In the future, dentists will have to treat more and more elderly patients in their daily practice. Thanks to successful prophylactic efforts of our days, they will enjoy quite good oral health, but they will also suffer from restrictions and illnesses that come with old age. It is important to adapt to this growing group of patients in good time. The author of the following article would like to support the dentist in this and describes what new treatment concepts and age-appropriate practice procedures could look like.
Preventive efforts in dentistry have become more and more important since the 80s and have improved the dental and oral health of the population. Even in the 1970s, therapies were mainly symptom-related, and in very few cases preventive. Dentistry was primarily concerned with the treatment of caries and its consequences – filling and extraction therapies were in the foreground. As a result of this approach, the majority of people over 60 years of age had to be fitted with prostheses: initially with rather simple total or partial prostheses using the model casting method, also in combination with crowns or plastic prostheses with simple clamp constructions. With the prosthetic judgement in 1972 – every person with statutory health insurance was entitled to full reimbursement for prosthetic measures – more complex restorations were created and the number of crowns and bridges increased, which was associated with enormous costs for the health insurance companies. Prophylaxis did not become an important concept until the 1980s; it was only in the middle of the decade that it was officially introduced into the Social Code. This was also associated with greater attention being paid to periodontology at universities and in practice. The establishment of recall systems made it possible to avoid illnesses at an early stage and to preserve teeth and dental prostheses in the long term through regular practice visits. Individual prophylaxis and group prophylaxis supplemented the dental prevention concept. And in the following decades it became apparent that prophylaxis pays off. Systematic prophylaxis was particularly successful in the area of child and youth dental care. The DMFT value in the group of 12-year-old children fell from 4.8 teeth in 1980 to only one tooth in 20041. The individual performance statistics for Conservative Dentistry in the KZBV Yearbook 2005 showed a decline in fillings of 3.7% per patient in 2004 compared with 2003 (for primary and substitute health insurance funds). In the period from 1970 to 2004, fillings fell by a total of 38% and extractions by around 50%. This trend towards healthier teeth and lower demand was also noticeable in prosthetics: Between 1997 and 2004, the number of single crowns fell by 14%, the number of bridges by 26% and the number of partial dentures by 3%.
More seniors in the future
The significantly improved general oral health today suggests that the care needs of future seniors are likely to change. It is important for the dentist to take a closer look at this because the number of seniors in his practice will increase. The number of over 60-year-olds will double between 1970 and 2050, while the number of 0-20-year-olds will halve by 1.2 . With regard to care statistics, a shift of medical or dental care from the practice to the home area is in the offing 7.8 . In Germany, for example, there are currently around 2.13 million people in need of care; of these, around 670,000 are in nursing homes and 1.45 million in private homes. As a rule, this group of people does not receive sufficient dental care. The dentist should adjust to the increased and changed dental care needs of senior citizens today and develop new concepts. For the everyday practice the increased number of seniors means a higher expenditure of time in the anamnesis. Many elderly patients take medication for cerebral disorders, antihypertensive drugs, antiarrhythmic drugs, antidepressants, anticoagulants and antidiabetics. Patients over 65 require on average seven drugs and more than 14 per day.
- “alt=”Improvement of prosthetic hygiene in residents of nursing homes for the elderly through professional oral hygiene instruction (Source: Prof. Dr. Petra Scheutzel, Dr. Tanja Heilf, University of Münster: Annual Meeting of AG Alters- und Behindertenzahnheilkunde: Tipps und Tricks im Umgang mit dementen Patienten; zm 98. Nr. 14, 16.7.2008, (2019)” origsrc=”https://www.zmk-aktuell.en/specialist/general dentistry/story/typo3temp/GB/72cc890b56.jpg” style=”cursor:pointer;”>Improvement of prosthesis hygiene for residents of nursing homes through professional oral hygiene instruction (Source: Prof. Dr. Dr. H. H. H., University of Freiburg, Germany). Dr. Petra Scheutzel, Dr. Tanja Heilf, University of Münster: Annual conference of the AG Alters- und Behindertenzahnheilkunde: Tipps und Tricks im Umgang mit dementen Patienten; zm 98. Nr. 14, 16.7.2008, (2019).
Classification into different groups
In order to do elderly patients justice in everyday practice and to offer them adequate preventive care, it is advisable to use a simple classification according to their oral hygiene skills 3 :
Group I: Patients without limited oral hygiene ability – tooth and denture care can be performed independently. – Motivation and professional instructions are implemented.
Group II: Patients with slightly restricted oral hygiene ability – Need special aids for oral hygiene, such as handle reinforcements, magnifying glasses and cosmetic mirrors – Control of oral hygiene and prosthesis cleaning by trained nursing staff and contact persons.
Group III: Strongly impaired oral hygiene ability – Need constant help from nurses for dental, oral and denture care and personal hygiene from nurses and contact persons.
Group IV: patients no longer capable of oral hygiene – nursing staff must carry out oral and prosthetic care. – Close cooperation between dentist and nurse is necessary, especially if teeth are still present.
The dentist should order all these patients at least twice a year and carry out a professional tooth and/or denture cleaning. A further possible classification, which is helpful in everyday practice life, is based on the mobility and independence of the patients. We distinguish between Go-Gos, Slow-Gos and No-Gos.
Go-Gos- For the practitioner more or less without complications. – As a rule, patients are self-determined and responsible. A therapy can be entered into and carried out without the consent of a caregiver. – In practice, no special precautions have to be taken. – Patients appear for recall and are appropriately integrated into continuous prophylaxis. – An independent, qualitatively acceptable oral hygiene is given.
Slow-Gos- Are limited in their mobility. They find it difficult to make a practice visit. As a rule there are severe walking disabilities (wheelchair user, rollator). – In addition to motor impairments, there are often mental impairments of varying quality. Patients are dependent on outside help. – Treatment without the consent of a caregiver is sometimes no longer possible. Here it is important to clarify in advance who agrees to treatment and who bears the costs. – There are clear deficits in oral hygiene and the ability to take care of oral hygiene is reduced due to limited sensory, motor and cognitive abilities. – There is a general willingness to cooperate. These patients need to be addressed intensively in terms of communication. Questions and explanations must be repeated. This is crucial for feedback and a trouble-free course of treatment.
No-Gos patients who can no longer leave their home environment or care facility. They are dependent on the help of third parties. – Often third parties also regulate legal matters. This means that treatment can only take place after consultation with the caregiver. Home visits must be coordinated and the carers must be informed and instructed. In addition to physical ailments, mental ailments increasingly dominate.
More about the author: Dr. Gerhard Weitz