disturbing to the patient. Background noise, such as radio or television, should be kept to a minimum during dental appointments. If a patient becomes uncooperative during dental treatment, exhibiting restlessness or anxiety, dental professionals should try to determine the cause. Perhaps the patient needs to use the restroom, or the patient may be hungry or just upset because her or she is in an unfamiliar environment. Involving the caregiver is often helpful. The caregiver should be allowed to accompany the patient to the dental operatory and hold his or her hand and encourage and reassure the patient during dental treatment. However, patients with moderate to severe dementia may require IV sedation for needed dental treatment to be performed.
Regarding modifications in treatment, a stepped approach is best in patients with dementia. Procedures that are least invasive should be completed first, leaving the most invasive procedures until later, if such a plan does not compromise the patient’s health or comfort. The focus of treatment in a patient with dementia should be to address the chief complaint, keep the patient pain-free, and ensure adequate nutrition. Many people who have dementia experience “sundowning,” a condition of increased agitation, confusion, anxiousness, and aggression in late afternoon and evening (Mayo Clinic, 2017). For this reason, dental appointments should be made early in the day to increase the likelihood of patient cooperation. If possible, the patient with dementia should be seen for treatment when the dental office is not busy; this will be less disorienting and
ACCESS TO DENTAL CARE AND UTILIZATION PATTERNS OF OLDER ADULTS Older adults in the United States have fewer dental visits per year on average compared to children but about the same number of visits as younger adults. In 2014, 83% of children and adolescents age 2 to 17 made a dental visit and 62% of adults age 18 to 64 made a dental visit, compared with 62.4% of adults age 65 and older (CDC, 2017a). However, there may be cognitive, functional, or transportation issues preventing many older adults from visiting the dentist. The lack of perceived need has been cited as a major barrier for older adults in seeking dental care (Bersell, 2017). Dentists themselves may have contributed to the utilization problem. For example, when delivering dentures in the past, dentists Only slightly more than half of those diagnosed with oral cancer survive for five years (Oral Cancer Foundation, 2017). Early detection is critical for improving prognosis. Inability to pay for dental care and lack of dental insurance have also been shown to be a barrier to accessing professional oral care (Yarbrough & Vujicic, 2019). Older adults are the least likely age group to have private dental insurance. Among adults aged 65-74, 34.3 % have dental insurance compared to 22.3% of those aged 75-84 and 19.9% those 85 years of age and older (Kramarow, 2019). Most elders pay for dental care out of pocket. Income
disparities have a significant influence in the ability of people 65 years of age and older to obtain dental treatment. In 2017 approximately 74% of older adults with adequate financial means had a dental visit in the last 12 months compared to only approximately 43% of older adults who were considered poor or near poor (Kramarow, 2019).
may have told older patients that they did not need to return unless something was bothering them. However, annual dental care remains of critical importance for older adults. Perhaps the most important reason for continued annual dental visits regardless of dentate status is oral cancer screening. The average age at which oral cancer is diagnosed is 63 however about 20% of the cases are diagnosed in people aged 55 or younger (Cancer.net, 2022). Conclusion As the number of older adults increases as a proportion of the U.S. population, more older adults will be seeking dental care from dental professionals than ever before. Dental academic institutions will need to provide a strong curriculum to provide their graduates with the skills and knowledge to provide appropriate care to older adult patients. The provision and coordination of interprofessional care between dentists and physicians will become The Special Care Dentistry Association (SCDA) provides resources and networking opportunities to help dental professionals improve their ability to provide oral care for special needs patients, including geriatric patients. SCDA advocates for the oral health needs of special needs patients and promotes the sharing of ideas and collaborative efforts to improve these patients’ quality of life. The association also provides a product resource guide that could prove helpful for clinicians. These resources are available at http://www.scdaonline.org/ The American Dental Association Council on Advocacy for Access and Prevention The American Dental Association Council on Advocacy for Access and Prevention (formerly the Council on Access, Prevention and Interprofessional Relations [CAPIR]) works to promote legislation and develop programs that improve Resources Special Care Dentistry Association (SCDA)
increasingly important because many older adults will present with chronic disease and polypharmacy, as well as cognitive and functional disabilities. Dental professionals who embrace the challenges of geriatric dentistry and expand their knowledge of the dental concerns common to older adults will derive satisfaction from providing needed services to this growing patient population. access to oral health services. The council, which has a special interest in vulnerable populations, including older adults, joined with the ADA’s National Elder Care Advisory Committee to publish a resource for dental professionals. This resource, titled “Paying for Dental Care: A How-To Guide (Incurred Medical Expenses),” can be accessed at http://www.ada.org/en/member-center/member-benefits/ practice-resources/paying-for-dental-care-a-how-to-guide- incurred-med The Portal of Geriatrics Online Education (POGOe) The Portal of Geriatrics Online Education (POGOe) provides free educational materials, evidence-based literature, and teaching tools for healthcare providers who deliver care for older adults. A video created by Dr. Rita Jablonski titled “Oral Hygiene and Care-Resistant Behaviors: Making a Difference” is available on POGOe at http://www.pogoe. org/productid/20998
Page 67
EliteLearning.com/Dental
Powered by FlippingBook