Elevating Geriatric Dentistry: Best Practices and Considerations

Geriatric dentistry stands at the intersection of precision, ethics, and patient care. In this blog, we delve into essential guidelines, separating the dos from the don’ts to aid both emerging and seasoned dental practitioners in delivering exceptional care.

Creating a Geriatric-Friendly Office (Do) [1, 2]

Accommodating Waiting Room:

• Ample & Appropriate Seating: Provide sufficient seating with arm rests and firm cushions to accommodate geriatric patients and allow patients to rise from sitting position.
• Clear Signage: Implement clear and easy-to-read signage to assist older individuals in navigating the waiting area effortlessly. Color contrast and larger font lettering.
• Adequate Lighting: Ensure well-lit spaces, even lighting without no areas of darkness and glare to enhance visibility, considering the potential vision impairments common among geriatric patients.
• Soft furnishings could reduce the way sound reverberates or bounces around the room. For example, carpets, curtains, soft decor and noise absorbent panels could provide a quite and comforting waiting room for the geriatric patients with hearing impairments.

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Friendly Staff:

• Empathetic Training: Train staff to be empathetic, fostering a compassionate approach towards geriatric patients and their unique needs.
• Patience: Emphasize the importance of patience and staff interactions, acknowledging that older individuals may require additional time and understanding.
• Knowledgeable Staff: Train your staff with comprehensive knowledge about the specific needs and challenges faced by geriatric patients, ensuring they can provide appropriate assistance.
• Mobility Awareness: Train your staff to the mobility concerns of older individuals and encourage proactive assistance when necessary to escort the patients to and from dental chair.

Do Not Ignore Cognitive Challenges (Don’t) [1, 3]

Clear and Concise Communication for Patients with Cognitive Impairments:

• Visual Aids: Utilize visual aids such as pictures, diagrams, and simple charts to enhance communication with patients experiencing cognitive impairments.
• Short Sentences: Encourage staff to use short, straightforward sentences to convey information, making it easier for patients to understand.
• Repeat and Confirm: Repeat important information and ask patients to confirm understanding to ensure clarity and reduce confusion.
• Patient’s Preferred Communication Method: Identify and use the patient’s preferred communication method, whether it’s verbal, written, or visual, to enhance comprehension.

Collaboration for Consistent Oral Care in Patients with Dementia:

• Caregiver Consultation: Engage in regular consultations with caregivers to understand the patient’s specific oral care needs and routines.
• Detailed Care Plans: Develop detailed oral care plans in collaboration with caregivers, considering any specific preferences or challenges the patient may have.
• Training for Caregivers: Provide training sessions for caregivers to ensure they are equipped with the knowledge and skills needed to maintain consistent oral care routines at home.
• Regular Updates: Maintain open communication with caregivers to receive updates on the patient’s condition and adjust oral care routines accordingly.
  

Prioritize Communication and Patient Education (Do) [1, 3]

• Prioritize strong rapport with elderly patients.
• Patience, respect, empathy, and adaptability are crucial in treating geriatric patients.
• Clearly communicate procedures, treatment options, and risks and limit the use of medical/dental jargon and technical terms.
  Encourage questions to empower and build trust.
• Use visual aids and simple diagrams for clarity.
• For visually impaired patients use clear language and verbal cues and ensure accessibility of written information with color contrasts and larger fonts.
• Face hearing impairment patients directly, speak clearly, use visual aids, gestures, and consider hearing aids. Also maintain a quite environment.
• Adapting Oral Care for Physical Limitations by modifying toothbrush handles for patients with osteoarthritis or rheumatoid arthritis with straps or grips.
• Use electronic toothbrushes with wide, gripping handles. Consider floss holders for effective cleaning between teeth.
• For denture wearing patients educate on daily brushing of the dentures with non-abrasive cleanser and yearly dental office visit for adjustments.

Do not Overlook Health History (Don’t) [4]

• Assess medical history thoroughly for conditions or medications affecting oral health and be aware of potential drug-drug interactions.
• Address dry mouth by review of medications impacting saliva production.
• Promote hydration to mitigate dry mouth and recommend saliva substitutes.
• Consider more frequent 3-4 month recall with fluoride application for patients with dry mouth or at a higher risk of decay or who may have more limited physical abilities.
• Collaborate with healthcare providers for integrated patient care (For e.g. Physicians, Psychologists, Nutritionists, and Occupational Therapist).

Embrace Technological Innovations (Do) [5, 6]

• Enhance diagnosis, treatment, and patient experience.
• Embrace digital radiography for precise imaging.
• Use intraoral scanners and cameras for improved diagnostics.
• Utilize CAD/CAM systems for enhanced precision.
• Offer dental implants to restore missing teeth.
• Offer periodontal treatment options by placing subgingival/periodontal pocket drugs (e.g. PerioChip-2.5 mg of chlorhexidine gluconate)

Do not Compromise Ethical Standards (Don’t) [7]

• Prioritize ethical integrity as the foundation of geriatric dental practice.
• Avoid overdiagnosis and unnecessary treatments.
• Uphold transparent billing practices for patient trust.
• Respect patient confidentiality, informed consent, and ethical principles.
• Avoid ageism and respect patient autonomy.
• Evaluate dementia patients’ ability to provide consent.
• Verify legal authority for medical conservatorship with caregivers if needed.

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References:

1. Aging and Dental Health. (2023, August 24) Retrieved from: https://www.ada.org/en/resources/research/science-and-research-institute/oral-health-topics/aging-and-dental-health
2. Hospital Design For Seniors (2017)
3. Smith, Tanya. Considerations for the Management of Geriatric Patients. Today’s RDH. 2022 Nov 14.
4. Treating elderly patients: Minimize risk with informed consent and updated health history (2020, May)
5. Five tech trends to watch in 2023 (2023, Jan)
6. https://www.rxlist.com/periochip-drug
7. Smith, C.S. (2022). Ethical Considerations in Geriatric Dentistry. In: Hogue, CM., Ruiz, J.G. (eds) Oral Health and Aging. Springer, Cham.