Appropriate dental materials for treating elderly, infirm, institutionalized patients
The deterioration in dental health that occurs when elderly people move into institutional care can be dramatic. Good, life-long habits of dental hygiene are broken, either because the move is associated with significant new health problems, or because daily routines have been upset. Regardless of the reason, rapid development of caries and other dental problems are observed in institutionalized patients. In Norway, this group of patients is the responsibility of the public dental health service. In order to investigate the materials currently employed in the treatment of this patient category, a selection of dentists was invited to answer a two-page questionnaire.
Dentists having experience with this patient category were selected by the chief dentist in each fylke (county). The selected dentists had from 2 to 42 years’ experience with institutionalized patients. Their experience conforms to the situation generally reported: the debilitated general health of patients means examination and treatment must be performed quickly, away from the surgery, and on patients whose ability to cooperate is compromised, often quite drastically. Dentists were asked to rank diagnoses that required treatment. Secondary caries and primary root caries dominated, with prosthesis adjustment or replacement, tooth fracture and extraction variously ranked next, and with root filling rarely being undertaken.
The dentists were asked to specify their choice of materials for caries treatment and prophylaxis, for rebasing prostheses and as impression materials, and to give their reasons in each case. Ease of application under difficult circumstances was cited repeatedly. Fluoride release for inhibiting caries was mentioned by some practitioners. Glass-ionomer products dominated for restorative treatments. A clear tendency toward one product dominating within each material group indicates a general effect of centralized purchasing, with newly employed dentists conforming to established practice. Interestingly, recent graduates were significantly more likely to select prophylactic treatments of root caries.
The full report (in Norwegian) with the quantitative analysis of the replies to the questionnaire may be obtained as a download from www.niom.no/treating_elderly. The survey and its analysis were supported financially by the Norwegian Directorate of Health under project no. 2012000908.