Adapting your care appropriately

We all grow older chronologically. It is a fact. However, there is a growing gap, in this day and age, between chronological and biological age.

Many patients who are chronologically older are physically and psychologically very young in outlook. It is our responsibility to treat all patients with the same due diligence and respect, regardless of their chronological age. We must also provide the very best care and not fob somebody off simply on the basis of age. We must find out what each patient wants and treat them as individuals.

However, with age some things do inevitably change and, as a result, we must adapt our care appropriately. This does not alter the fact that the majority of patients that I see want to keep their remaining teeth. So what are the challenges we face?

Firstly, disease is often more advanced. Periodontal disease is not an age related phenomenon as such. It is just that the disease has had longer to advance. In my experience, many such patients have also delayed seeking care because they still have fears dating back to the good old days of dentistry when they were gassed and had their teeth ripped out. Is that just my observation?

Older patients have more chronic medical diseases, such as heart disease, that may influence our treatment decisions. Some may be unable to manage long periods of time in the dental chair, if they can actually get to the practice in the first place. Mobility is often an issue with some patients being unable or incapable of driving.

They are also often on long-term drug therapy involving numerous medications. One of the major side effects is xerostomia, this also being related to the reduction in the number of salivary acini. Xerostomia makes patients more susceptible to caries, and root caries in the presence of attachment loss can be a particular problem. Caries preventative advice is crucial in periodontal patients. I am aware of reports that xerostomia reduces periodontal prognosis but I am not entirely convinced of this yet.

Other medical problems include prolonged bleeding (particularly in patients on anti-clotting agents or those with reduced liver function) and altered drug metabolism caused by reduced renal and hepatic function.

Eyesight and hearing abilities reduce with age. We must therefore cater to the fact that we have to be more careful and appropriate in the way that we consent our older patients so that they fully understand the consequences of periodontal care.

Dexterity, particularly in arthritic patients, will reduce oral hygiene results. The advent of power brushes and the appropriate use of mouthwashes are ways that have helped us to partially overcome this issue.

We must constantly be adapting our approaches to periodontal care as time passes, so that each patient has a level of care appropriate to their needs and desires. Perhaps treating the elderly patient as a concept should be retired and simply be called ‘patient specific care’. Food for thought.

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