Geriatric dentistry is the branch of dentistry dealing specifically with the oral health needs, treatments and concerns of senior citizens. As our population ages this important aspect of dentistry becomes more and more relevant to a larger and larger number of patients. Once the first baby boomers reach retirement in 2011 the number of citizens in the United States at or above the age of 65 will increase almost exponentially until 2030 when the end of the baby boomers reach 65 years old. This means that tremendous number of patients being treated over the next 50 years will be 65 years old or older and will need doctors who are well trained in diagnosing and treating the oral health needs senior citizens.
One of the most significant aspects of treating senior citizens is getting an accurate list of all the medications they are taking, both prescription and over the counter medications and being aware of any potential adverse interactions with the medications that the dentist may need to place the patient on. As the number of medications a patient is taking increases the chance of an adverse interaction increases geometrically. This leads to a significant concern to all treating physicians not just dentists.
Today the average senior citizen takes 5 prescription medications and two over the counter medications on a daily basis, and it is not unusual for a senior citizen to be taking 10 or more prescription medications and 5 or more over the counter medications. It is quite obvious that medically managing a senior citizen is extremely complex requiring extensive pharmaceutical knowledge.
Another aspect of geriatric dentistry is accounting for the physical changes that occur as we age. One of the most significant changes that we go through as we age is that our lean muscle mass is replaced by adipose tissue (fat). This means someone who is the same weight at 65 to 80 years old as they were when they were 30 years old has more of their mass as fat and less of their mass as lean muscle when they 65 years old and older then when they were 30 years old. This has profound implications on the way medications act, their potency, their half-life (the time they remain in the body), their complications and their interactions with one another. These changes affect what medications are appropriate to prescribe and often alter the dosage from the recommended levels.
Loss of dexterity especially in the hands due to age related maladies can cause many patients difficulty with their daily oral hygiene. This can make it difficult to grasp a toothbrush and nearly impossible to set and manipulate dental floss with their fingers. Some solutions would be to recommend large handled toothbrushes that are easier to grasp and the use of pre-strung dental floss in a Y-shaped holder. Failing eyesight can also hinder proper hygiene. Patients can’t clean what they can’t see. Fortunately corrective eyeglasses, vision enhancement surgeries and cataract surgery all help improve patients’ vision.
Physical accessibility to a health care provider and their facility can often effect whether senior citizens receive health care. Limited personal mobility, difficulty walking, difficulty climbing stairs and difficulty attaining transportation to and from a health care facility can all limit and actually preclude senior citizens from receiving the health care they need. Handicap parking, handicap accessible facilities and handicap and senior public transportation can all help alleviate these obstacles to heath care for the physically limited and handicapped patient.
As with all health care a proper comprehensive health history, through examination, through diagnostic tests and developing a rapport with each individual patient lead to the best possible and most appropriate oral health treatment. Having a team oriented approach in which the patient’s other health care providers are consulted with, help develop and are aware of the proposed dental treatment plan will also help to improve the patient’s oral care treatment. This multifaceted team type of approach to health care becomes even more important for geriatric patients and medically compromised patients than for healthy younger adults.