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.

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.

Trends in predoctoral education in geriatric dentistry.

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

Economic considerations in geriatric oral health care: the Canadian experience.

Two different provincial programs for geriatric oral health care are described. Their relevance to the United States requires an understanding of the universal, national hospital (1961), and medical (1971) care programs of Canada and the different sociopolitical philosophy of its people. Ontario's new geriatric preventive dentistry program provides free preventive dental services to elderly residents of collective living centers by province-wide dental public health staff. Although it covers only 7% of Ontario's older population in these centers, initiatives are underway to include other elderly persons and to provide cost subsidization for referred treatment, if required. Since 1973, Alberta has provided, through dentists and denturists in private practice, comprehensive free dental benefits to all residents over 64 years of age. About 38% of eligibles now use the plan annually. Cost escalation per dentist user has been quite modest but less so for denturist users. The future of these two models and the problems associated with them are discussed.

The role of government in financing oral health care services for the elderly.

As the elderly population in our country continues to grow, so does the need for comprehensive health care services. This article focuses on the federal government's role in financing dental health care services for the elderly.

The role of foundations.

This article discusses the function of a foundation and the role it can play in aiding the development of geriatric dentistry.

Structuring policy options in geriatric oral health care.

Efforts to contain health care costs typically affect the elderly most. Comprehensive health care for the elderly includes dental services in addition to medical care. This article discusses the factors underlying the elderly's scant utilization of dental resources and suggests several strategies which may appreciably assist the elderly in procuring such necessary services.