The Complex Conundrum of Age and Dental Health

With one in five elderly citizens missing out on regular dental appointments, older people in America are facing an oral health crisis. Can a solution be found?

dental care for elderly

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There is a dental health crisis quietly brewing in the United States. At the moment, around a fifth of people aged 75 years or over have not visited the dentist in the past five years. This elderly population is dealing with chronic toothache, degenerative tooth loss, and persistent infections because its members are not getting the dental care that they so urgently need.

There are many different reasons why older people might avoid the dentist. For many, even routine check-ups and examinations can be very frightening. And this fear only gets worse as the amount of missed appointments increases, so they get trapped in a vicious cycle. For others, the problem is a little more complex. How do you convince an older person to cooperate with dental exams if they have late stage dementia?

It is a critical question, but one which has no clear answer. And with such a litany of obstacles standing in the way of good oral health for older people, it looks like many individuals will continue to suffer in silence. The good news is that the US government is attempting to put measures in place that could help elderly patients to seek advice and assistance when it comes to taking care of their teeth.

Dealing with Dental Care and Dementia

The single hardest obstacle for both dentists and patients to overcome, as regards elderly individuals and their oral health, is the onset of dementia. While mobility problems, lack of funds, and social anxiety can all prove difficult, they are nothing compared to treating a person with a reduced mental capacity. How do you persuade somebody who cannot really remember why brushing is important that they need to visit the dentist?

For patients with late stage dementia, it isn’t always possible to explain what is happening during a dental exam. So, panic and fear are very common, as they are for young children. In some cases, patients staunchly refuse to let a dentist anywhere near their teeth, even if it is clear that they are in pain.

This creates a real ethical and moral dilemma for dentists and for carers. Is it worse to allow an elderly patient to go without dental care that will alleviate pain and soothe suffering or is respecting physical space and agency more important? In other words, should physical force or coercion ever be used, even as a last resort? These are tough questions and the answers are usually left with the caregivers.

However, it is the responsibility of a dentist to offer advice on how badly care is needed and what the consequences are likely to be if it is not given. Ultimately, the situation is tough on all parties. There is, of course, the option of sedation, but this too is a final resort. Many patients with dementia are on a cocktail of prescription drugs and adding strong anesthetics to the mix can be very risky.  

Tips and Tricks for Dealing with Dementia Patients

Over the years, caregivers and dental specialists have come up with a wealth of different tricks and tips to try and make exams and procedures easier for dementia sufferers. They range from out of hours visits to visual distractions, singing, comfort gestures, and even bribery. Very often, the most difficult part is persuading the patient to open their mouth. They are very often fearful, frustrated, and angry, because they do not recognise the people or the environment.

They may become extremely distressed or even physically violent, but a dentist must remain calm and compassionate at all times. Whether or not a dementia patient responds aggressively to contact or the suggestion of treatment, they are still a person who needs help. And as dentistry is, first and foremost, a caring profession, there is no excuse for not providing this help when patients are most in need.

The following methods and suggestions are sometimes used to help dental examinations go more smoothly for dementia sufferers.

Checking for Aspiration Requirements

This is extremely important. If you are a dentist, you must remember to check that the patient has no extenuating aspiration requirements. As for caregivers, it is your job to provide this information when asked. If there are issues, steer clear of conventional toothpastes. Use an alcohol free CHX for immediate aftercare and then switch to an OTC mouth rinse for prolonged cleaning and routine dental care.  

Choosing an Interdental Brush Head

For some patients, the regular back and forth brushing motion is too aggressive. They may have sensitive teeth and be vulnerable to too much pressure or they may simply dislike having their mouth moved around so rapidly. If this is the case, both caregivers and dentists can swap out standard toothbrushes for interdental brush heads. These little devices do the same job, but they have a thin wiry top. This is used to gently probe between the teeth and withdraw dirt and food morsels. This type of cleaning should be followed with an alcohol free mouthwash.  

Describing Actions Out Loud

The shock of sudden movements and gestures can be hard to deal with if you have dementia. And as the most important aim is to maintain calm and carry out an exam with no stress, a dentist may have to resort to lots of clear, descriptive chatting. It can helpful to announce movements before they are made, especially when it comes to approaching direct contact with the mouth. It does not matter too much if the patient has a full grasp of why certain actions are taking place, just that they will not hurt and they are not scary.   

Smiling Wide and Staying Positive

One of the easiest ways to make a dementia patient feel more relaxed is to smile at them. And this should come easy to dentists, because they do it all day. If there is one thing that a dental specialist knows how to do, it is put a patient at ease with a grin. Maintaining a positive tone of voice, smiling often, and speaking softly can make a world of difference. As can sitting down with a caregiver prior to a scheduled exam. A committed and dedicated dental professional should be happy to talk through patient requirements before an appointment.

Assisting Elderly Patients with Mobility Issues

So, dementia is the most complex issue standing in the way of many elderly people and good dental health. But it is not the only obstacle. There are just as many elderly patients who do not visit the dentist because they suffer with mobility problems and are too proud to ask for help. They may not want to be physically helped into the surgery or they might worry about aftercare and the consequences of dental procedures.

In most cases, mobility issues can be overcome by arranging to visit these patients at home. This is usually an acceptable solution for routine examinations and appointments. It is not ideal, however, and if any kind of specialist equipment is needed (x-ray technology, for example), the patient will still need to visit the surgery. If a dental procedure is required, it can only be carried out on site for reasons of safety.

If mobility issues are the only problem, alternative transport to the surgery can be arranged or the patient could be paired up with a nurse, companion, or caregiver (if they do not already have one). In reality though, mobility restrictions often come with a deep resistance to change and a stubbornness when it comes to accepting help. There are lots of elderly patients who, when they are finally persuaded to attend appointments, decide not to cooperate.

For dentists, the objective is to remain calm and professional. They must try to relate to all patients, whether they are six years old or eighty. Visiting the dentist can be frightening no matter how old you are, after all. If you have added health complications and struggle to walk or get out of a chair, these anxieties are only going to be compounded. Fortunately, in these instances, patience does usually pay off.

Allowing Elderly Patients to Move Slowly

While it can be uniquely difficult for a dentist to see a patient in pain and not be able to proceed with routine solutions, there are situations in which slow progress is the answer. If a patient is fully aware and mentally independent, they must be permitted to move at their own pace. If there is persistent pain, but no approval for a procedure, the best course of action is to prescribe appropriate painkillers and stay in regular contact.

According to a recent study, after around 5-6 appointments, the majority of older patients (particularly those who have resisted treatment) begin to cooperate more easily. Whether this is because the chronic pain becomes too much to deal with or just because they start to trust their dentist is unclear, but it does mean that a delicate and patient approach can be effective.

And once a patient does begin to open up, essential treatment and procedures can begin. If there are regular exams and appointments, a root canal can be carried out as a way to alleviate pain and fix the problem. If fillings are needed, they can be performed quickly and efficiently, so as to minimise the amount of time spent in the chair. Ultimately, a good ‘bedside manner’ can go a long way towards helping older people open up and lose their fear of cooperating.

What a dentist absolutely should not do, whether a patient has dementia or not, is talk to them like they are a child. With dementia sufferers, particularly, this can be tricky and confusing; if you do not have much experience dealing with the condition, how do you approach it? Nevertheless, dementia or not, older patients are very aware of their status as adults and do not appreciate being talked to in a sing song tone of voice.

Building Up Trust and Familiarity

The key to encouraging any patient, young or old, to trust their dentist is consistency. The more often a person visits their local surgery, the less fear it will hold for them. So, keeping up with regular exams and appointments is vital. Once a personal rapport has been established, it should be easier to talk to patients about their needs and convince them of the necessity of invasive treatments, where required.

As already mentioned, the patience plays off. Every day, dentists across America are helping older people to get their smiles back. There are lots of elderly individuals who have suffered in silence with tooth decay and degenerative tooth loss and they assume that the issue has no solution. Most are amazed and delighted when a dentist takes the time to show them exactly how much can be done to repair their teeth.

From crowns to bridgework and dentures, modern dentistry can achieve remarkable things. It just takes a little time to show older patients why the procedures are worth the trouble. Like many medical processes, it relies on a skilful combination of professionalism, dental talent, human compassion, and that most vital of elements – care. It is high time that the dental industry, in its entirety, began to look at older patients as a very unique, but ultimately rewarding, set of challenges.  

And, of course, an appreciation for what carers and relatives go through is necessary too, particularly in cases where a patient has dementia. These are the people that a dentist must look to for advice and direction, even as they are being consulted for their own expertise. With more training and a specialised focus on geriatric dentistry, the dentists of the future will hopefully be more equipped to treat patients of all shapes, sizes, backgrounds, and age groups.  

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