Dental News - Oral care of older patients: Prevention before intervention

Dental Tribune International

Fri. 1. September 2017

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BRISBANE, Australia: In light of the ageing population, dentists need to be aware of the risks posed by retained dentition and exposed root surfaces in elderly patients, whose oral health problems are multifactorial. A recent article has recommended a maximum interception approach involving all members of the health care team and promoting evidence-based self-care, taking into account salivary, plaque and lifestyle risk factors.

Dental professionals must be prepared for the sheer number of older patients, especially among the baby boomers (the generation born between 1946 and 1964), retaining their natural teeth for longer, stated article author Prof. Laurence James Walsh, from the School of Dentistry at the University of Queensland in Australia. Particular problems include root surface caries in patients with a strong history of coronal caries and those who suddenly develop salivary hypofunction. Furthermore, elderly patients suffer from more chronic diseases and are medically more complex.

Treatment options need to be adjusted to each patient’s situation. This includes considering how treatments can maximise the patient’s quality of life and make him or her comfortable and pain-free, as well as treatment being within their economic reach, argued Walsh.

Older patients sometimes cannot maintain sufficient oral health, owing to a decline of fine motor skills and reduced sight. Hence, Walsh advised a multidisciplinary approach with doctors, nurses and carers working together to provide good oral health for patients living in long-term care facilities. A key message must promote oral health as part of overall health, he said.

“A central tenet of modern preventive dentistry is to avoid intervening before prevention has been given a chance to work,” emphasised Walsh.

The older population is at risk of falling into the cycle of dental neglect or worsening oral disease. Carers might be reluctant to perform oral hygiene, since they may feel they lack the necessary knowledge and skills to do so safely, wrote Walsh. This adds to the perception that the mouth is an intimate personal space. Consequently, many carers believe that patients should be looking after their own teeth and dentures. In the case of patients who develop dementia, these barriers to oral care can magnify.

“Protocols for oral care must be tailored to the patient’s needs and be realistic given the limitations in time, finance and energy which can be expended,” said Walsh. Furthermore, the lack of education is a need that should be addressed.

The article, titled “Minimal intervention management of the older patient”, was published online on 11 August in the British Dental Journal.