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Preparing Patients for Future Oral Healthcare Decline.
Elderly dental patients typically are challenging to treat due to their poor cognitive skills and manual dexterity. Older patients need treatment-planning strategies specific to their individual needs.

Prepare for the Future:  Patient Education

The discussion needs to begin with the 50-60 year old patient regarding the need to prepare their mouths for the future assault that aging brings.  Like their physicians do, a dental plan of action should be established.

There are a number of issues that pre-retirement patients should be aware of, such as dry mouth secondary to medications.  The dental plan should address both the financial and treatment planning arrangements in anticipation of future challenges.  This plan needs to protect the teeth from dry mouth and resultant root caries, maximizing the patient’s individual insurance benefit.
Routine care for the elderly is critical.  Some even benefit from a 3-4 month cleaning schedule.  Daily use of fluoride may also be recommended.

There are a number of common myths in our culture about aging teeth that should be discussed:
  • If there is no pain, there is no tooth problem
  • Teeth become softer with age and are more susceptible to decay
  • Tooth loss is a normal part of aging
  • If bleeding occus with brushing, stop immediately
  • Teeth are not as important for an older person since they prefer to eat soft foods
  • Dentures, just like real teeth, stay in the mouth 24/7
  • Dentures are a great alternative to real teeth—simpler to clean, more cost-effective, and easier to function
Dental treatment planning for the future decline should start in the 50’s, 60’s, and 70’s.  Dental restorations should be designed to withstand the lack of oral care that commonly occurs as a result of the aging process.  Fillings and crowns need to be easy to keep clean.  Extraction and implant placement should be considered in situations where there is a guarded prognosis.  Treatment planning should provide for implant retained lower dentures to allow proper nutrition and bone preservation and help prevent ill-fitting dentures from rubbing ulcers.  This level of care needs to be completed when the patients are healthy and able to receive the care.

Focus on Prevention
Most of the dental care needed by the elderly is long-term care facilities (LTCFs) is not provided by a dentist.  A recommended protocol is outlined below:

Daily Oral Care
  1. Every resident should have a daily oral care plan
  2. Supervised tooth-brushing should occur twice daily-after breakfast and before bedtime—with a regular toothbrush and fluoride toothpaste, not a toothette or sponge.
  3. An accountability system with regular evaluation should be established.
  4. Yearly oral health education of staff should be provided via inservicing
Daily Fluoride Application
  1. A decay risk assessment should be performed to determine fluoride need.
  2. An assessment of resident pharmacy formularies should be performed to determine fluoride prescription coverage and availability.
  3. Appropriate fluoride application should be administered depending on the level of decay risk: fluoride toothpaste, fluoride rinse, and fluoride gel.
  4. Staff training should occur annually for proper administration of fluoride toothpaste, fluoride rinse and fluoride gel.
Regular Professional Cleanings
  1. The last cleaning and due date for the next cleaning should be documented in the resident’s medical record upon admission.
  2. Assessment and identification of barriers to obtaining regular professional cleanings should be performed (id, funds, transportation, behavior challenges).
  3. Confirmation and documentation that the facility dental provider offers regular professional cleanings (ie, every 3-6 months) for the residents should be secured.
Dentists need to play an active role in the oral healthcare of geriatric patients, including those residing in LTCF’s.
From Compendium Feb. 2013
 
Don’t Forget To Floss.
Don't forget to floss 
by Dr. Patel

It's an activity almost no one enjoys, yet is so important when it comes to staying on top of your oral health.

Flossing:  It can be awkward, difficult, time-consuming or maybe you just don't understand the importance of it, but it's an essential part of your daily cleaning routine.

Just the Facts:  Floss at least once a day to achieve optimal oral health.  Daily flossing helps remove plaque from the areas between your teeth where the toothbrush can't reach, which is important because plaque that is not removed by brushing and flossing can eventually harden into calculus or tartar.  Flossing also helps prevent gum disease and cavities.

REMEMBER:  NOTHING ELSE YOU CAN DO TAKES THE PLACE OF FLOSSING.  NOT TOOTHPICKS, NOT CHEWING GUM, NOT EVEN MOUTHWASH.

Getting it done:  Try to make flossing a priority in your daily life.  It makes no difference when you floss--pick a time of day when you can devote an extra couple of minutes to your oral hygiene.  And it's just not adults who need to floss--children should be having their teeth flossed by an adult as soon as they have 2 teeth that touch.

Flossing should not be painful with normal, healthy gums.  You may feel discomfort when you first start flossing, but don't give up.  That discomfort should ease within a week or two.  If your pain persists, talk to your dentist.

If you find flossing difficult, consider a different flossing method.  People who have difficulty handling dental floss may prefer to use another kind of device such as a wooden plaque remover, dental pick or pre-threaded flosser.  Ask your dentist how to use them properly to avoid injuring your gums.  You may simply need to try another type of dental floss--waxed, unwaxed, thick or comfort floss.  Stick with it and you'll have adopted a health habit for life!

 
Chewing Gum Can Be Healthy For Your Teeth.
There has been evidence of improved oral health associated with chewing gum containing xylitol, twice a day for 15 minutes.  There is a a definite increase in saliva production and flow.  This increase results in lower plaque and healthier gums.  This is particularly significant for our aging population who typically experience decreased salivary production and flow.  The resultant decrease leads to increased decay and gum disease.  Chewing sugar-free gum can add to the quality of life for the aging population.
Dentistry Today-August 2012
 
Preventing Infections.

In light of recent news reports concerning a Tulsa, Okla.-based oral surgeon, the American Dental Association (ADA) understands that there may be heightened interest in infection control procedures. Regulations for dental office inspections are determined on a state by state basis by the state dental board.

The ADA has long recommended that all practicing dentists, dental team members and dental laboratories use standard precautions as described in the Centers for Disease Control and Prevention's (CDC) Infection Control in Dental Health Care Settings guidelines. Studies show that following proper infection control procedures greatly reduces risk to patients to the point of an extremely remote possibility.
Infection control procedures are designed to protect patients and health care workers by preventing the spread of diseases like hepatitis and HIV. Examples of infection control in the dental office include the use of masks, gloves, surface disinfectants and sterilizing reusable dental devices. In addition, dental health care providers are expected to follow procedures as required by the Occupational Safety and Health Administration.
Before you enter the examining room, all surfaces, such as the dental chair, dental light, instrument tray, drawer handles and counter-tops have been cleaned and decontaminated. Some offices may cover this equipment with protective covers, which are replaced after each patient.
Non-disposable items like the dental instruments are cleaned and sterilized between patients. Disposable items like needles or gauze are placed in special bags or containers for monitored, proper disposal. Infection control precautions also require all dental staff involved in patient care to use appropriate protective garb such as gloves, masks, gowns and eye-wear. After each patient, disposable wear like the gloves and masks are discarded. Before seeing the next patient, the members of the treatment team scrub their hands and put on a new pair of gloves.
Patients who have questions about infection control in the dental setting should talk with their dentists, who will be glad to explain or demonstrate their procedures.  More information on infection control in dental offices is available online athttp://www.ADA.org
Please be assured that we look at these guidelines as a minimum standard for our practice.We hold your safety and well being as paramount to how we work. We would welcome our patients to walk through with us on the various procedures we utilize in our practice.
 
Mussels Can Help With Certain Tooth Pain.
From a recent Readers Digest article-
Some tooth pain develops when the hard outer enamel wears away and exposes the softer underlying dentin, which is sensitive to stimuli such as hot and cold.  Pain-fighting toothpastes and chewing gums contain minerals that can augment enamel but don't adhere long enough to permanently rebuild it.  For a solution, Chinese scientists turned to mussels, which secrete an adhesive to attach to underwater rocks, and they created a substance with similar sticky properties.  When scientists coated worn-out teeth with the mussel-like adhesive and then soaked them in a bath of minerals, the teeth rebuilt a protective layer that simulates enamel.  This discovery lead to better products for sensitive teeth.
 
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