Every year, at this same time, patients appear with a strange affliction. You all know where I`m going with this. Typically, it starts with us asking “Is there anything we can do for you?” and getting the reply “All I Want for Christmas is my Two Front Teeth”. It`s always said with the same silly smile and with the hope that we will return with a witty answer. We just roll our eyes and try to ignore it as there is nothing we can do to help these poor people who have this seasonal disease. “Ho Ho” we say!
In reality, this is the title of a song written in 1944 by a teacher called Donald Gardner after noticing that most of his class of seven year olds were missing teeth all at the same time. These kids would now be in their seventies, and it`s made me think.
Changing dental needs of the elderly.
When I started in dentistry, most people in their seventies would have full dentures. Now, the majority of this age group have some, or all, of their teeth as we have got better at treating and preventing problems. However, this creates a whole new set of issues in continuing to treat teeth and enable oral care in people who have an increasing number of other health related problems, or are just more infirm. Dental care of the elderly is about balancing treatment of caries and periodontal problems against complicated medical conditions and multiple medications.
Although everyone is on the same continuum of age, I`ve got a few suggestions for making sure we don`t get caught out with the older age group.
We need to make sure medical histories are updated at each appointment. This is part of our responsibility anyway, but desperately important in an age group with a greater risk of changes to health and medications.
We should all know what to look out for, but have a copy of the BNF handy anyway!
It`s also important to be thoughtful about treatment planning and take into account the difficulty older people may have with transport and support. Listen to their stories and find out what their priorities are as they are bound to be different to those of a thirty year old. It`s good to listen to people, old or young, personal histories can catch you out as appearances can be deceptive. Todays `seniors` are yesterdays Mods, Rockers and Hippies!
High caries rates and are associated with age too, fuelled by exposed root surfaces and dietary changes. There is a higher chance of coming across failing multiple restorations and complicated prosthodontic needs. All things designed to make treatment planning a challenge. On these occasions, talk through the choices with thoughtfulness because you will never guess which patient will want to opt for implants and which ones will want to cut their losses and opt for dentures.
Let`s be vigilant and thoughtful this Christmas as well as the rest of the year.