Abstract
This retrospective study analyzes indications for house calls by dentists in a domiciliary setting. Its database consists in 69 visits made by a dentist office in Munich from 1998 to 2013 at the homes of 29 non-institutionalized seniors (≥62 years old, 15 females, 14 males, average age 83.7 years old). The analysis focused on the patients’ general state of health, their dental and oral health, the kinds of dental treatments administered, as well as economic aspects and the quantitative development in the frequency of house calls during the study period. The most frequent pre-existing conditions that made a house call necessary were cardiovascular illnesses (60%) and dementia diseases (36%). Multi-morbidity, dependency on care, accessibility issues, and frailty because of advanced age played a central role. The patients’ oral health was acceptable, with the exception of those with dementia diseases, who were more frequently toothless (40% versus 5.6%) and had a higher percentage of carious and decayed teeth (26.3% versus 10.3%). The most frequent procedures were treatments for denture sores and the repair of removable dentures (53.6%). The main focus was on reparative dentistry. The average house call took 37 minutes including travel time. Thus, the time needed was a multiple of the time necessary for treatment in the dental office. The lack of economic efficiency may be the reason why many dentists in Germany hesitate to make house calls. Despite the introduction of additional fees for the treatment of patients in need of long-term care on April 1, 2013, the number of house calls is low and increases only slowly. At the same time, the need for house calls will rise in the future due to an increasing proportion of elderly persons in the population and a decline in the percentage of toothless elderly.
Highlights
The number of seniors in need of long-term care in Germany was around 2.5 million in 2011
Dentists hesitate to make house calls with seniors firstly because of low payments in the face of high costs for running a dental office [2] and secondly because they are afraid of medical complications in the treatment of these patients [3]
Especially the elderly have a greater demand for dentist house calls because they incur a greater risk of dental diseases due to age-related physiological changes, chronic diseases, and the use of diverse medications [4]
Summary
The number of seniors in need of long-term care in Germany was around 2.5 million in 2011. Frail and functionally dependent seniors face particular difficulties in accessing dental care. Dentists hesitate to make house calls with seniors firstly because of low payments in the face of high costs for running a dental office [2] and secondly because they are afraid of medical complications in the treatment of these patients [3]. Especially the elderly have a greater demand for dentist house calls because they incur a greater risk of dental diseases due to age-related physiological changes, chronic diseases, and the use of diverse medications [4]. This need will increase further because of the demographic development and the reduction in edentulousness [5]
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