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Dentists should offer more preventive treatments for elders: Local consultant

8 months ago

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  • Notes need for holistic treatment plan for Sri Lanka’s rapidly increasing ageing population
BY Ruwan Laknath Jayakody The ageing population, which is rapidly increasing and making up a significant proportion of the patients at dental practices with most of them being experienced in dental treatments, tends to have high expectations of the treatment outcome, and therefore, the incorporation of more preventive treatments would ensure increased prognosis of the existing dentition as well as that of the prosthesis, a local report noted.  These observations and recommendations were made by Dr. S.B. Samarakoon (Consultant in Restorative Dentistry attached to the Teaching Hospital, Ratnapura) in a short report on “Oral health and an ageing population” which was published in The General Dental Practitioner – Volume 38 in April, 2021.  The world population, which exceeds six billion at the moment, is ageing. Major advances in health care along with numerous socio-economic factors have resulted in increased life expectancy. The FDI World Dental Federation’s “Oral health for an ageing population” estimated that by 2050, 25% of the world population will be above the age of 60 years. Sri Lanka is also experiencing a similar phenomenon. As noted by the FDI World Dental Federation and A.C. Ezeh, J. Bongaarts, and B. Mberu’s “Global population trends and policy options”, due to these developments, dentists are bound to experience an increased percentage of elderly patients in their practices.  Often, the clinical presentations of these elderly patients differ from those of others. Most of the time, a person who is over the age of 60 years is likely to be suffering from at least one type of chronic illness. As explained in F. Müller, Y. Shimazaki, F. Kahabuka, and M. Schimmel’s “Oral health for an ageing population: The importance of a natural dentition in older adults”, the disease itself, along with the medications taken for the same, may result in complications with regard to oral health.  E.M. Ghezzi, K. Kobayashi, D-Y. Park, and P. Srisilapanan’s “Oral health care systems for an ageing population: Concepts and challenges” noted that diseases such as diabetes, hypertension (high blood pressure), hypercholesterolemia (high cholesterol), chronic heart disease, chronic kidney disease, arthritis (the swelling and tenderness of one or more joints), osteoporosis (disease that weakens bones to the point where they break easily), respiratory diseases, cancer, mental disorders, and substance abuse are commonly encountered in the elderly.  The treatments for almost all of the above mentioned conditions consist of a number of medications which have to be taken over a long period of time. Ghezzi et al. and W.M. Thomson and S.Y. Ma’s “An ageing population poses dental challenges” pointed out that another issue that is common among the elderly is injury due to falls which can lead to short- and long-term health complications.  There is a significant difference in the clinical presentation among the elderly population. In most cases, the elderly are more likely to have more than one condition present at the same time in the mouth. Ronald noted additionally that the severity of the presentation is higher due to the presence of medical complications as well as polypharmacy (the routine use of five or more medications).  When a treatment plan is formulated for an elderly patient, certain factors, as mentioned by Samarakoon, should be taken into consideration.  Socio-economic variables should be taken into consideration when treating the elderly. The clinician would be encountering a patient who has had ample experiences in dental treatments. He/she would be well versed in the success and failures of certain treatment modalities. Sometimes, he/she might be familiar with the nomenclature that the clinicians use. An Australian study noted that therefore, the clinician should be well-versed in the prognosis of the treatment options that he/she has proposed and should also be willing to provide extensive information during the consultation.  It is important to consider the financial situation of the elderly patient as well. Some could be self-supporting while others may be taken care of by their children or next of kin. As observed by D. Lauritano, G. Moreo, F.D. Vella, D.D. Stasio, F. Carinci, A. Lucchese, and M. Petruzzi’s “Oral health status and the need for oral care in an ageing population: A systematic review”, this socio-economic condition of the patient might prevent him/her from receiving the optimal treatment.  The general medical condition of the patient might not be indicative for invasive treatments. Lauritano et al. added that the physician who is looking after the general health of the patient might indicate that the patient’s physical and mental status is not suitable for the proposed treatment plan. A lifetime of dental treatments would educate the patient regarding the limitations of the dental treatments as well as the ability of the clinician. This, in turn, would play a part in lowering or raising the expectations of the treatment outcome. The quality of life that the patient is experiencing would also play a part in the final treatment outcome. Per Lauritano et al., the perception of the patient regarding how he/she should be living gets reflected in the treatment he/she seeks.  “For example, an edentulous (toothless) patient may seek treatment or be content with not having teeth. The patient who seeks treatment may want removable dentures or implant-supported, fixed bridges for both arches. “Sometimes, there may be patients who seek more aesthetic outcomes. They may want to replace missing teeth, bleach the teeth, or cover exposed teeth surfaces. The patient’s medical and mental health would determine whether a simple treatment plan with few visits or a complex treatment plan with a number of visits is suitable for him/her. It is prudent to consider the ability and motivation of the patient regarding the long-term maintenance of the existing dentition as well as prosthesis.”  In these circumstances, it is important to consider all the factors when a treatment plan is designed. The clinician should have a detailed discussion with the patient. It is important to point out the advantages and disadvantages of all the possible treatment possibilities. The prognosis of the treatment methods and expected outcomes, if it fails, should be correctly informed. M.M. McNally and N. Kenny’s “Ethics in an ageing society: Challenges for oral health care” noted that sometimes, elderly patients are liable to seek legal redress if they are not properly informed of the outcomes. “It is of importance that effective preventive treatment methods are incorporated into the treatment plan. The aim of the prevention programme should be properly explained, thereby reducing the burden to the patient as well as to the clinician. The patient’s ability to adapt and maintain the proposed treatment plan should be taken into consideration.”  The clinical setup should be appropriately arranged to make the visit as comfortable as possible for the elderly patient. R.L. Ettinger’s “The unique oral health needs of an ageing population” elaborated that priority parking, easy access to the clinic, chair/wheel-chair, pharmacy and laboratory facilities, and having educated and trained supporting staff are vital in this regard.  
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