As medical advancements continue, more people are keeping their teeth for longer. Therefore, as dentists, we need to be able to manage older individuals appropriately. As people age, systemic diseases can manifest. Treatment often needs to be tailored to accommodate for these medical and dental conditions. You can read more about managing specific medical conditions such as Alzheimer's and Parkinson's Disease.
Dentists should also bear in mind that older patients have decreased sensitivity to tests. Due to a smaller pulp chamber, older patients have decreased sensitivity to pulpal tests such as cold and hot. Moreover, they will generally have receded gums and decreased alveolar bone height.
Elder individuals can be categorised broadly into three categories. When treating geriatric patients, appropriate treatment should be undertaken. A combination of complex medical history, realistic outcomes and barriers to care should be considered.
1. Functionally Independent Adults
These individuals are able to function on a day to day basis without the need for a carer and undertake daily activities without the need of carers or assistance. This group makes up about 70% of individuals above the age of 65. They are able to access dental care without the need of assistance. These individuals should be treated as per normal adults.
What to do:
Treat as per normal adults
Restorative work, dentures, periodontal maintenance
Regular recalls
Reinforcement of oral hygiene
Essentially all treatment options are on the table.
Comprehensive care provision: Relief of pain → restoration of function → preventive and aesthetic
2. Frail Older Individuals
These individuals live in the community but have lost the ability to go about day to day activities without the assistance of family and friends. They are unable to attend dental services without the help of others. Treatment planning of these individuals require an understanding of the medical and pharmacological history and evaluation of their oral hygiene routine and ability to undergo certain treatments. Frail older adults make up about 20% of the population aged above 65.
What to do:
Assess mental capacity to consent
Assessment of medical history
Limited Treatment: Maintenance and Monitoring
Restoration of function with removable prosthodontics work
Restorative work
Pain management
Work with carers to help improve oral hygiene
Prescription of preventive dental products
3. Functionally Dependent individuals
These individuals will live in nursing homes or completely homebound and need significant assistance for individuals in their day to day activities. They can often be bedridden. Delivering dental care to these individuals is challenging due to barriers to care including: ability to travel, complex medical history, ability to consent. These individuals make up 10% of the population aged above 65.
What to do:
Very limited treatment usually focused on pain relief and prevention of future infections
Consider the use of GIC and atraumatic restorative technique (ART)
Palliative care approach
Assessment of mental capacity to consent
Assessment of medical history
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