Elderly patients – engaged, motivated and committed to good oral health
Featured Products Promotional FeaturesPosted by: Dental Design 9th January 2022
Since March 2020, delivering quality dental care to the elderly has become even more of a challenge. First, there is the ongoing issue of backlog. In August, four in 10 dental surgeons predicted it will take “at least” another year to clear the backlog of patients as a result of Covid (it should be noted that a quarter of respondents said most patients on their waiting lists are children).[i]
Elderly people are among those groups who have been, and continue to be, disproportionally affected by the pandemic. How dental teams communicate with these patients, encouraging them to return to the practice if they are in pain, or when they are invited for a routine consultation, is crucial. They may be reluctant to see anyone but their regular dentist, for example, who might not be available due to extended waiting times, so every effort must be made to accommodate their needs.
However, the notion that all elderly adults are vulnerable and/or dependent must be dismissed. You will see plenty of older patients who are engaged with their oral health, and highly motivated in daily mouth hygiene. They are interested, are keen to learn and take advice on board, so they can avoid invasive treatment and retain their own teeth for as long as possible. If reduced dexterity is an issue for efficient cleaning, the market is full of products to make the job easier for them; again, good communication and relationships based on trust and loyalty are the key to successful clinical outcomes.
Elderly adults tend to present with heavily restored dentition. There may also be damage caused by invasive procedures that were standard in dentistry when they were younger, unlike modern conservative treatments that aim to preserve as much healthy tissue as possible. These patterns of restoration may lead to problems, as will years of wear and tear. Age-related salivary changes and dry mouth are a cause of caries.[ii] Caries can also be the result of gingival recession, common as we get older, which may expose the root surface.[iii]
Supporting patients through changes relating to the aging process is crucial; it’s about dignity and respect, helping them appreciate they may need a bit of extra help while 
recognising their years of commitment to maintaining their health. Other members of the dental team will be able to offer guidance with things like gentle brushing technique, how to improve their nutrition and the importance of staying hydrated as they get older.
In some cases – and despite all their hard work – endodontic therapy may be your recommendation. There are many strategic reasons to treat a tooth and save it from extraction in older people; the main one being (as in patients of every age) to improve their oral wellbeing by getting them out of pain. Also, extracting a tooth might compromise the surrounding prosthesis, hence every effort must be made to retain it. An extraction might also have a negative impact on function and/or aesthetics; never underestimate the importance of an aesthetically beautiful smile to an older patient.
If endodontic therapy is recommended as the most efficient way to restore their confidence with smiling and speaking, as well as their health, treatment planning must be thorough, covering all the alternatives as part of securing their consent. Explain that, pre-treatment, you will need to conduct tests to ascertain if there have been any age-related changes to the pulp, such as vascular and arteriosclerotic changes. Your patient must also understand their role in keeping the treatment stable, by practising elevated daily hygiene and committing to attending regular maintenance appointments.
Successful endodontics must be supported by quality products at every step; from scrupulous irrigation and debridement to canal shaping and enlargement, despite the potential for encountering more complex, challenging anatomy. The comprehensive endo range available from COLTENE covers it all, from CanalPro™ Irrigation Solutions to its HyFlex™ EDM files and the new MicroMega One RECI reciprocating file, which is very thin, yet strong and flexible for conservative endodontic treatment that preserves the healthy tooth tissue and supports a comfortable experience for all patients. The HyFlex™ EDM files and MicroMega One RECI reciprocating file can be used with the CanalPro™ Jeni, a high-tech digital solution that combines an endometer with integrated apex locator.
Treating the elderly may present challenges, but never dismiss them as vulnerable, or not as engaged with their oral health than younger patients. In fact, the reverse is often true! Elderly patients will want to keep smiling with confidence. They also want to avoid pain and the need for an extraction and are willing to elevate their daily routines to ensure the result of any treatment endures. When delivered with skill, using high-quality products, endodontics is a safe and efficient route to restoring their wellbeing, allowing them to enjoy the benefits of better health for many years to come.
Mark Allen, General Manager at COLTENE
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
[i] Four in ten dental surgeons say it will take at least a year to clear the backlog from COVID-19. Royal College of Surgeons of England, 26 August 2021. Link: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/4-in-10-dental-surgeons-say-a-year-for-backlog/ (accessed September 2021).
[ii] Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging. 2015 Feb 11; 10:461-7. doi: 10.2147/CIA.S54630. PMID: 25709420; PMCID: PMC4334280.
[iii] Clin Interv Aging. 2015 Feb 11; 10:461-7.
