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5 Things You Need to Know About Geriatric Dentistry

Learn how to better care for elderly patients in your practice.

August 22, 2022
Raymond Choi image
Raymond Choi, DDS

About 10,000 people in the United States turn 65 every day.¹ With the elderly population increasing day by day, the healthcare industry needs to be prepared to care for them in a meaningful way – and that includes the dental profession.

To better understand how to care for these patients, it’s important to first address why some dentists hesitate to treat them. Caring for elderly patients can be complicated. It involves patience, understanding and careful preparation. Some dentists simply do not have the capacity to treat patients in their practice who may require special accommodations like:

  • Appointment times that are extended, shortened or take place at a certain time of day
  • Caregivers present to help with communication and treatment plan retention
  • Transportation to and from appointments
  • Auditory or visual aids
  • Walker- and wheelchair-friendly operatories and waiting rooms

For dentists who are able to adjust their treatment habits and work with staff to accommodate more elderly patients, there are five helpful principles for success.

1. Start with a thorough patient assessment.

When any new patient sits in a dental chair in your office, you’re of course going to review their medical history, including what medications they’re on, what comorbidities they have and what dental treatment they have undergone in the past. While this is standard procedure for all patients, geriatric patients require a little more consideration.

A more comprehensive patient assessment can feel overwhelming at first. Ultimately, taking the time and effort to complete a thorough assessment of a geriatric patient can save you – and the patient – a lot of time and energy. The following checklist example can be useful in identifying the patient’s needs and helping pave the way for your treatment plan.

Create your own patient assessment checklist to determine which treatment path is most effective.

Assessing the patient’s current psychological, social, medical and behavioral status enables you and your staff to better judge what kind of provisions or special accommodations will be needed. Older patients in your practice may have impairments that affect their vision, hearing, motor skills, cognitive functions, or their capacity to care for themselves. By preparing accommodations for these challenges in advance and reducing stressors – such as extensive paperwork, excessive questioning or long wait times – you can create a more comfortable experience for your geriatric patients.

For dental patients who are 65 years old and older, impairments and disabilities can affect their dental care experience. By studying their medical history and completing a simple assessment, you can better meet their needs.

2. Accept that your standard treatment paths may not be appropriate for geriatric patients.

After you have assessed the patient and understand their basic needs and impairments, start a conversation. Ask the patient, and/or their caregiver, what their dental goals are. Some patients focus purely on function and speed of delivery: They want to be able to chew and speak normally as soon as possible. These types of treatment plans, however, can often clash with what is best for the patient’s overall comfort.

A patient might want implant surgery, but they are on medications that conflict with anesthetics and they have trouble keeping their jaw open for extended periods of time. Ultimately, this treatment route might not be appropriate for this type of patient.

That’s why it is always critical to consider the patient’s overall condition and ask yourself questions before you present a treatment plan:

  • Which teeth do I save and which teeth do I extract?
  • If multiple teeth are missing, where should I place the implants?
  • Does the patient absolutely need a distal extension partial denture, or can they do without?
  • Will I need to increase the frequency of maintenance or reevaluations with this patient?

Colin Milner, the founder of the International Council on Active Aging, encourages a “person-centered” approach to elder care and wellness.² This concept evolves around the idea that every individual experiences aging differently. And if the experience differs from patient to patient, we need to tailor our treatment plans to each individual.

3. Adjust your practice layout to be more senior-friendly.

The physical layout of your office space may not be friendly to geriatric patients. For example, a patient with a walker or cane could easily trip and fall on an uneven rug. Even low couches and chairs may pose problems to seniors who have trouble standing up.

Design and accessibility best practices are essential for making geriatric patients feel comfortable and safe when in your practice.

The goal is to prevent injury, improve safety, and make the patient feel valued and welcomed. The following steps will improve the mobility and comfort of senior patients.³

  • Ensure all door frames are wide enough for walkers and wheelchairs.
  • Provide plenty of seating that is not low to the ground.
  • Prevent tripping hazards by removing rugs or loose carpet shags.
  • Use masks with see-through windows for patients who are hard of hearing.
  • Minimize background noise such as music or noise machines.
  • Provide written materials in a large font for the visually impaired.
  • Mark any steps with hazard strips.
  • Offer sufficient lighting.

Providing geriatric patients with the ease and convenience of a senior-friendly practice space makes it more likely they will want to return for treatment. A welcoming atmosphere and a good first impression can also make the dental practice a safe-space for the elderly.

4. Remove the stigma of ageism in your practice.

Most dentists inherently shy away from treating geriatric patients. These barriers put up against the elderly can stem from preconceived beliefs that treating older patients might not be as productive as other patients. In reality, a census study showed that by 2030, the number of adults in the United States who are over the age of 65 will increase by more than 30%. These same adults are also responsible for purchasing or consuming 70% of all dental services. This is a compelling reason for dentists to invest in a robust elder care strategy in their practices.

Although it is true that geriatric patients need treatment plans of different priorities and more accommodating services than other patients, there is one aspect that remains the same: how they are valued as human beings. We can’t forget that our patients are real people with real struggles. All patients, no matter their age, deserve to be treated with respect, fairness, compassion and patience.

Education on this topic is a simple way we can work to remove age-related prejudice in our dental practices. A study conducted on the geriatric oral health competency among dental providers states that currently “the competency and confidence required for dentists to be able to treat older adults with multiple health conditions and using prescribed or over-the-counter medication is insufficient.”

By learning more about geriatric dentistry and the medical conditions elderly people face, you can gain the confidence to meet the needs of your patients.

5. Be open to adding new services and growing your practice.

Elderly patients’ specific dental needs can provide your practice with an unexpected growth opportunity. One opportunity for growth involves incorporating dental sleep medicine into your practice.

clinical investigation published by the Journal of the American Geriatrics Society found that 56% of Americans 65 and older have a high risk of obstructive sleep apnea (OSA). The risks associated with OSA can be serious, including heart disease, high blood pressure, type 2 diabetes and stroke. These health conditions can be addressed with dental sleep medicine.

There are a number of dental sleep appliances available that advance the mandible, thereby activating the airway muscles and ligaments to prevent the airway from collapsing. Some appliance options include:

Dental sleep appliances function as a comfortable alternative to the Continuous Positive Airway Pressure (CPAP) machine. With so many seniors facing the threats of sleep-disordered breathing, dentists have an opportunity to step in and provide help after a medical diagnosis has been confirmed.

Another growth opportunity involves incorporating small-diameter implants, or “mini” implants, into your practice. Small-diameter implants like the Inclusive® Mini Implant are ideal for geriatric patients because they:

  • Offer a minimally invasive surgical protocol
  • Allow for immediate loading when primary stability is achieved
  • Can accommodate new or existing dentures
  • Require less bone for placement, lessening the need for grafting procedures
  • Give seniors on fixed incomes an economical option for treatment
  • Provide edentulous patients with newfound comfort and confidence

Offering new products and services to your practice is a great way to increase revenue and provide patients, especially geriatric patients, with life-changing solutions.

Geriatric case example

The truth is, we’re all getting older. As the life expectancy in America increases, the healthcare system must prepare to handle the sustained need for geriatric health services. As dentists, the least we can do is provide those services to our existing and new geriatric patients. Even existing patients who are easing into that older demographic need our attention. I myself learned that lesson before I began pursuing a higher level of in-depth geriatric dental education.

For over 20 years, my patient Jan had never had a cavity. One day, she came in for a routine cleaning, and I was absolutely stunned when I examined her: 12 cavities.

I couldn’t believe it. I asked her if she had been continuing her regular brushing and flossing habits. She answered that she of course was continuing to do so. Then, I asked about new sugary foods or drinks she might have introduced since her last exam. Jan denied having made any meal changes.

Finally, I asked how she had been feeling lately and if any medical complications had arisen since we last saw her. That’s when she looked at me and mentioned a new diagnosis from her primary care physician. We talked about the challenges that come with age, and she shared the names of medications she began taking since our last exam. After researching these medications, I learned that several of them cause severe dry mouth.

That’s when I began wondering what else I needed to learn about caring for older, more vulnerable patients in my practice.

Why bother with geriatric dentistry?

Treating older, frail patients safely and effectively requires a different perspective. We can fabricate any number of excuses to avoid expending a little more effort on these types of patients.

What I’ve found throughout my personal experience with older patients in my private practice and my master’s degree program in geriatric dentistry is that these patients have the potential to refer more patients to consider your practice. When a son and daughter see their parents or grandparents being treated well in a dental practice, they’re likely to consider using that dentist for their own care. It’s also likely they will post a positive review on social media, which will encourage more people to consider your practice for themselves or an older relative of their own.

It's time to improve the level of care we provide to geriatric patients in our practices. Aging may be inevitable, but insufficient dental care for older patients doesn’t have to be. Let’s give our geriatric patients the care they deserve.

REFERENCES

  1. America Counts Staff. 2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers. 10 Dec. 2019. United States Census Bureau. Available from: https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-will-be-age-65-or-older.html
  2. Dychtwald, Ken; Morison, Robert. What retirees want: a holistic view of life’s third age. New Jersey: John Wiley & Sons, Inc; 2020. 19 p.
  3. American Dental Association. Aging and Dental Health. ADA. 9 Nov. 2021. Available from: https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health
  4. U.S. Bureau of Labor Statistics, Consumer Expenditure Survey, 2018.

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