As a patient gets older and they are diagnosed with dementia or Alzheimer, they tend to pay less attention to their dental care. As these patients become dependent on others to care for their teeth, their teeth may become more decayed at a faster rate than before their diagnosis.
When we see a geriatric patient, most of the time, they are also complicated with many systemic diseases such as high blood pressure, diabetes, high cholesterol, stroke and are on a large amount of medications. Many of these patients also have had joint replacements and have had strokes or are dealing with Alzheimer’s and dementia and this can result in a very combative or sometimes stoic patient who may not be able to respond or communicate their needs to us.
When we see geriatric patients, it is often that they have not kept up with their dental care and may have a lot of food trapped in their teeth, or have not even brushed their teeth for days or weeks or sometimes even months. One can only imagine the type of damage that this can cause to the patient’s dentition. Depending on the age of the patient, the oral assessment that is seen, the condition of the patient mentally as well as physically, we come up with the needed treatment for the patient.
Most of the time, depending on the status of the patient, sometimes the most conservative treatment is the best option for the patient. Placing the patient on regular more frequent cleaning regimen is the best defense towards prevention of further destruction to the patient’s teeth and gums. Sometimes, conservative treatment of leaving remaining root in the patient’s gums to prevent putting the patient through extensive dental surgery is warranted if the patient is very old or if their medical condition does not warrant them to undergo surgery.
Complications from medical conditions can cause severe decay in this population also due to dry mouth that the patient may be experiencing due to age and also due to side effects of a large concoction of medications that they may be taking. Many medications can cause the patient’s saliva flow to decrease and as a result of that, can cause the patient to have a lot of decay. Saliva helps wash away food debris and neutralize the acidity of the mouth after eating. If a patient experiences dry mouth, they will have a higher rate of decay.
Many geriatric patients also have special need due to strokes or joint replacements restricting them to having to be in a wheelchair. Some patients can be transferred to the dental chair, while others would have to be treated directly from the wheelchair. Some patients may have to be treated at their residence if they are bed bound.
Some patient’s who have had a stroke have to be upright due to the inability to swallow or have no ability to be treated in a recline position will also have to be taken in as an important factor during treatment. Other times, if an extraction or oral surgery must be done on these patients, a medical consultation to the patient’s physician would have to be planned to hold any blood thinners or aspirin prior to the extractions. Also, antibiotics that needs to be given to the patient prior to their treatment if they have had joint replacements in the recent years or with heart murmur or valve complications will require antibiotic premedication before a dental appointment. Again, all theses factors must be considered and thorough evaluation of the patient’s medications and medical status must be considered.
Special care for the geriatric takes a very special dentist who has experience in taking care of these special growing aging population. Picking a dentist who has been trained and have extensive experience in treating geriatrics is very important. A dentist who is has had medical training and hospital dentistry training is imperative. As we know, care of a loved one as they age can present as a challenge as we need to advocate for them in many ways. This is often the most delicate times in their lives.