which may in part be delivered outside the dental office. The health care provider needs patience and has to be familiar with issues of frailty as well as being profoundly knowledgeable about geriatric disease and it's influence on oral health well beyond purely dental issues.

Service utilisation
It is a fact that utilisation of medical services rises with increasing age while dental visits become irregular, less frequent or cease all together. Impaired general health and growing multimorbidity are factors explaining non-utilisation of dental services. Elderly people who spend much time for medical consultations and have high expenses for medication have fewer dental visits (Kiyak und Reichmuth 2005).

Frail elderly in nursing homes and clients of home care services do not benefit from the good dental infrastructure. Only 34,1 % of all people depending on nursing care had a dental consultation within the past five years (Knabe und Kram 1997). 12,4 % could no longer be transported to a dental office. They were in need of treatment in the nursing facility.


Preventive oral health care
Many elderly patients are unaware of dental prophylaxis or do not feel addressed by adverts with young, good looking and healthy dental team members and patients. Such offers no longer appeal to the frail elderly person and his age group. As regular prophylaxis is frequently neglected oral health can become desolate. Contact with dental services may only occur again in a rehabilitation centre after medical incidences, for example after a stroke.

Dental treatment
An elderly patient in good general health may be treated similar to younger patients in general dental practice. Treatment of geriatric patients who are less able to withstand therapeutic strains and whose adaptability to new prosthetic devices may be limited is more challenging. Therefore the dentist should develop long-term treatment plans taking into account, whether a prosthetic concept relying solely on fixed prosthesis is feasible or whether an early change to removable appliances might be preferable.

During the planning phase the dentist should offer the patient to bring a familiar person along for support to discuss therapeutic options. The enables the advisor to obtain has first-hand information to assist the patient in a participatory decision making process.

Dental treatment problems for patients with dementia will be increasingly important in the future. In the context of a necessary oral rehabilitation treatment under general anaesthesia may be unavoidable. Early diagnosis of dementia may allow dental treatment while the patient is still able to cooperate in order to achieve a high level of oral health which can then be maintained by regular and systematic prophylaxis when the general condition worsens.

With increasing multimorbidity the number of medicines prescribed also increases. Many of these have relevant side effects in the oral cavity. This underlines the importance of a detailed anamnesis which for elderly patients should be updated regularly with every routine examination.