Geriatric dentistry ppt

 Introduction
 Geriatrics as a Dental Specialty
 Geriatric Dentistry education barriers
 Geriatric Dentistry / Challenges & Opportunities
 The Geriatric Patient
 Objectives of Geriatric dental care
 The Geriatric Dentist
 Recommendations

Introduction
 An individual with the age of 60 years & over was defined as
an older person by UN World Assembly on Ageing in 1982 at
Vienna Austria
 That assembly yielded 62 points as mechanisms & policies
and defined as “Vienna International Plan of Action on
Ageing”
 That Plan of Action was the first international instrument on
ageing, & provides a basis for the formulation of policies &
programmes to address aging related needs, expectations &
challenges

Terms and Definitions
 Geriatrics is the branch of medicine that studies elderly
diseases.
 It is distinguished from Gerontology that is the study of the
social, psychological & biological aspects of aging
 The terms “geriatric dentistry” & “gerodontology” emerged
in the 1970s, with the recognized need for health care for
aging baby boomers (persons born between 1946 and 1964,
after World War II)
Kranarow et al., 2007

Importance of Geriatric Dentistry
 An estimation of 703 million persons aged ≥65 ys in the world
in 2019 & its projected to double to 1.5 billion in 2050 to
make up nearly 20% of the world’s population
UN 2019
 Poor oral hygiene & tooth loss may increase morbidity &
even mortality in the frail elderly population
Osterberg et al., 2008
 Trained general dentists in geriatric will be the key healthcare
providers for elderly population who have different levels of
dependency
Kossioni et al., 2009

Geriatrics as a Dental Specialty
As a Service
• Dental care delivery to elderly population
involving; diagnosis, prevention & treatment
of normal age-related problem & diseases as
part of an interdisciplinary team with other
health care professionals
As an Education
 that portion of the pre-doctoral dental
curriculum that deals with special
knowledge, attitudes & technical skills
required in the provision of oral health care
for elderly people‘
Holm-Pedersen et al., 2015; Mohammad 2001

 Brazil was the first country in the world to recognize &
establish the specialty of geriatric dentistry in 2001
Hebling etal., 2007
 In UK, Australia & New Zealand geriatric dentistry falls under
the ‘Special needs dentistry’;
 The specialty focusing on the prevention & management
of oral health conditions for people who have physical,
sensory, intellectual, mental, emotional or social
impairment or disability. Mostly for adults, adolescents
& therefore older people

 In 2003 both New Zealand (University of Otago) & Australia
(University of Adelaide, University of Melbourne & University
of Sydney) have established a three-year graduate programs
for a degree of Doctor of Clinical Dentistry in Special Needs
Dentistry, that includes geriatrics
Borromeo 2012
 A review commissioned for a special supplement of the
Australian Dental Journal, supported that geriatric dentistry
should be a specialty & not part of special needs dentistry
Slack-Smith et al (2015)

 The Japanese Society of Gerodontology (JSG) was created in
1986, it publishes Japanese Journal of Gerodontology
 Japan’s first Department of Geriatric Dentistry was
established at Nippon Dental University in 1987
Inaba 1988
 A Gerodontology textbook was edited & published by the JSG
in 2015 as a mandatory subject for undergraduate dental
students
 In 2014, the JSG had about 3,140 members, of which 250
were active specialists and geriatric dentistry is now a
designated specialty in Japan.
Ronald et al., 2017

 Among the German-speaking countries of Austria,
Switzerland & Germany;
 A lack of compulsory gerodontology content in the
German & Austrian dental curriculum
 Was established as a mandatory subject that is included
in the national final examinations in Switzerland
Nitschke 2013

 Generally, the guidelines of the European
College of Gerodontology (ECG) in 2009,
highlight the necessity of including
gerodontology content in all traditional subjects
to adequately preparing students for the
provision of dental treatment to senior patients
Kossioni et al., 2009

 In US, geriatrics commonly considered to be a part of ‘Special
Care Dentistry’ by the Commission on Dental Accreditation
 The Special Care Dentistry Association (SCDA) formed the
American Society of Geriatric Dentistry (ASGD) in 1965 & l
the SCDA Council of Geriatric Dentistry in 2013
 Since 1986, the Harvard School of Dental Medicine has
offered a further certified two-year study training for dentists
in the specialised care for geriatric population
 The SCDA has developed a diplomate program in geriatric
and special needs dentistry in 2004
Ettinger RL, Beck 1984

 In 2006, the US Commission on Dental Accreditation added
the following statement for a new standard on patients with
special needs, including geriatric patients:
 “Graduates must be competent in assessing the
treatment needs of patients with special needs …
patients whose medical, physical, psychological, or social
situations may make it necessary to modify normal
dental routines in order to provide dental treatment for
that individual. These individuals include, but are not
limited to, people with developmental disabilities,
complex medical problems, and significant physical
limitations”

 A study of US dental school websites by Levy et al. in
2013, found 9 postdoctoral programs that “offered a
certificate program or fellowship in geriatric oral health
Levy et al., 2013
 A more recent study found postdoctoral geriatric dentistry
programs in 12 dental schools & six medical institutions
Ronald et al., 2017

 The Royal College of Dentists of Canada does not recognise
geriatrics as one of its nine specialties
 In 1967, geriatric dentistry a part of another dental discipline’s
lecture or seminar series in the of Canadian dental curricula
Leake 2000
 In 1992, Vincent & colleagues stated that Canadian dental
schools had no specific courses in geriatric dentistry
Vincent et al., 1992
 The most recent published review by Ettinger (2010) on the
history of geriatric training in Canada, confirmed inadequate
training at both predoctoral level & the postdoctoral or
fellowship level

Geriatric Dentistry education barriers
 Ettinger specified the 3 main barriers to teaching geriatric
dentistry that relate to:
1. An overcrowded curriculum time that doesn’t allow time
for geriatric training
2. Lack of faculty positions to allow hiring of a specialist in
geriatric dentistry
3. limited number of training programs & trained personnel
worldwide, so it is hard to recruit qualified faculty to
existing positions
Ettinger 2010

Geriatric Dentistry education barriers
 Another barrier to teaching geriatric dentistry worldwide,
was recorded in other studies related to the attitude of
dental students towards elderly patients
 It is perceived that the oral health of the elderly does
not require as much attention, as they have already
enjoyed the benefits of care in their earlier years
 Unless education in care of the elderly was included, it
is difficult to change students’ attitude from neutral to
positive for better health care delivery

Development of Geriatric Dentistry Education
Challenges
1. Limited financial resources
2. Lack of trained professionals
3. Lack of interest
Opportunities
1. A multidisciplinary specialty, so its has the
ability to develop as a separate discipline
2. Its importance is being realized &
incorporated into dental curricula in
predoctoral, postdoctoral & continuing
dental education programs

The Geriatric Patient
 Generally elderly were classified according to age group in to:
I. Young-old → 65-74
II. Middle-old → 75-84
III. Oldest-old → ≥ 85
Zizza et al., 2009
 It was suggested to further categorize them into three functional
groups, based on their ability to seek dental care independently
 Classifying them allows for a more detailed & accurate analysis &
makes diagnosis & treatment planning more personalised
Ettinger & Beck 1984

I. The fit elderly or functionally independent elderly
 They function independently, can drive their
own vehicles, or use public transport
 They can receive care from their general
dentists who need to take a thorough medical
& drug history before treatment planning
 They do not receive regular prescribed
medication
 These elderly are thus not defined as having
special needs

II. The frail elderly
 They lost some of their independence, but still live
in the community with the help of family, friends
or professional support services
 Can still access general dental services, but may
need help with transport
 Their oral health require a greater understanding
of medicine & pharmacology & a careful
evaluation of their ability to tolerate dental
treatment & to maintain daily oral hygiene

II. The frail elderly
 Common conditions contributing to frailty include
Alzheimer's disease, multi-infarct cerebrovascular
disease, Parkinsonism, osteoporosis, osteoarthritis
& healed fracture events
 They may require regular prescribed drug therapy

III. The functionally dependent elderly;
 Have chronic, debilitating, physical & medical or emotional
problems or any combination that compromises their
capacity &independency thus they are homebound or
institutionalized
 Both frail elderly & functionally dependent groups are
included in the special care definition

The Geriatric Patient- The complex overlap
Socioeconomic
issues
Physiological/
Psychological/
Pharmacological
&Medical issues
Oral issues

The Geriatric Patient- SES
 There is a complex relationship between personal
socioeconomic status (SES) & oral health
Schwendicke et., al 2015; Han et al., 2015: Listl 2011
 Household income & educational level are significantly
associated with periodontitis & edentate status in elderly people
Han et al., 2015; Kim et al., 2014
 Income-related inequalities in the utilization of dental services
was reported by several elderly populations residing in 14
European countries
Listl 2011

The Geriatric Patient-
Physiological Changes
 Aging is related with a number of physiological changes
 The gastrointestinal, renal, cardiovascular, respiratory &
immune systems often decrease in efficiency impacting
the entire body including oral health
 Mobility might decrease due to physical changes such as
reduced bone, muscle mass & osteoarthritis that impact
health care utilization
 A variety of audio & visual changes such as cataracts &
hearing loss can make communication, patient education
& oral health care increasingly difficult to maintain
Ouanounou & Haas (2015); Yellowitz (2016);Chouhan et al., 2017; Tan et al 2018

Medical Conditions
 Most elderly have one or multiple chronic condition including
hypertension, arthritis, diabetes, stroke, respiratory infections,
cardiovascular & cancers.
 These conditions have oral manifestations & require
consideration before initiating any dental treatment
Long et al., 1998; WHO 2018
 Other common conditions include Dementia that is
characterized by a progressive deterioration in cognition
affecting individual’s capability to function independently & to
manage their medications, systemic conditions & oral hygiene
thus increasing their susceptibility to develop dental caries,
periodontal disease & oral infection
Razak et al., 2014; Tan et al., 2018

Pharmacological
 Most of elderly are taking prescribed or over the counter
medications
 These medication may cause a dry mouth or xerostomia &
thus affecting speak & chew ability, leading to increasing
caries rate, periodontal disease, traumatic ulcers, fungal
infections & reduces denture retention in the edentulous
patient
Wiseman 2004

Oral Health
 The links between oral diseases & general health are
multifaceted & complex
 Systemic diseases influence oral health, either directly via
pathological pathways & indirectly via disease or therapy-related
changes
 Oral health changes also have an impact on systemic health,
periodontitis has been found to be associated with higher
mortality & increased risk of numerous NCDs, such as diabetes,
cardiovascular disease, chronic renal disease, pneumonia &
gastritis
Abnet et al., 2005; Holmlund et al, 2010; Marik 2001; Ren et al., 2016; Schwahn et al., 2004

Oral Health
 Number of lost teeth has been shown to be a predictor of
cardiovascular mortality as well as reductions in quality of life
 Poor dental status with missing teeth or ill fitting dentures &
even well-fitted dentures (that are less efficient than natural
teeth in terms of chewing), push changes in diet to softer
foods
 Such foods often contain more fermentable carbohydrates,
which raise elderly’ risk to developing dental caries &
generally causing malnutrition
Vissink et al., 1996; Glick 2005; Papas et al., 1991; Mack et al., 2015

Objectives of Geriatric dental care
1. To recognize & relieve oral health issues of elderly
people
2. Restoration & preservation of function for
maintaining normal life in elderly patients
3. To maintain ideal health & function of masticatory
system by establishing adequate preventive
measures

Geriatric Dentist/ Required Competencies
knowledge
• Biology, physiology, psychology & sociology of
aging
• Pharmacology & drug interactions
• General medicine/systemic diseases
Skills
• Ability to communicate with elderly patients
& other care providers
• Diagnose treatment needs, perform
specialized procedures & plan overall
management of elderly patients
Attitude
• Empathy, understanding, caring, compassion,
respect for elderly patients & flexibility in
treatment planning
Kress &Vidmar 1985

Recomendations
Role of Dental Care Providers
 They should meet their responsibility towards elderly
patients group through participating in geriatric educational
initiatives & subscribing to related journals to effectively
treat & manage the elderly & to be aware of their special
needs
 Collaboration, communication & exchange of information
between dentists & physicians is necessary to integrate
health promotion strategies into Common risk factors
approach

Recomendations
 Using firm, standard height
chairs with arms for support
 Providing adequate lighting in
each room, to minimise any
visual disorientation or mental
confusion
 Setting up dental furniture to promote & facilitate good
communication & access, the dental room should accommodate
wheelchair patients or those who use walkers

Recomendations
 Carefully selecting & placing signs to support the
independence of the elderly patient
 Large-print leisure & oral preventive educational material
should be available for geriatric patients in the reception
room
 Portable dental equipment for providing care to the
functionally dependent elderly at home or in nursing homes

Recomendations
 Broadcasting sources such as TV & radio are of increasing
importance for spreading knowledge of oral self-care through
providing preventive oral health information for the elderly
 Articles on geriatric dentistry could be placed in senior’s
magazines & newspapers & socially circulated
Role of Media

Recomendations
Role of Government
 Governments have responsibility for
the elderly, through
 Framing a long-term care strategy to
meet the needs of the growing
number of elderly at risk particularly
for poor elderly
 Establishing a long-term care policy which meets the multiple
needs of the elderly & encourages healthy aging, independence
& autonomy of elderly
 Equitable allocation & distribution of the health care resources
 Restructuring of the health & educational systems

References
 World Assembly on Aging, & Vienna International Plan of Action on Aging. (1983). Vienna
International Plan of Action on Aging: [World Assembly on Aging, 26 July-6 August 1982, Vienna,
Austria]. New York: United Nations.
 Zizza, C., Ellison, K., & Wernette, C. (2009). Total Water Intakes of Community-Living Middle-Old and
Oldest-Old Adults. Journals of Gerontology, 64A(4), 481-486. doi:10.1093/gerona/gln045.
 Kranarow E, Lubitz J, Lentzner H, Gorina Y. Trends in the health of older Americans, 1970–2005.
Health Aff (Millwood) 2007;26(5): 1417–25.
 Ettinger RL, Beck JD. Geriatric dental curriculum and the needs of the elderly. Spec Care Dentist.
1984 Sep-Oct;4(5):207-13
 Vincent JR, Tenenbaum MP, Massicotte P. Teaching of geriatric dentistry; training of ‘‘mobile
dental service’’ dentists. J Dent 1992; 29: 15–17.
 Wyngaarden JB, Smith LH Jr. Doencas da pele. In: Cecil Tratado de Medicina Interna, 18th edicao.
Rio de Janeiro: Editora Guanabara Koogan, 1988: 2015.
 "Dental Board of Australia - Registration Standards". www.dentalboard.gov.au. Retrieved 2019-08-
19.
 "Dental Specialties". www.ada.org. Retrieved 2019-08-19.
 "Geriatric Dentistry". hsdm.harvard.edu. Retrieved 2019-08-19.
 "RCDC - Specialties". www.rcdc.ca. Retrieved 2019-08-19.
 Levy N, Goldblatt RS, Reisine S. Geriatrics education in U.S. dental schools: where do we stand, and
what improvements should be made? J Dent Educ 2013;77(10): 1270–85.
 Hebling E, Mugayar L, Dias PV. Geriatric dentistry: a new specialty in Brazil. Gerodontology
2007;24(3): 177–80.
 Mohammad A. Geriatric Dentistry: AClinical Guidebook, 2nd edn. Colum-bus, OH: Ohio State
University,2001.

References
 Borromeo GL. Workforce education: the coordination of oral health care for the elderly and the role
of the dental profession. Ann R Australas Coll Dent Surg 2012;21: 77–80.
 Ettinger RL. The development of geriatric dental educa-tion programs in Canada: an update. J Can
Dent Assoc 2010;76:1
 Ronald L. Ettinger, Zachary S. Goettsche and Fang Qian: Postdoctoral Teaching of Geriatric Dentistry
in U.S. Dental Schools. Journal of Dental Education October 2017, 81 (10) 1220-1226; DOI:
https://doi.org/10.21815/JDE.017.079
 Slack-Smith LM, Hearn L, Wilson DF, Wright FAC. Geriatric dentistry, teaching, and future directions.
Aust Dent J 2015;69(4): 419–33.
 Marchini L, Ettinger RL, Chen X, et al. A description of gerodontology education in a selection of high,
middle, and low-income countries on five continents. Unpublished manuscript.
 United Nations, Department of Economic and Social affairs, Population Division, World Population
Prospects 2019: Highlights. ST/ESA/SER.A/430.
 Leake JL. The history of dental programs for older adults. J Can Dent Assoc. 2000;66(6):316-9.
 Vincent JR, Massicotte P, Barolet RY. The teaching of geriatric dentistry in Canada. J Can Dent Assoc.
1992;58(9):731-5.
 Ettinger RL. The development of geriatric dental education programs in Canada: an update. J Can
Dent Assoc 2010;76:1.
 Nitschke, Ina; Kunze, Julia; Reiber, Thomas; Sobotta, Bernhard A J (2013). Development of
undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009.
Journal of Dental Education, 77(5):630-639.
 Eyison J, Mann J, Holtzman JM, Mersel A. A comparative study of the attitude of dental students
towards the elderly. Eur J Prosthod Restor Dent 1992; 2:87–90.

References
 Kress GD, Vidmar GC. Critical skills assessment for the treatment of geriatric patients. Spec Care Dent
1985; 5(3):127–9.
 Wiseman M. The Dentist’s Perspective, Baycrest, 2004; Volume 5.
 Long RG, Housek L, Doyle JL. Oral manifestations of systemic diseases. Mt Sinai J Med 1998; 65(5–6):
309–315.
 Glick M. Exploring our role as health care providers. J Am Dent Assoc 2005; 136(6): 716–718.
 Schwendicke F, Dörfer CE, Schlattmann P, et al. . Socioeconomic inequality and caries: a systematic
review and meta-analysis. J Dent Res 2015;94:10–18. 10.1177/0022034514557546.
 Listl S. Income-related inequalities in dental service utilization by Europeans aged 50+. J Dent Res
2011;90:717–23. 10.1177/0022034511399907.
 Han DH, Khang YH, Choi HJ. Association of parental education with tooth loss among Korean Elders.
Community Dent Oral Epidemiol 2015;43:489–99. 10.1111/cdoe.12172 .
 Kim DW, Park JC, Rim TT, et al. . Socioeconomic disparities of periodontitis in Koreans based on the
KNHANES IV. Oral Dis 2014;20:551–9. 10.1111/odi.12168.
 Ouanounou, A., & Haas, D. A. (2015). Pharmacotherapy for the elderly dental patient. J Can Dent
Assoc, 80(18).
 Yellowitz, J. A. (2016). Geriatric health and functional issues. The ADA Practical Guide to Patients with
Medical Conditions, Second Edition, 405-422.
 Tan, E. C., Lexomboon, D., Sandborgh‐Englund, G., Haasum, Y., & Johnell, K. (2018). Medications that
cause dry mouth as an adverse effect in older people: A systematic review and metaanalysis. Journal
of the American Geriatrics Society, 66(1), 76-84.
 Administration on Aging (AOA). (2014). A Profile of Older Americans: 2014. Retrieved from
https://www.acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2014-
Profile.pdf.

References
 World Health Organization. (2018). Retrieved from http://www.who.int/en/news-room/fact-
sheets/detail/ageing-and-health.
 Papas, A. S., Niessen, L. C., & Chauncey, H. H. (1991). Geriatric dentistry: aging and oral health. Mosby Year
Book.
 Vissink, A., Spijkervet, F. K. L., & Amerongen, A. V. N. (1996). Aging and saliva: a review of the literature.
Special Care in Dentistry, 16(3), 95-103.
 Abnet CC, Qiao Y-L, Dawsey SM et al. Tooth loss is associated with increased risk of total death and death
from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort. Int J
Epidemiol 2005 34:467–474.
 Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of
7,674 subjects followed for 12 years. J Periodontol 2010 81: 870–876.
 Mack F, Schwahn C, Feine JS, et al. The impact of tooth loss on general health related to quality of life
among elderly. Pomeranians: results from the study of health in Pomerania (SHIP-0). Int J Prosthodont
2005 18: 414–9.
 Marik PE. Aspiration pneumonitis and aspiration pneumonia.N Engl J Med 2001 344: 665–671.
 Ren Q, Yan X, Zhou Y et al. Periodontal therapy as adjunctive treatment for gastric Helicobacter pylori
infection. Cochrane Database of Systematic Reviews 2016: CD009477. https://doi.
org/10.1002/14651858.CD009477.pub2
 Scannapieco FA, Cantos A. Oral inflammation and infection, and chronic medical diseases: implications for
the elderly. Periodontol 2000 2016 72: 153–175.
 Schwahn C, Volzke H, Robinson DM et al. Periodontal disease, but not edentulism, is independently
associated with increased plasma fibrinogen levels. Thromb Haemost 2004 92: 244–252.
 Mack F, Schwahn C, Feine JS, et al. The impact of tooth loss on general health related to quality of life
among elderly Pomeranians: results from the study of health in Pomerania (SHIP-0). Int J Prosthodont
2005 18: 414–9.

Geriatric dentistry ppt

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Geriatric dentistry ppt

Similar to Geriatric dentistry ppt (20)

More from Ghada Elmasuri

More from Ghada Elmasuri (7)

Recently uploaded

Recently uploaded (20)

Geriatric dentistry ppt