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    Posted May 30, 2014 by
    Calgary, Ontario

    Dr. Trey Petty on Caring for the Oral Health Needs of the Elderly

    Families caring for the elderly – or becoming elderly themselves – are often faced with new and intimidating developments in their oral health. I spent two years after dental school in a program in geriatric dentistry and became very well educated and comfortable with all aspects of oral health for people that are considered “geriatric”. I would like to use this article as a kind of primer for those new to this field of dentistry to clarify the process of caring for the elderly with oral health needs.

    1) Basic Dental Rights

    Firstly, let us discuss the idea of basic dental rights. This idea actually applies to all individuals, regardless of age, but can be more applicable to the medically complex or elderly who cannot necessarily take care of themselves. Basic dental rights can be stated as follows: all individuals have the right to the freedom from infection, pain, and swelling. This is achieved – where possible – through minimally invasive dentistry. It is important to keep this in mind because no one wants to – or should be required to – go through life on a daily basis with pain or infection, or swelling from infection or a tumor, that can restrict the intake of basic sustenance. As caretakers and oral health professionals, we must be extra vigilant to make sure that these rights are being fulfilled for the elderly individual. The debilitated elderly may have trouble communicating what they feel, so we may have to do it for them. This brings us to the next consideration in geriatric dentistry:

    2) Functional Categories

    As humans age, many often return to a state of dependence; dependence on others for care. But no two people are completely alike so different levels of functionality will be present. In the dental field, we have created four categories that help us – and caregivers – understand what our role is in providing care for the patient.

    Functionally Independent — Good health, living autonomously - the majority of elderly
    Frail Independent — Failing health, living at home without care
    Frail Dependent — One or more handicaps, living at home with care
    Functionally Dependent — In nursing home or long term care facility

    Once we understand the level of functionality, we can apply the basic dental rights in a way that can influence treatment decisions.

    3) Factors affecting treatment plan decisions

    As mentioned, functionality and basic dental rights combine to inform our choices for dental treatment. Based on these factors, we can determine if it’s really necessary to subject an elderly patient to complicated treatment, including surgery. Would minor correction and mitigation of pain be a better choice? Other factors to consider when deciding on treatment for an elderly individual are:

    1. Patient Attitude
    2. Quality of Life
    3. Limitations of Treatment
    4. Iatrogenic Potential
    5. Prognosis
    6. Dentists’ Limitations

    4) Care and Comfort

    All patients deserve treatment that provides the highest level of care and comfort possible. But, as mentioned previously, the elderly patients with cognitive impairments, such as dementia, may have trouble communicating their concerns and needs. That is why making the effort to maintain a clear and enunciated level of communication between yourself (the dentist) and the patient is critical. To make elderly patients more comfortable, make sure to clearly introduce yourself, speak directly at the patient’s level, ideally with a smile – “Hello, my name is Dr. Trey Petty. I am a dentist, and I’ll be the one taking care of you today.” If it appears that the elderly patient did not properly hear you, never be afraid to repeat yourself – “I’m sorry. Let me introduce myself again. My name is Dr. Trey Petty. I’m a dentist. How are you today?” Repetition is often a key to communicating with the elderly with dementia.

    Making choices for relatives and loved ones can be a difficult and stressful situation. When I became a dentist, I vowed to make these choices as easy as possible for caregivers and the elderly themselves. This article has aimed to make the process easier by providing a few factors to keep in mind when considering oral health procedures.
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