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Geriatric dentistry

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Geriatric dentistry

  1. 1. KESIHATAN PERGIGIAN WARGA EMAS DR HIRZI B KAMALUDIN KP TG TUALANG
  2. 2.  JKM • Person that is over 60 years of age (as used by UN World Assembly on Ageing in 1982 at Vienna Austria)
  3. 3.  Process of gradual maturation Constant process – growth & development of living organism Depending on genes, environment, lifestyle
  4. 4. • 65 – 74 yoYoung old • Impairment • 75 – 84 yo Old old • Disability Oldest • 85+ yo old • Handicap
  5. 5. YEAR ELDERLY POPULATION % (MILLION) 1970 0.546 5.2 1980 0.745 5.7 1991 1.032 5.9 2000 1.398 6.3 2010 2.251 7.9 2020 3.44 9.9(estimate) 2030 (UN 5.284 15estimate)
  6. 6. 1) Selangor – 334,2692) Perak – 280,1183) Johor – 278,0284) Sarawak – 211,1915) Kedah – 184,0676) Pulau Pinang – 159,2357) Sabah – 138,3868) Kelantan – 135,935 SOURCE: BANCI PENDUDUK & PERUMAHAN 2010
  7. 7. MALE FEMALE71.7 76.6 1980 – 66.4 2000 – 70.2 2020 – 77.5 SOURCE: JPM
  8. 8.  Olderwomen outnumber older men Worldwide • 2005 – 83 men for every 100 women >60 Developing countries • 2005 – 91 men for every 100 women • 2015 – 89 men for every 100 women • 2030 – 86 men for every 100 women
  9. 9.  Gerodontics Delivery of oral health care to older adults Involves diagnosing, preventing, & treating problems associated with normal ageing & age related diseases Part of interdisciplinary team with other helath care professionals
  10. 10. Functionally Functionally independent Frail elderly dependent elderly elderly• 70% • 14% • 5% & the rest• Able to get to • Chronic • homebound/ dentist conditions with institutionalised impaired mobility
  11. 11.  Seniors who have 1 or more physical/ mental disabilities Predominantly females > 75 yo Alone/ widow Dependent in ADL Incontinent Cognitively impaired Economically disadvantaged
  12. 12.  Self rated health (SRH): • 58.1% perceived themselves as having good health • Better among elderly male Functional status (dependency): • Female, young old, non Bumi, rural, no spouse (Mental Health Data 2005) Cause of death: 55 – 64 yo: neoplasm 65 – 74 yo: circulatory system 75+ yo: respiratory system
  13. 13. Socioeconomic issues -Financial -DisabilityMedical & health issues Oral health -Diseases related issues -Behaviour
  14. 14.  Poverty/ financial Older widows mostly live in poverty Primary carer of orphaned & vulnerable children = elderly Increase in per capita cost of healthcare Dependent on social care system
  15. 15.  Improved public health, sanitation Carrying diseases of middle age Cancer, CVD, neuro disorders etc Most >65yo have at least one chronic health condition (increased burden on health care system) Diagnosed, undiagnosed & misdiagnosed diseases
  16. 16.  More retaining teeth at 65 yo Remaining teeth heavily restored Increase in dental service utilisation Root caries vs. coronal caries Perio disease (change of inflammatory response with age)
  17. 17.  Understanding impact of fast growing elderly population to dental profession Patient’s expectation Cost implications: RCT vs extraction with/ without implant Medical health Post op healing & resilience Availability of appropriately trained professionals
  18. 18.  Thorough exam: soft & hard tissues incl denture Perio disease, caries & common oral health problems in elderly: be alert Oral systemic linkage Consult appropriate professionals Intercollaboration with family members & LTC staff Transdisciplinary care
  19. 19. 3keys area: 1. Patient education, carer/ family member training 2. Integration of oral health care into ADL 3. Periodic preventive professional care
  20. 20.  Diet & nutrition • Frequent sips of water Oral hygiene • Brushing teeth • Use fluoridated toothpaste • Mouthwash
  21. 21.  Denture care • Remove dentures  As often as possible during day while undergoing treatment  Before sleep  When using mouthwash  When denture is causing pain
  22. 22.  Denture care • Rinse dentures after meals with water • Brush dentures daily with soft brush & mild soap (not toothpaste) • Soak dentures with water at night or when not in use • Soak denture with vinegar & water (1:1) for 1 hr/ wk → disinfection
  23. 23. Patient’s need Beyond practitioner’s skill Appropriate referral OVERALL HEALTH
  24. 24.  DR NORJEHAN BT YAHAYA  Hospital Kuala Lumpur DR SITI ZALEHA BT HAMZAH  BDS (UWA), DClinDent (SND) (Otago)  Hospital Serdang
  25. 25. Geriatric patients with special needs is defined as • 60 years & above • Present with at least 3 of conditions as the following:-
  26. 26.  Frail & functionally dependant (rely on carers for ADL) Neurologic & cognitive impairment Communication & behavioural problem Increased chronic medical conditions incl. polypharmacy
  27. 27.  Chronic psychiatric/ psychological condition Nutritional/ swallowing problem Poor motivation towards oral health care Elderly ASA III / ASA IV Require dental tx under conscious sedation/ GA
  28. 28. • Consultation REASON FOR • Urgent treatment REFERRAL • Further managementRESPONSIBILITIES • Complete patient’s details OF REFERRING • Relevant document incl. valid OKU card/ CLINICIAN photocopy of guarantee letterRESPONSIBILITIES • Prioritising patients OF REFERRAL • Review referrals according to guidelines CENTRE • Advice for referred patient
  29. 29. Majority of elderly with a mild or moderate disability or medical condition can & should be treated in GDPNot everyone with disability requires SND, as not all disability limits oral health
  30. 30. Those that can express need & able to easily access mainstream dental services, despite disability do not need SNDSND relates to patient complexity, rather than complexity of dentistry being provided
  31. 31.  Access • No stairs (ramp/ elevator) • Safe parking Reception furniture • Not low to floor • Firm • With arms
  32. 32.  Reducing risk of fall, flooring should be • Consistent • No rugs or clutter on floor • No slippery surface Lighting to reduce age-related vision • Without glaring • Consistent level of lighting • Avoid small print • Use contrasting paper & ink colours for written material
  33. 33.  To adjust age-related hearing loss • Stand closer to patient • Remove mask • Maintain face-to-face, eye contact, eye level • Touch appropriately • Drop pitch, speak distinctively • May increase volume but do not yell • Minimise background noise • Use quiet location for interaction • Turn off any music • Turn off dental equipment whenever possible
  34. 34.  Other communication enhancement • Use titles & surnames unless asked specifically asked to use first name • Provide written instruction • Communicate with caregivers but do not ignore patient
  35. 35. Outreach dental service for those who cannot reach it themselvesIncl oral health & dental treatmentIncl residential care & nursing homes, hospitals, day centres & patient’s homesIncl preventive oral health care but not dental screening
  36. 36.  Aims: • To deliver appropriate oral healthcare to those who cannot access dental care facilities • Can be provided by primary dental care/ hospital dental service Needs: • Institutionalised elderly more likely to have poor oral health (Fiske & Griffith 2000) • Routine vs last resort
  37. 37.  Frail elderly & Functionally dependent elderly >90 yo benefits the most (Helgeson et al 2002) Use less energy to travel Younger population who are homebound
  38. 38.  Dental team Equipments Preparation Training Referral system Health & safety issues Mix & match care
  39. 39. THANK YOU

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