Dental Approach to the Elderly Patient:

Dental Approach to the Elderly Patient:

Dra. Jéssica Gazel Bonilla
Odontóloga Geriatra
Universidad Federal de Paraná, Brasil, 2009.

Dental Approach to the Elderly Patient:

Dental Approach to the Elderly Patient:
Introduction:
The human being goes through various stages during its development and within which undergoes many changes both physically and psychologically.
The population over 65 is diverse, not homogeneous at all. People with similar ages, have completely different health characteristics. Older Adults have their own characteristics,
systemic, pharmacological, nutritional, psychological, economic, social, dental, etc.. that
complicate their evaluation. The mouth is the window to the health of the body and reflecting signs and symptoms of health and / or disease
even some diseases that affect the body as a whole can have its first demonstration in
oral cavity.

Factors that may influence the Oral Health PAM:

Mouth tends to dry by the decrease in saliva due to medications.
The skin of the lips in very old age wrinkled.
Increased wear of the tooth surfaces, alveolar bone loss, sharp teeth, brittle and yellow.
Decreased taste.
Nerve tissue and blood vessels is reduced, causing less sensitivity.
The ability to withstand the pressure of a dental prosthesis and decreases the ability to chew is reduced.
Less defensive and reparative capacity of tissues against bacterial aggression, often fungal infections and, in case of injury slowing healing, precipitating the loss of teeth.

Diseases Base:

– Enf. cardiovascular
– Diabetes Mellitus
– Hypertension
– Osteoporosis
– Enf Hemic and Coagulopathies
– Hepatic Disorders
– Visual and Motor
– Renal
– Nutritional Disorders Mental origin.
– Tables to cause some degree of immunosuppression.

When a patient has any of these diseases , it is essential to determine if the patient is being treated and if the box is stabilized before performing any dental maneuver , however simple it may be.

If circumstances warrant, the patient should be referred to the physician for evaluation , even if it means delaying dental treatment.

In patients with liver and / or kidney problems , precautions should focus on systemic changes that generate these pictures, especially circulatory, hematological and immunological level and that may complicate dental treatment.

It is also important to adjust the dose of any drug to indicate , as almost without exception they are metabolized in the liver and excreted renally , so inevitably the concentrations of drug to the patient undergo modifications.

Patients with motor, visual and mental disturbances, unquestionably are limited to maintain proper oral hygiene. They are essential indicate Toilet simplified techniques .

Although the oral health of PAM is determined by various factors both internal and environmental, we now know that a high percentage of the elderly population presents quite precarious condition oral health , reflected in the fact that the most prevalent condition is edentulous.

Drug Therapy:

All drug administered to a patient, along with exercise its beneficial pharmacological action, entails the ability to produce side effects and adverse reactions in the body, especially in long-term treatment.
These side effects should be widely known by the dentist to control and counteract its effect whenever possible. His eventual appearance should be explained to the patient before starting therapy, so be forewarned if they occur.

Most common side effects of oral medications:

Xerostomia and Sialadenosis (chronic injury that affects simultaneously to multiple salivary glands).
Dysgeusia (altered taste)
Allergic stomatitis
Gingival changes (hyperplasia, bleeding, gingivitis).
lichenoid reactions
Erythema multiforme or polymorph
Lupus Erythematosus and Pemphigus drug.
Oral candidiasis
OSTEONECROSIS BY BISPHOSPHONATES

Many of the drugs used by elderly patients as causing major side effect is xerostomia , decreased salivary flow.
The main complication resulting from long-term xerostomia is the increased incidence of root caries and oral candidiasis, besides the appearance or increased discomfort in patients with removable prostheses.
When a patient suffering from xerostomia , determine the cause that generates, before indicating any product. Thus, in the case of reversible changes as the stress and anxiety patients with dehydration , diabetes uncompensated cases or when the xerostomia is caused by certain drugs .
Patients on anticoagulant therapy require temporary suspension of the drug, when the dentist to perform procedures required to cause some degree of bleeding. The whole process has to be carried out in close communication with the treating physician , it is he who determines when and for how long the patient discontinued therapy.

Dental Considerations for drugs:

Medical Consultation
Protocol stress reduction
Protocol on orthostatic hypotension (semi-supine position chair)
Precautions local anesthetic and vasoconstrictor.
Investigate oral side effects
Alert on drug interactions.

Classification of the Older Person:

The following are the definitions are approximate consensus in the medical field of the Classification of Older Persons

Patient Healthy and Independent:

It is an older person without any disabling disease.

Is independent to make their basic and instrumental activities their daily lives and no severe mental or social problems and related to your health.

Patient Partially Dependent :

Patients who need some help to make their everyday tasks.

Not have dementia or social conflicts that generate health risk.

His health problems can be treated with conventional service and relevant medical specialty
Patient Totally Dependent

A person who needs help to perform activities commonly considered basic for the autonomous development of daily living.

Patient Fragile or High Risk:

Retains its independence precariously.

The main feature of this profile is the risk to become dependent or have a continuing situation of disability.

At high risk of generating geriatric syndromes
.
Patient confined:

Is one who can only leave their home, assisted by a wheelchair or stretcher

Older than 80 years.

Predominantly female.

With disability for activities of daily living.

Institutionalized Patient:

– It is that which has loss of autonomy, which indicates that the person must learn to comply with the rules and routines of hospital.

Geriatric Patient:

– One or more chronic diseases and directly involved in a state of
disabilities.

– They are dependent to perform basic daily activities have a high incidence
neurodegenerative or mental illness.

Objectives of the clinical history:

1 – Knowing the patient fully, not just your mouth. (General health and psychological and social aspects.)
Two. Identifying patients with any previous disease, involving a serious problem for your life or that may complicate medical / dental treatment.
Three. Improve communication with the patient’s physician, about health problems.
April. Help set a good dentist-patient relationship, showing that he attends integrally.
May. Protect the dentist from the legal point of view (Informed Consent).
6. The needs that exposes the patient, their treatment priorities and expectations you have about the success of this.
7. Not only recognize specific diseases, but the psychological state of px, their personality traits, behaviors or special states of mind.

Comprehensive Geriatric Assessment:

O
Oral: State of the mouth, restorations,
salivation, prosthetics, occlusion, etc..
S
Systemic: Physiological changes, chronic illness, medications, etc..

C
Functional Capabilities: Independence, oral hygiene, mobility, etc.
A
Autonomy: To make decisions or reliance on family
R
Reality: To establish a treatment plan according to the constraints.

In older adults, the first sign of disease rarely is a specific symptom, as in younger people.
They can manifest as an obstruction of their functional capacity.

In Older Adults, not always the diseased organ or tissue is what determines the functional disorder.

In addition, the overall is not separate from their oral health, since any of these aspects can deteriorate or get another condition.

Should assess the social situation of the patient, functional independence, their cognitive potential and try to detect possible symptoms of depression.

Issues to consider before starting the Treatment :

If the elderly value their health.
If you want to improve your image.

If you understand what he says and you want treatment.

If you are qualified to receive it.

If your feedback is psycho-physically adequate.

Informed consent.

Overall capacity and longevity.

Social, economic factors, diet, oral hygiene and displacements.

The most important:

If treatment would improve their quality of life

Treatment Plan:

The possibility of successful treatment, whether it is partial or total.

The ability to maintain natural teeth in the mouth as long as possible
Should achieve the desired aesthetic effect.

Use prosthesis without mobility or without psychological rejection, and the possibility of no treatment

Determinants in the clinical management of the geriatric patient:
1. The patient’s wishes and expectations.
2. The type and severity of the patient’s dental needs.
3. The impact of problems in the quality of life of patients.
4. The probability of positive treatment outcomes.
5. The availability of reasonable alternatives to treatment and less complex.
6. The patient’s ability to tolerate stress treatment.
7. The patient’s ability to maintain their oral health.
8. The financial capacity of the patient and other resources.
9. The skill of the dentist (including resources such as their skills and equipment).
10. Other relevant matters.

Forecast :

In elderly patients , the prognosis First, we have to consider the problems and
existing medical complications depend largely on their physical, emotional and nutritional , their mental and general health status .

A number of important aspects that the dentist should evaluate and implement .
We will have to assess the individual’s ability to understand the importance of hygiene in the Maintaining your oral health and your physical ability to deal with it.

Consider the aesthetic and functional factors that will improve your image and stimulate their desire to act in society , which would help to improve their quality of life.

Identify the family environment and the eventual availability of people to help him in his hygiene.

To investigate the possibility that the patient can access the office and you can scroll inside.

To assess the ability to understand instructions or need a companion.

Determine if you can give permission for treatment or if such assignment is to a family .

Conclusions:

Primary care in the elderly patient should be focused on educating the patient and caregiver regarding:

Different techniques of plaque control, care and proper use of dentures.

Application of fluoride and root caries prevention, prevention and detection of orofacial cancer

Prevention of disease Temporo Mandibular Articulation ..

Scheduling according to systemic pathology (patients with heart disease should be cited more frequently).

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