Second Opinion: Comprehensive plan needed for aging patients

By Nathan Oakes, DMD, contributing writer

January 17, 2018 — With the rapid growth of the aging population in the U.S., it is likely your practice is already seeing a rising number of older adult patients. Whether these are existing or new patients to your practice, this patient group will be an important focus within dental practices moving forward.

Adapting comprehensive treatment plans is important to meet the needs of these patients. In my practice, we try to do the following:

  • Limit patients’ time in the chair.
  • Ensure patients’ entire medical history is evaluated when treatment planning.
  • Thoroughly communicate with patients and their family/caregivers.
  • Make sure the treatment fits the physical age and capabilities of the patient.
  • Offer patients the opportunity to share experiences to make them feel welcomed and cared for.

Practical concerns

According to the American Dental Association’s Oral Health Topic on aging and dental health, potential physical, sensory, and cognitive impairments associated with aging may make oral health self-care and patient education and communications challenging. And for older adults, even what most consider “routine” practices, such as brushing at least twice a day and visiting the dentist twice a year, may be extremely difficult for these patients.

At some practice, they see many aging and older adult patients. If these patients have multiple comorbidities that will affect the outcome of a successful treatment plan, then They tend to reconsider the treatment options. For example, a patient who cannot lay back and has difficulty breathing probably isn’t the best candidate for a three-unit bridge in the posterior maxillary arch.

Sumir Mathur, DMD, practice owner of three practices in Phoenix, emphasizes the need to treat these patients in as few appointments as possible.

“For an aging population with limited flexibility and transportation, it’s vital to treat these patients in as few appointments as possible,” Dr. Mathur said. “We use technology to help assess and treat patients at an advanced pace.”

Cristina Griffee, DMD, who owns two Dental practices in southeast Florida, and her teams go above and beyond to accommodate elderly patients.

“If they are limited to a wheelchair, we make sure to leave the patient in their wheelchair for most, if not all of the appointments,” Dr. Griffee said. “When patients do sit in the dental chair but have had previous back or knee surgery, we offer the appropriate headrest, lumbar support, and knee bolsters when needed.”

In addition, specific dental conditions, including dry mouth root, coronal caries, and periodontitis, are commonly associated with aging. Elderly patients also may show increased sensitivity to pharmaceuticals, local anesthetics, and analgesics.

When treating elderly patients with periodontitis, Dr. Griffee recommends measuring the difference between active infection and bone loss with mobility of teeth.

“Any infection should be treated aggressively; however, many elderly patients will exhibit bone loss in the periodontium,” she said. “If there is no mobility present and the patient isn’t experiencing pain, it’s best to be conservative in your approach to treating the patient.”

As every patient and their mouth are different, so is tailoring treatment so the whole health of the patient is crucial, Dr. Griffee noted.

“Look at the whole person medically and dentally to ensure a positive and healthy outcome,” she said.

Patient and family communication

When working with this patient population, a few communication techniques are especially helpful.

“I want everyone to feel welcome and not like they’re just another individual taking up space.”

The first is to take it low and slow. Low in this case means getting to their level, looking them in the eye, and giving them the opportunity to listen to your recommendations.

To make it easier, I encourage them to ask questions pertaining to treatment and help this process by asking common questions, such as “Can I go home with my new teeth?” This helps to provide an environment to be social and where questions are acceptable and not judged as silly.

Many elderly patients are accompanied on their visits by family. I typically refer to patients as “Mom,” “Dad,” “Grandma,” or “Grandpa” when talking with family members. Referring to them as family is disarming and elicits a nurturing and educational environment.

I want everyone to feel welcome and not like they’re just another individual taking up space. Developing this relationship gives them a purpose to be at the appointment and helps set goals for future appointments.

(  Dr Tim’s take away: This is very common in much older nursing care population )