Treating Senior Patients: Quality of Life Concerns

Written by Ronald Groba, DDS, and Frank Nia, DMD, MSEd
Saturday, 01 March 2008
The full article can be accessed here

TREATMENT CONSIDERATIONS 

As noted, many seniors face plenty of obstacles before even reaching their dental appointment. That said, it is important to have a clear understanding of each patient's unique story and dental history, regardless of age. However, when dealing with an elderly patient, it is sometimes the case that the patient does not have a strong relationship with a dental professional or cannot track dental records down due to extended periods with little or no professional dental care. In this case, dental professionals must do a thorough, detailed examination of the oral cavity. Questioning a senior patient or family member about the patient's oral health habits may also help develop dental background or history. Doing so will ensure a comprehensive treatment that is more likely to improve the patient's quality of life (Table).

Table. Gentle Ways to Inquire About Patients' Cleaning Habits.

Do you find it physically difficult to reach certain parts of your mouth?

Do you suffer from pain that makes it hard to brush or floss?

Do physical limitations prevent you from brushing twice a day?

What do you do with your denture at night?

What are your favorite oral products?

What products would you like to see available and what would they accomplish?

Seniors' quality of life may be diminished by something as minor as difficulty getting into the dental office. Often when seniors seek dental care, they encounter accessibility obstacles such as lack of railings, escalators, elevators, and automatic doors. More easily injured and tired, seniors may be inhibited by a heavy door or exhausted by a flight of stairs. Keep seniors' limited capabilities in mind around the office. Make clear signs directing clients to the elevator and prop a heavy door open during the day if possible. 

While dental professionals may make treatment possible for seniors, seniors may not fully understand the need for or appreciate professional oral care. Even when care is briefly explained, some senior patients may have a difficult time understanding the increased need for a dental professional's attention. According to the National Institute of Dental and Craniofacial Research, many conditions that plague the body manifest in the mouth, such as diabetes, heart disease, oral lesions, xerostomia, and Sjögren's Syndrome, an autoimmune disorder that primarily affects women.11 In fact, seniors are more in need of dental care as they age. 

CARING FOR EDENTULOUS PATIENTS

Some seniors believe that having lost all their teeth eliminates the need for a dental professional's services, which couldn't be further from the truth. Older patients who wear dentures need regular dental appointments to ensure proper denture fit over time, screen for diseases and sores, access instructions for practicing good oral hygiene at home, receive product recommendations, keep abreast of technological advancements, and other denture care issues. For instance, 2 implants with appropriate attachments, placed under a lower denture, can greatly enhance the patient's quality of life. Additionally, medications, infections, weight loss, or obesity can affect health, and the surface and shape of the oral cavity, and many senior patients may not even be aware of the availability of products suitable to help care for their mouths. 

Dental professionals may suggest a denture cleanser like Polident fresh cleanse (GlaxoSmithKline) or ProTech (Denture Care) to help remove plaque and eliminate germs.  Denture care and overall oral health for seniors will become increasingly important as the population ages and vulnerability to disease, illness, and side effects of medication present increased challenges to seniors' oral healthcare. The following guidelines can be followed by practices providing senior-inclusive oral healthcare:

Make sure the patient has a complete understanding of the proper oral care they should be practicing at home. 

Instruct edentulous patients to be particularly careful when cleaning their dentures, as dentures are a porous material shown in studies to harbor bacteria, which can be reduced via overnight soaking. 

Supply samples of denture cleanser and large-print treatment instructions for elderly patients to bring home.

Work with elderly patients to schedule regular dental exams, organize extra reminders, send large-print postcards, and leave clear, understandable messages on voicemail. 

Arm patients with the tools to make good health decisions. Print out a worksheet calendar with regular care appointments and dates when they should order more dental products. Include approximate costs to help seniors manage a budget. 

MEET THE NEED 

As the population ages, dental professionals need to be more aware of the existence, circumstances, and quality of life of senior patients. As the baby boomer generation retires and uncovers an increased need for oral healthcare, a practice's success may depend on it. An underutilized consumer group for dental services, elderly patients display an obvious need for dental care, leading to improved quality of life. As seniors face numerous physical and psychological challenges outside of the office, dental professionals should make it as easy as possible for older patients to take the first steps toward responsible oral care.