Geriatric Dentistry Research Articles

Geriatric dentistry in the next millennium: opportunities for leadership in oral health.

"The twentieth century will be remembered chiefly, not as an age of political conflicts and technical inventions, but as an age in which human society dared to think of the health of the whole human race as a practical objective." Arnold Toynbee, British historian. Individuals throughout the world often view the passage of a new year as a time for re-evaluation of personal and/or professionals goals. The new millennium offers the dental profession a chance to view the future and observe the challenges and opportunities facing it. Professor Toynbee's observation is particularly poignant when one considers the improvements in oral health made in the last 100 years. Caries, once considered a ubiquitous oral disease, has been prevented in some children in developed countries. Research on periodontal disease continues to identify risk factors and the pathobiological mechanisms underlying the disease. Concurrently the population of the world is aging presenting new opportunities for improving oral health. In this paper the data on aging, chronic diseases and oral health is largely from the US but reflects to varying degrees other industrial countries. By integrating these demographic, epidemiologic and biologic data, one can paint a portrait of the future dental patient and their oral health needs. From this portrait, dental professionals can identify leadership opportunities to improve the oral health of an aging world population.

Fundamentals of dentistry for geriatric rehabilitation--an introduction to geriatric dentistry

The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatric medicine, geriatric dentistry, and geriatric dental public health.

Teaching Program in Geriatric Dentistry at The University of Iowa

Teaching Program in Geriatric Dentistry at The University of Iowa

Geriatric Dentistry in Future

Geriatric Dentistry in Future

American Society for Geriatric Dentistry, European College of Gerodontology (ECG) and McGill University, Montreal

American Society for Geriatric Dentistry, European College of Gerodontology (ECG) and McGill University, Montreal

Doing the Right Thing: Resolving Ethical Issues in Geriatric Dental Care

This article reviews key ethical concerns facing dental professionals caring for older adults and offers guidelines for resolving them. Approaches to securing informed consent for treatment and assessing decision making capacity are discussed. Next, the question of deciding among several treatment options when patient preferences are unknown is considered. Finally, guidelines are offered on restraint use for older adults with behavioral problems.

Geriatric dentistry in long-term-care facilities: current status and future implications.

The status of oral health care of geriatric patients in long-term-care facilities is reviewed. Barriers to improving the dental management of institutionalized geriatric patients are discussed. The elderly population segment is the fastest-growing population, which presents a great burden to dental health professionals. Institutionalized geriatric patients are currently not receiving adequate care, and the number of these patients will double by the year 2020. The future implications are of considerable importance. Commitment by dental professionals to meet the oral health needs of this underserved population is key to the improvement of and change in the current status of this population.

Trends in predoctoral education in geriatric dentistry

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

高齢者歯科のこれから

It has been well recognized that geriatric dentistry will become more important in the 21st century because of the increase of the elderly population and their longevity of life. Geriatric dentistry should tackle prevention, medication, and welfare as one. The main theme of prevention is health promotion to obtain high quality of life by maintaining their own teeth and occlusion. The purpose of medication is to enhance the quality of life by repairing masticatory function and esthetics. Moreover, dentists should take part in the care for the elderly with complex medical conditions through oral health care and rehabilitation of eating. Technology assessment is one of the most useful ways to examine the quality of medicine and quality of life. In this paper, technology assessment has been performed to evaluate complete denture treatment using our original scores. The subjects were classified into two groups, one group of 28 persons (12males, 16 females, mean age 71.5 years) who were treated by complete denture treatment at the university hospital and another group of 30 (13 males, 17 females, mean age 72.3 years) who were treated by complete denture treatment at private offices in Kure City. The complete denture score was obtained by examination of quality of medicine, the chewing function and satisfaction scores of complete denture prosthesis defined treatment outcome, and the QOL score was used to identify their own quality of life. As a result, complete denture score in the group at the university hospital was significantly higher than that in the other group. Significant relationship was detected between the complete denture and satisfaction scores (p<0.01). The complete denture score was closely related to the QOL score. Under limited conditions of this study, it could be concluded that high quality of complete denture treatment enhances the edentulous patient's quality of life.

Book Review

Textbook of Geriatric Dentistry edited by Poul Holm‐Pedersen and Harald Löe published by Munksgaard

BOOK REVIEWS

Book reviewed in this article:Fundamentals of Operative Dentistry— A Contemporary Approach Richard S. Schwartz, DDS, James B. Summitt, DDS, MS, and J. William Robbins, DDS, MSClinician's Manual of Oral and Maxillofacial Surgery Paul H. Kwon and Daniel M. Laskin 2nd editionUnderstanding Orthodontics Harold T. Perry, David P. Forbes Carol StreamPractical Dentofacial Orthopedics Frans P.G.M. van der Linden“Osseointegration in Skeletal Reconstruction and Joint Replacement” Per‐Ingvar Bråemark, Bjørn Rydevik, and Richard Skalak“Textbook of Geriatric Dentistry” (2nd ed.) Poul Holm‐Pedersen and Harald Löe

Geriatric dentistry at the crossroads

Geriatric dentistry at the crossroads

Geriatric dental education and training in the United States: 1995 white paper findings.

“As the 21st century quickly approaches with an expansive geriatric population growth, are we adequately preparing health professionals to address patient needs? Will there be a shortage of competent clinicians and proficient faculty? Is there a proposed agenda to improve educational outcomes, clinical expertise, and oral health status of older adults? These and related concerns have prompted a focused geriatric education project within the United States. The Bureau of Health Professions (BHPr) of the Health Resources and Services Administration has provided the impetus and leadership through the Geriatric Education Futures Project. Dentistry is one of eleven disciplines invited to participate in this important effort which also includes medicine, nursing, social work, public health, allied and associated health, managed care, long‐term care, case management, interdisciplinary education, and ethnogeriatrics. The first two phases of this project were: 1) writing White Papers which give “a critical review of the state of the art of geriatric education, project a future response to societal need and provide policy recommendations to achieve the preferred future;” and 2) sponsoring an invitational National Forum on Geriatric Education and Training in the spring of 1995 to present, discuss, and accept the White Paper findings, as well as enlisting broader participation and support from appropriate educational institutions, professional organizations (including the American Society for Geriatric Dentistry and the American Dental Association), government agencies, foundations, consumer organisations, etc. The third phase is ongoing and includes the development of national innovative educational collaboratives, dissemination of the White Papers and related documents, and continued “catalytic activities directed toward the implementation of a national agenda for action in geriatric education.” The complete text of all discipline‐specific White Papers can be found in A National Agenda for Geriatric Education, Volume 1: White Papers1. In an effort to more extensively disseminate the findings from the Dentistry White Paper, Gerodontology is reprinting the first two‐thirds of the Dentistry White Paper which includes the state of the art in geriatric dental education and future vision needed to meet the needs of older adults, as well as summary identification of the 19 dental policy recommendations (See Table 3). Special Care in Dentistry2 has recently published the complete text of these specific recommendations including the rationale, action required, responsible agents, and expected outcomes. Although some information contained in this White Paper may be specific only to the United States, it is also apparent that much of its content has relevance to gerodontology efforts in industrialised countries throughout the world.”–Bernice A. Parlak and Susan M. Klein (see endnote)

THE WISCONSIN APPROACH TO FACULTY DEVELOPMENT IN GERIATRIC DENTISTRY

Demographic and dental trends in late 20th century America have resulted in a great demand for expertise in geriatric dentistry. In schools of dentistry, this expertise has translated into increased focus on the needs and management of the older dental patient. The goal of the dental component of the Medical College of Wisconsin Faculty Training Project in Geriatrics for Physicians and Dentists was to recruit dentists committed to the health issues of the elderly and help them to acquire the clinical, research, education, and administrative skills and knowledge necessary for careers in academic dentistry. Each trainee received advanced training in dentistry; was under the mentorship of a fellowship‐trained dentist and geriatrics‐boarded physician; and shared numerous training experiences with a physician geriatric fellow, to the enrichment of trainees of both disciplines. Clinical experiences involved lecture and seminar‐based didactics and treatment of a variety of populations in several care settings. Research experiences centered around a mentored investigation and were supplemented by course work. Education and administration learning experiences included didactics in both subjects, opportunities to plan and provide lectures to different audiences, and an administration project. Program evaluation focused on progress, process, and product assessment; the results of a competency self‐assessment instrument developed by the project's evaluators demonstrated program efficacy in all areas.

Oral health and treatment needs in a non-institutionalized elderly population: experience of a dental school associated geriatric clinic.

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.

Social problems in geriatric dentistry: an overview.

Many studies have reported on the dental status of elderly patients. The results demonstrate consistent differences between normative and perceived needs in addition to varying levels of awareness of dental education among carers. This review article attempts to integrate a range of social factors which must be considered if holistic and comprehensive care is to be delivered to elderly patients.

Standardized patients for teaching geriatric dentistry.

Effectively managing geriatric dental patients requires behavioral, communication, and assessment skills which are not easily taught or evaluated by traditional methods. Standardized patients (SPs) are persons trained to simulate real patients. The advantages of using SPs instead of real patients are that student experiences can be realistic, yet predetermined and controlled. In a program at the University of Illinois College of Dentistry, SPs are used to provide practice and to evaluate dental students regarding their performance in managing specific geriatric dental patients. In the past three years, over 1500 student-SP interactions specific to geriatric dentistry have been conducted with a wide variety of cases, including examination, diagnosis, and treatment planning. Additionally, program outcomes are discussed.

Planning oral health care for the elderly in Israel for the years 2000 and 2025.

The methodology and conclusions of this workshop are reported here because the problems requiring solution are not unique to Israel. They will increasingly have wide geographical and political application. The population of Israel since its establishment in 1948 has increased about sixfold. The numbers of the elderly (65+) have increased about tenfold. The current situation must be examined and estimates obtained for the next ten years. Only thus can the system be enabled to cope with the problem as it develops. The chosen method was a carefully preplanned, multisectorial workshop. Recommendations were discussed, amended and finalised. The recommendations of the workshop included: Baseline national data is urgently required. Guidelines are required for selecting specific target populations to which priority should be given. The current favourable situation of adequate oral health manpower in Israel makes it possible to encourage providers of oral health care towards treatment for the elderly. It is essential that the appropriate health authorities allocate sufficient funds for the following urgent purposes: the conduct of a national survey of the elderly population; the establishment of oral health units on a trial basis in some selected hospitals; support institutions of higher education to facilitate training in geriatric dentistry. CONCLUSIONS. The workshop was multidisciplinary because it was necessary to include all the expertise and experience available as vital elements of the policy making process. This type of workshop was found to be an effective tool for planning oral health services.

Oral Hygiene Awareness, Oral Health Condition and Number of Present Teeth in Elderly Outpatients in the Geriatric Dentistry of the Nippon Dental University

Oral Hygiene Awareness, Oral Health Condition and Number of Present Teeth in Elderly Outpatients in the Geriatric Dentistry of the Nippon Dental University

A controlled evaluation of computer assisted training simulations in geriatric dentistry

The increasing number of geriatric dental patients and the development of treatment plans that require consideration of complex psychosocial, socioeconomic, and medical/medication factors necessitates a change in the traditional teaching of treatment planning. A computer-assisted instructional program was developed to simulate the dentist-geriatric patient interaction and to train students in clinical decision making for the geriatric patient. This study compared the effects of this program with a more traditional approach based on readings from the geriatric dentistry literature. Twenty third-year dental students were matched on grade point average and randomly assigned to the computer or literature-based groups. They were pretested using a clinical analogue of a geriatric patient and then instructed to use either the computer or literature-based educational units. The students were then post-tested on a second clinical analogue. Students performed similarly at pretest. At post-test, both the computer and literature-based subjects were found to have acquired significantly greater evaluation points, to make fewer errors, and to design more involved treatment plans than at pretest. Comparison of computer and literature-based subjects' performance revealed no significant main or interaction effects regarding type of educational unit used. Consistent nonsignificant trends were noted with the computer-based subjects out-performing literature-based subjects on each outcome variable. In addition, the computer-based subjects had more positive feelings about the educational unit than the literature-based subjects at a statistically significant level. These findings suggest that the computer program is an effective alternative method for developing clinical decision skills in students treating geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)