Geriatric dentistry, teaching and future directions.

BACKGROUND: Many nations are facing a demographic shift in the age profile of their population, leading the World Health Organization to a 'Call for Public Health Action' on the oral health of older people. METHODS: A search of the literature relevant to geriatric dentistry teaching was undertaken using MEDLINE, Web of Science, Eric and Psychlit. A search of dental professional school websites in Australia and policy and international practice documents was undertaken. RESULTS: The international literature describes requirements for geriatric dentistry courses and various approaches to teaching, including didactic teaching, practical experiences and external placements. Challenges are identified in the area of geriatric dental education. Educational institutions (with others) have an obligation to lead change, yet there appears to be little formal recognition in Australian dental curricula of the need to develop quality education and research programmes in geriatric dentistry. CONCLUSIONS: Internationally, the inclusion of geriatrics within dental curricula has been the subject of consideration since the 1970s. The current evidence indicates that geriatrics/gerodontology is not a significant component of dental curricula. Given the projected age distribution in many countries, the need for implementation of dental curriculum content in the area of geriatrics/gerodontology is evident.

Geriatric Dentistry in the 21st Century: Environment and Opportunity.

The aging of the baby boomers in the 21st century is creating unprecedented numbers of vulnerable older adults. The increase in people keeping their teeth and their increasingly complex conditions all point to more people with more complex needs. Although these demographic shifts are providing unparalleled challenges for our health care system, they also bring new opportunities to develop and implement innovative systems for reaching and maintaining the oral health of older Americans.

Odontología siglo XXI: el odontólogo frente al envejecimiento poblacional / 21st century dentistry: the dentist facing population aging

No es nuevo hablar de envejecimiento, dado que en la historia de la humanidad siempre existieron los ancianos. Lo que sí se hace presente es una mirada diferente en relación al rol de la vejez en la sociedad, buscando una nueva identidad y descubriendo qué significa un adulto mayor en el siglo XXI. En el siglo XX surgen tres aspectos que nos llevan a comprender las transformaciones de las sociedades industriales: a) envejecimiento demográfico, b) envejecimiento humano y c) prolongación de la esperanza de vida. La transición demográfica ocasiona que el envejecimiento de una población no sea inmediato, sino diferido. El descenso de la fecundidad es el factor que, a lo largo de la transición demográfica, inicia y mantiene el incremento de la proporción de las personas mayores. El envejecimiento de la población está instalado en todos los países del mundo, con toras sus repercusiones sociosanitarias y económicas. El odontólogo, por ser parte del equipo de salud, no puede desconocerlo

Odontología siglo XXI: el odontólogo frente al envejecimiento poblacional / 21st century dentistry: the dentist facing population aging

No es nuevo hablar de envejecimiento, dado que en la historia de la humanidad siempre existieron los ancianos. Lo que sí se hace presente es una mirada diferente en relación al rol de la vejez en la sociedad, buscando una nueva identidad y descubriendo qué significa un adulto mayor en el siglo XXI. En el siglo XX surgen tres aspectos que nos llevan a comprender las transformaciones de las sociedades industriales: a) envejecimiento demográfico, b) envejecimiento humano y c) prolongación de la esperanza de vida. La transición demográfica ocasiona que el envejecimiento de una población no sea inmediato, sino diferido. El descenso de la fecundidad es el factor que, a lo largo de la transición demográfica, inicia y mantiene el incremento de la proporción de las personas mayores. El envejecimiento de la población está instalado en todos los países del mundo, con toras sus repercusiones sociosanitarias y económicas. El odontólogo, por ser parte del equipo de salud, no puede desconocerlo(AU)

Geriatric prosthodontic care.

The geriatric population (age 65 and older) is the fastest growing segment nationally and globally. The large population will continue to increase because of baby boomers that have recently turned 65 years old. Within this cohort, there is much diversity in health, socioeconomic levels, education, and health beliefs. There is a decline in edentulism yet still there are oral health conditions that persist with age, such as caries, tooth loss, and increased needs for prosthodontic dental treatment. Several factors should be taken into account in geriatric prosthodontic care, including quality of life and psychosocial needs.

Approaches to caries prevention and therapy in the elderly.

The population of the world is aging. A greater proportion of older people are retaining increasing numbers of natural teeth. Aging is associated with changes in oral architecture and muscle weakness, making personal oral hygiene more difficult, particularly for the oldest and most frail individuals. Furthermore, there is exposure of root dentin with its higher pH for demineralization in addition to enamel as a substrate for caries. Aging is also associated, for many in the developed world, with taking multiple medications, with the associated risk of dry mouth. These variables combine to increase caries risk in older vulnerable populations. Caries occurs on both the crowns of teeth (predominantly around existing restorations) and the exposed roots. Prevention needs to be aggressive to control disease in this combination of circumstances, with multiple strategies for limiting the damage associated with caries in this population. This paper explores the evidence that is available supporting preventive strategies, including fluorides in various forms, chlorhexidine, and calcium phosphate supplementation.

Geriatric dentistry--meet the need.

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an inter-disciplinary team with other health care professionals. Geriatric health is an ignored and under-explored area worldwide. Oral health reflects overall well being for the elderly population. Conversely, elderly patients are more predisposed to oral conditions due to age-related systemic diseases and functional changes. The major barriers to practising geriatric dentistry are the lack of trained faculty members, a crowded curriculum and monetary concerns. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the elderly. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, dental professionals must have a proper understanding of the magnitude of the services to be provided to the elderly. This could only be realised through an education programme in geriatric dentistry, which should be started without further delay. This article hence sets out the objectives, needs, present scenario, strategies and types of dental treatment required by the elderly population.

A pilot study: are dental hygienists in Texas ready for the elderly population explosion?

PURPOSE: At the beginning of the 20th century, people 65 and older comprised 4.1% of the population. By the year 2030, it is estimated that people 65 and older, the 'Baby Boomer' generation, will comprise more than 20% of the population. This will have a profound effect on the practice of dentistry and on society as a whole. The purpose of this study was to determine whether dental hygienists in Texas felt prepared and willing to treat the elderly in alternative practice settings such as nursing homes. METHODS: After institutional review board approval, a questionnaire was mailed to 500 hygienists. A 5% systematic sample of dental hygiene graduates was taken from four dental hygiene schools in Texas, United States of America (USA). Of these, 175 were returned for a 35% response rate. Questions asked were degree held, how prepared the participants felt to treat the special needs of the elderly, if participants were willing to work in alternative practice settings such as a nursing home and if they felt additional education was needed. Frequency distributions, correlations and chi square were used to analyse the data. RESULTS: Results revealed 86.5% of the respondents felt prepared to somewhat prepared to treat the special needs of the elderly based on education; equally, 86.5% felt more education was needed to better prepare them to treat the elderly. Over half of the respondents would not be willing to work in alternative practice settings such as nursing homes. CONCLUSION: The average respondents do not feel fully prepared to treat the elderly with special needs, and they think more education is needed to better prepare them to treat this important target population.

Uma década da Odontogeriatria brasileira / A decade of Brazilian Geriatric Dentistry

Introdução: O rápido crescimento do contingente de idosos na população brasileira é acompanhado por mudanças epidemiológicas que necessitam de especial atenção por parte dos profissionais da saúde, bem como dos setores da gestão pública. A atual condição de saúde bucal dos idosos brasileiros reflete uma somatória de crenças e valores acerca das necessidades percebidas, vividas e experimentadas por esses indivíduos ao longo de suas existências. A atenção à saúde e a qualidade dos serviços odontológicos prestados no passado também contribuíram para essa realidade. No início deste milênio, a Odontologia atentou para o fato de que a saúde bucal dos idosos requer muito mais do que domínios de técnicas e materiais.Assim, em 2001, a Odontogeriatria foi reconhecida pelo Conselho Federal de Odontologia como uma especialidade,a qual se fundamenta em razões que outrora pareciam ser desconhecidas pela maioria dos cirurgiões-dentistas. Entretanto, a quantidade de profissionais capazes de prestar atendimento odontológico adequado a essa parcela da população ainda parece inadequada. O acesso aos serviços de qualidade apresenta uma série de condicionantes que interferem de maneira direta na saúde das pessoas. Conclusão:Frente ao atual panorama de transição demográfica e epidemiológica, o presente estudo de revisão apresenta as principais características dos idosos brasileiros e a atual condição de saúde bucal desse coletivo.A estrutura em tópicos permite uma série de observações inerentes à Odontologia, aos seus profissionais e à formação e qualificação de recursos humanos em Odontogeriatria.

Introduction: The fast growth of elderly population in Brazil is followed by epidemiological changes thatneed special attention from health professionals, as well as sectors of the Government. The present conditionsof oral health of elderly in Brazil can be reflected in a sum of beliefs and values around perceived necessitiesand experienced by those individuals throughout life. The attention to health and the quality of dental servicesprovided in the past also contributed to this reality. In the beginning of this millennium, Dentistry sciencerealized that the oral health of elderly requires more than mastered techniques and materials. So, in 2001,Geriatric Dentistry was recognized by the Brazilian Federal Council of Dentistry as a specialty, based onreasons that once seemed to be unknown to dental surgeons. However, the number of professionals capableof offering the necessary treatment to this group of people still seems inadequate. The access to high-qualityservices presents a series of conditions that affect directly people´s health. Conclusion: In accordance to thecurrent demographical and epidemiological transition, this review study presents the main characteristics ofBrazilian elderly and their current oral health status. The structure in topics allows a series of inherentobservations to Dentistry, to its professionals and to the training and qualification of human resources inGeriatric Dentistry.

The older dental patient - who cares?

People in the United Kingdom are living for longer and taking their natural dentitions with them into old age. If the dental profession as a whole is to be prepared to support the care of older people, a clear understanding of what it is to be old will be needed. But with much talk of this heavy metal generation having complex restorative needs, the technical aspects of care are being emphasised. This paper suggests that there may be more basic needs to be addressed.

The development of geriatric dental education programs in Canada: an update.

The Canadian population is aging, and the oral health needs of this aging population have changed. The majority of older people are now dentate, which means that they continue to need the services of a dentist, specifically dentists who have been trained in geriatric oral health care. This paper reviews the history of geriatric training in Canada. Such training remains inadequate at both the predoctoral level and the postdoctoral or fellowship level. If geriatric or special needs dentistry were to be accepted as a specialty program, it might become more attractive as a career path for dentists.

Trends in NHS primary dental care for older people in England: implications for the future.

OBJECTIVE: To examine trends over time in the National Health Service (NHS) dental service provision for older people in England and consider the implications for future care. BACKGROUND: The number and proportion of older people in the population nationally are increasing and their oral health needs are changing as more people retain teeth into older age. MATERIALS AND METHODS: Descriptive analysis of routinely collected activity data for primary dental care in England was undertaken over the 6-year period, 1999/2000-2004/05. Data were cleaned, grouped into age bands for analysis. Activity rates per head of population were calculated for key aspects of care. Population forecasts and national survey data were used to inform future predictions of care required. RESULTS: There was an increase in absolute terms of total items (14.4%) and items per capita (10.7%) between 1999/2000 and 2004/05, with a peak of 15.7 million items claimed in 2003/04. Over the 6-year period, increases per capita were seen for dental examinations (11.3%), periodontal treatments (8.9%), fillings (1.9%), crowns (14.3%) and extractions (4.9%) amongst older people as a group. In contrast, there was a marked decrease in the episodes of care involving domiciliary care (-46.4%) and upper complete dentures (-32.9%) per capita over this period, items that were most commonly provided for the oldest age-band (85 years and over). Apart from complete dentures, the demand for care is predicted to increase. CONCLUSION: The volume of primary dental care provided for older people has been increasing at a rate which exceeds population growth, but remains low. Planners and commissioners should urgently review the provision of dental care of older people to ensure that their oral health needs are being met particularly in relation to dentures and domiciliary care.

Endodoncia en odontogeriatría: parte I / Endodontics in geriatric dentistry: part I

El envejecimiento es un fenómeno natural, inevitable y una parte intrínseca de todas las formas de vida. La expectativa de vida al nacer se incrementa tanto en Argentina como en el mundo. Esto determina una creciente longevidad de la población. En virtud de las políticas preventivas y de salud, estas personas conservan su dentición propia. Esto implica que en este grupo etario habrá un incremento de la demanda de atención odontológica y una mayor necesidad de terapias endodónticas. Para satisfacer esta demanda, el odontólogo en primer lugar debe integrar un equipo multidisciplinario con el médico de cabecera y los distintos especialistas, para poder así brindar la mejor atención. En segundo lugar debe conocer las particularidades anatómicas, fisiológicas y patológicas que se producen en la cavidad bucal y en la dentición de esas personas con el avance de la edad.

Endodoncia en odontogeriatría: parte II / Endodontics in geriatric dentistry: part II

El odontólogo debe considerar las condiciones biológicas, sistémicas, psicológicas, socioeconómicas y culturales que presentan los adultos mayores para poder ofrecerles las mejores estrategias para su atención. La terapia endodóntica de este grupo etario presenta algunas diferencias con el tratamiento de los pacientes jóvenes. Como ejemplo de esas diferencias se puede señalar que su sintomatología es menos severa, atípica y vaga. Del mismo modo, en cada etapa del tratamiento se producen diferencias específicas que se deben conocer, para poder orecer a estas personas una terapia endodóntica adecuada.