Geriatric Dentistry, An Emerging Speciality
“Last scene of all,
That ends this strange eventful history,
Is second childishness and mere oblivion,
Sans teeth, sans eyes, sans taste, sans everything.”
From Shakespeare’ As you Like it
People do know about Pediatric Dentistry but Geriatrics. Oh! Is It Important. Why don’t they have a specialization program in Geriatrics? Is Geriatrics more important than Pediatrics? What is the scope of the specialty and everything. These may be interesting questions to probe and Interestingly, in India and even in the United States very few dentists are specialized in Geriatrics.
The Baby Boomers are retiring and most of them need dental care and most of the time they will be coming into neglected populations, and more than that, their affordability gets affected as they retire. There are plans that the government may well scrap Social Security, of course slowly, but the dental care of baby boomers will become increasingly important. Baby Boomers' number is 80 million and the horrible thing about them is that most of them belong to the left side of the Cash Quadrant (80% of them are employees and Self Employed Professionals), most of them depend on social security benefits, and when they lose their financial ability, in a way or anther, they become both financially and physically challenged as their dentistry needs lot of care.
The incidence of Diabetes Mellitus and Hypertension is increasing at an alarming rate and America’s most performed surgical procedures continue to be Coronary Angioplasty. In such a situation, Dentistry of senior citizens must be more important but surprisingly, very few dentists stress on healing senior people. The problems of geriatrics were never a collective specialty and most of geriatrics was covered in Prosthodontics ,Oral Surgery and Periodontics. It needs effort for dental schools to incorporate geriatrics into the curriculum but unfortunately, dental school curriculum across the world is facing saturation and luckily, in United States the dental schools are at least ready to innovate.
Geriatrics and Pediatrics are so similar and, as Shakespeare famously says, Old Age is Second Childhood. Psychological evaluation of the patient is extremely important and most of the time Senior Citizens are frequently victims of Memory Loss and Alzheimer’s Disease. A lot of compassion is needed to understand their problems and ultimately, more than the dental problem, an overall evaluation of their medical health is definitely needed.
The Geriatric Dentist must work with the physician and increasing number of physicians must be motivated enough to make their patients visit a dentist. A Diabetic Patient must visit a dentist eventhough when he doesn’t have pain. He must make it a point to at least visit a dentist to get his gums evaluated. The only way dental care costs can be reduced is by regular checkups and the biggest problem for a Geriatric Dentist, as any dentist, is to motivate Old people to set foot in the dental office.
The general rules of patient management works for old people too, and understanding the past of the patient is important as most of the time old people are so receptive to talking but time must be given to make the patients open up and speak about their financial pptions. Patients should also talk more about family since, most of the time, old people are living alone. Moreover, making a point to empathize with their personal problems would be an important component for delivering geriatric care. And more importantly than treatment, maintenance would be important. And in a way Motivation is the key to success if one is dealing with Geriatric patients. Fixed Dentures, Crown Cuttings in United States and Complete Dentures and Removable Partial Dentures are common treatments performed and treatment options must be suggested based on the paying capacity of the old person.
If I have to state an example, if a retired judge who is still in practice is edentulous, and if he can afford, implants can be suggested. Keeping in line his professional ability to speak well, his annual income can be an important question to ask. And as always suggesting various options for payment could improve patient compliance and if practiced well dealing with Geriatric Patients is a win-win situation. One can make money, improve quality of dental care and, as always if used judiciously, it’s a balancing act to manage social values and money. In Some places, money is important and in some places social values are important and for one to succeed one has to balance the wheel well.
Additional Reading:
American Academy of Special Care Dentistry:
http://www.scdonline.org/displaycommon.cfm?an=7
Geriatric Dentistry in India:
http://www.geriatricdentistryindia.net/
Geriatric Dentistry in Eastern European Countries:
http://www.quintpub.com/display_detail.php3?psku=B2230
Geriatric Dentistry Course from Tufts:
http://ocw.tufts.edu/Content/18/lecturenotes/289071
Dr. Huffines, an American Dentist who practices Geriatrics:
http://geriatricdentistry.com/
Examining Baby Boomers Population in United States:
http://sparxoo.com/2010/03/02/examining-baby-boomers-stats-demographics-segments-predictions/
Home Care Dentistry:
http://www.homecaredentist.com/
About the author:
Venkatesh Chittarvu is CEO of Dental Surgery Inc and is into Dental Patient Outsourcing and Dental Office Franchising and is based Miami FL. The article is written as an initiative to improve dental care of Senior Citizens as community Initiative Program in Hyderabad, India.
