By Sharon Boyd, MA, RDH
Preventative dentistry is the cornerstone of good oral health. Yet as patients age, the need for preventative techniques tends to shift from restorative care to a maintenance approach. By continuing to maintain a stable oral environment, we facilitate the ability for our patients to maintain adequate nutritional intake, communicate with their loved ones and caregivers, and minimize financial obligations for individuals who might be living on a fixed income.
Why does any of this matter? Because of an aging global population.
The United Nations predicts that by 2050 there will be 1.5 billion adults over the age of 65. And approximately 3-in-4 of those aging adults will suffer from some form of periodontal disease or caries.
With greater access to preventative care over the past several decades, more adults are keeping their teeth longer than ever. However, economic and social considerations continue to contribute to common dental ailments. Edentulism continues to be a risk for aging patients, with 95% of geriatric dental patients showing at least some symptoms of periodontal tissue deterioration.
Weighing the responsibilities of dental management vs. treatment causes the focus to shift as patients progress in age and lifestyle limitations.
Is it Wrong to Adapt Care for Geriatric Patients?
To answer that–absolutely not. Changes in patients’ priorities and needs naturally shift depending on their stage of life. For an aging geriatric patient, the focus of care may need to be on concerns such as:
- Avoiding additional tooth loss
- Retention of existing dental restorations
- Minimizing the risk of root-surface caries
- Managing xerostomia symptoms and side-effects
- Fit and function of removable prosthetics
- Underlying health factors which take precedent
These differ from what might be priorities for younger patients–such as addressing occlusal wear, intrinsic staining, or incorporating aligner therapy for minor tooth movement. Although these ailments can—and do—impact older patients, they're typically less of a priority because of the natural toll on their smile from years of functional use. Dental providers also need to consider the role that dental wellness plays in managing co-existing conditions like diabetes or respiratory diseases.
A Shift in Patient Protocols
As the focus on prevention, restoration, and aesthetic techniques take a back seat, geriatric dentistry often incorporates more strategies such as:
1. Treatment Deferrals
In a typical scenario with young, healthy patients, most dental concerns are best intercepted as early as possible. But for older individuals, a “watch and wait” approach may be the preferred option. The majority of treatment planning takes on a customized approach, evaluating the needs and concerns of the individual as they relate to disease risks and oral hygiene habits.
For example, an older patient with a cracked tooth may not be experiencing any negative symptoms. While a typical standard of care for young, healthy patients might include a root canal and crown or complete extraction, neither of those may be better for a patient who is advanced in years. So instead, the best protocol might be to allow the patient to retain their natural tooth in the hope of getting a few more years of use out of it, so long as they know there are potential risks associated with doing so.
2. Low-Cost Alternative Treatments
A patient in their 40s or 50s who has missing teeth may make an excellent candidate for dental implants. But is such a big investment worthwhile for a completely edentulous individual in their 80s? While implants may perform at more optimal levels, geriatric patients may find it more worthwhile to “settle” for an affordable alternative like acrylic dentures, given their late stage of life. Or an individual with localized gum disease and underlying cardiovascular conditions may be best treated with periodontal therapy, but their personal preference is to have those teeth extracted.
3. Patient-Driven Care
Allow your patient to help co-plan and guide their treatment process. It may be that they're extremely active and plan on living until a ripe old age of 100. But if their priorities have changed over the last decade or so, and other concerns have taken a focus, adapt their care plans to cater to those needs. All the while supporting a holistic approach that incorporates the oral-systemic connection of their dental wellness as it ties back into co-existing conditions. Teledentistry options can also make care more accessible to those patients with limited mobility while also reducing out-of-pocket costs on their behalf.
As dental professionals, geriatric dentistry ought to change the way we typically treat our patients. No longer is it always about the best care method in the industry, but rather about what is best for the unique situation for that individual patient. It’s simple to understand this concept when managing patients who have special needs. But seniors with deteriorating health fit the same criteria. With older individuals, it’s best to think outside the box as we weigh the big picture of oral health as it relates to the final stages of an individual’s life.
Author: Sharon Boyd, MA, RDH has over 20 years of experience in the dental industry and is the founder of DentaSpeak, LLC. In addition to being a registered hygienist, she serves as a full-time patient education professional, with special interests in strategic dental communications. She often works as a liaison between practitioners and patients, bridging the gap between care needs and patient concerns. In her spare time, Sharon enjoys triathlon and volunteering at her family’s church.