Preparing Patients for Future Oral Healthcare Decline.
Elderly dental patients typically are challenging to treat due to their poor cognitive skills and manual dexterity. Older patients need treatment-planning strategies specific to their individual needs.

Prepare for the Future:  Patient Education

The discussion needs to begin with the 50-60 year old patient regarding the need to prepare their mouths for the future assault that aging brings.  Like their physicians do, a dental plan of action should be established.

There are a number of issues that pre-retirement patients should be aware of, such as dry mouth secondary to medications.  The dental plan should address both the financial and treatment planning arrangements in anticipation of future challenges.  This plan needs to protect the teeth from dry mouth and resultant root caries, maximizing the patient’s individual insurance benefit.
Routine care for the elderly is critical.  Some even benefit from a 3-4 month cleaning schedule.  Daily use of fluoride may also be recommended.

There are a number of common myths in our culture about aging teeth that should be discussed:
  • If there is no pain, there is no tooth problem
  • Teeth become softer with age and are more susceptible to decay
  • Tooth loss is a normal part of aging
  • If bleeding occus with brushing, stop immediately
  • Teeth are not as important for an older person since they prefer to eat soft foods
  • Dentures, just like real teeth, stay in the mouth 24/7
  • Dentures are a great alternative to real teeth—simpler to clean, more cost-effective, and easier to function
Dental treatment planning for the future decline should start in the 50’s, 60’s, and 70’s.  Dental restorations should be designed to withstand the lack of oral care that commonly occurs as a result of the aging process.  Fillings and crowns need to be easy to keep clean.  Extraction and implant placement should be considered in situations where there is a guarded prognosis.  Treatment planning should provide for implant retained lower dentures to allow proper nutrition and bone preservation and help prevent ill-fitting dentures from rubbing ulcers.  This level of care needs to be completed when the patients are healthy and able to receive the care.

Focus on Prevention
Most of the dental care needed by the elderly is long-term care facilities (LTCFs) is not provided by a dentist.  A recommended protocol is outlined below:

Daily Oral Care
  1. Every resident should have a daily oral care plan
  2. Supervised tooth-brushing should occur twice daily-after breakfast and before bedtime—with a regular toothbrush and fluoride toothpaste, not a toothette or sponge.
  3. An accountability system with regular evaluation should be established.
  4. Yearly oral health education of staff should be provided via inservicing
Daily Fluoride Application
  1. A decay risk assessment should be performed to determine fluoride need.
  2. An assessment of resident pharmacy formularies should be performed to determine fluoride prescription coverage and availability.
  3. Appropriate fluoride application should be administered depending on the level of decay risk: fluoride toothpaste, fluoride rinse, and fluoride gel.
  4. Staff training should occur annually for proper administration of fluoride toothpaste, fluoride rinse and fluoride gel.
Regular Professional Cleanings
  1. The last cleaning and due date for the next cleaning should be documented in the resident’s medical record upon admission.
  2. Assessment and identification of barriers to obtaining regular professional cleanings should be performed (id, funds, transportation, behavior challenges).
  3. Confirmation and documentation that the facility dental provider offers regular professional cleanings (ie, every 3-6 months) for the residents should be secured.
Dentists need to play an active role in the oral healthcare of geriatric patients, including those residing in LTCF’s.
From Compendium Feb. 2013