Innovations in Geriatric Oral Health Care

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.

Oral health care practice patterns for geriatric patients: An American Dental Association Clinical Evaluators Panel Survey

BACKGROUND

The geriatric adult population is expanding rapidly in the United States, with more of these patients expected to visit the dentist in the coming years. Understanding the dental community's preparedness and comfort treating this demographic is timely.

METHODS

Survey questions were developed to assess how dentists treat geriatric patients, what challenges they face, and what tools they need to provide the best care. This set of questions was administered electronically and emailed to the American Dental Association Clinical Evaluators (ACE) Panel on March 29, 2022. After 2 weeks, the survey closed, and data were summarized descriptively.

RESULTS

Of the 269 respondents, 59% indicated that treating geriatric patients is more challenging than treating nongeriatric patients. The most frequently cited challenges include comorbidities and their management (86%), cognitive impairment (68%), and home care needs for some of these patients (69%). The top 3 symptoms seen in these patients are dry mouth (89%), carious lesions (86%), and tooth wear (75%). Seventy-six percent of respondents reported being comfortable treating this demographic, and most (58%) indicated that training as a student contributed to this competency.

CONCLUSIONS

Most respondents are comfortable treating geriatric patients, but they still face many challenges, with managing comorbidities with dental treatment a top concern.

PRACTICAL IMPLICATIONS

A sound understanding of the impact of aging and associated medical treatments on oral tissues and patient management is essential. Equally important is finding innovative ways to improve access to care for this vulnerable population.

Providing Effective Dental Care for an Ageing Population

BACKGROUND

Effective treatment produces improved outcomes from the patient and clinician perspectives. The focus of this article is effective dental care for ageing patients. This concept must be embraced through research, education and, finally, clinical care.

RESEARCH

Older adults often carry a higher burden of health and socioeconomic issues that limit their participation in clinical trials. This leaves providers to extrapolate care decisions from research in other age groups. However, electronic health records allow researchers to converge extensive medical, pharmacologic, and dental data, thereby including older patients in research questions.

EDUCATION

Dental and medical educators are tasked with teaching skills specific to ageing patients. This requires teaching and active use of concepts such as whole health and patient-centred outcomes.

PROVISION OF CARE

For ageing patients, effective care is precision care (the right care to the right patient at the right time). Clinicians must be trained and then actively participate in the interdisciplinary approach to assure good oral health for all older patients.

Policies Supporting Oral Health in Ageing Populations Are Needed Worldwide

This literature review examines the need to develop appropriate policies specific to the oral health needs of older people that are individualised, cost-effective, and sustainable. Poor oral health and impaired oral function negatively affect the health and quality of life of older adults. Developing care systems that aim to meet patients' normative needs as well as their perceived needs and expectations is one factor in successful delivery of appropriate dental care. Cost is another significant driver of utilisation, and many older adults worldwide lack adequate resources for dental care. Failure to address these issues results in poor outcomes and increased costs of dental and medical care. Disease prevention and control at early stages can preserve public and private financial resources as well as quality of life and well-being for older adults at any stage of life.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.