Everywhere you look in dental journals, you see articles on implants, cosmetic dentistry and esthetic dentistry. But no one seems to be interested in looking after the patients in long-term care homes. We have restored, crowned, and root canal filled their teeth, which are now being left unattended and susceptible to decay.
It has been shown demographically that the population is aging. The need for a greater emphasis on geriatric care can be seen in the following three case reports.
The first patient (Figs.1 and 2) was bedridden at home in the late stages of Parkinson's disease. I was asked to examine the patient because she had one tooth left in her mouth, which was sharp and causing some problems. On examination, I determined that she also had a number of root tips. The caregiver and the doctor saw the fractured right central incisor, but could not see the root tips of the left lateral, cuspid, first bicuspid, and first molar that were buried in the gingiva.
The patient was a mouth breather, which caused the oral tissues to be inflamed. In this case, we smoothed the sharp piece of the right central and provided palliative care. The patient was treated with 0.12 per cent chlorhexidine swabs in the area of her right central incisor, KY jelly for her lips, and lots of fluids. She was also prescribed an antibiotic. We will keep this patient under observation.
The second patient (Figs.3 and 4) was also homebound, and was in palliative care with cancer of the prostate that had metastasized. We were asked to examine the patient because "he has pain in his lip and in his tooth."
This patient had most of his teeth. However, because of his pain and the drugs he was taking (a hydromorphone drip Dilaulid), he was in the habit of biting his lower lip with the upper second bicuspid.
This had caused a laceration. We extracted the upper bicuspid and the laceration healed. No further treatment was administered at this time, as his condition was critical. We are maintaining him on a fluoride rinse at night and a 0.12 per cent chlorhexidine rinse twice a day.
The third patient (Figs. 5 and 6) was examined at our clinic. The patient was in her 80s. She had undergone a full mouth reconstruction many years ago, but the devastation of her bridgework was considerable. A whole abutment crown was empty where a tooth was supposed to be. This crown was anchoring a seven-unit bridge, which had a precision attachment holding a partial denture. The remaining abutments had root caries and needed repair.
We removed the decayed material in the crown and filled the crown with a flowable self-curing composite. The root tip remained in the bone. We showed the patient how to clean under the crown, but left it in place because she was too ill to undergo further surgery. The patient had a serious blood dyscrasia, which required her to receive periodic transfusions of blood to maintain her hemoglobin. We will keep her under observation.
The health of these patients' mouths was not exceptional. When people get sick, they neglect their teeth. This is only natural. However, It should be equally natural for family members, caregivers, nurses, and doctors to look in the mouths of geriatric patients to assess their unhealthy situation and seek appropriate treatment.
As dentists, we have a responsibility to educate other healthcare professionals and the general public about the oral health of geriatric patients" as well as how to assess and take care of the persistent infections that occur in the mouths of these individuals. We also have a responsibility to educate the allied medical professions about dental neglect, and its impact on the general health of their geriatric patients.
There is a tremendous need for organized dentistry and government to address the problems that exist in treating the Alzheimer patient, the elderly patient who has some form of dementia, the stroke patient who experiences some disabilities, and the cancer patient in palliative care.
We have healthy 70-year-old patients who have had all or most of their teeth restored or enhanced with fixed bridges, veneers, crowns, cosmetic restorative procedures, endodontic procedures, periodontal procedures (gingival grafts etc.), prosthetic appliances, and even orthodontics.
These patients have spent time and money to maintain and improve their oral health. But if they have a stroke, or other disabling disease, their access to quality dental care will likely be severely curtailed. They will probably be placed in a nursing home, where no one has the time or motivation to help them care for their teeth, or even to assess their oral health at admission. They eat each day, but no one is available to encourage them to follow good oral hygiene, or to take a brush to their teeth and gingiva.
We dentists, who have been well paid to restore and maintain the teeth of these patients in the past, forget or lose track of them once they are no longer able to visit our offices. Yet unless we meet our responsibility to educate the care-givers, family, and other health care professionals about the daily preventive dental care of these patients, their teeth will eventually rot in their mouths. By the time we get to see them, we will have a dilemma on our hands. It is difficult to provide restorative or corrective treatment, because these patients are very old, are often taking many medications for different ailments, and may have allergies.
Even patients who practice good oral hygiene to control calculus and plaque need to have their teeth professionally cleaned and scaled regularly. Unless you have seen it for yourself, it is hard to imagine what happens to the oral health of patients who either cannot care for their own teeth, or have no one to do it for them. Their mouths are full of plaque, calculus, inflammation, candidiasis, denture sore spots, hypertrophied tissue, loose dentures, xerostomia and even cancer.
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