An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.

European College of Gerodontology: undergraduate curriculum guidelines in gerodontology.

Effective undergraduate teaching of gerodontology to present and future dental students is important if good oral health care of older people is to be assured. A review of the undergraduate curriculum for gerodontology is presented and indicates the need for a knowledge base from which new graduates can develop a special interest in care of older patients. The aim is improved care of older patients, satisfaction for teaching staff involved and improved professional standing for Dentistry. Motivation of students could also be achieved by the positive match between rising patient awareness and ethical responsibility of the profession for those older patients. As it stands, the undergraduate curriculum should include topics on specific care for the elderly and other patient groups, which extend the competences already agreed by the Association for Dental Education in Europe (ADEE). The logistics of teaching these topics will need co-ordination of those staff with appropriate skill and interest, preferably as a development of existing curriculum content.

[Aging and oral health care in The Netherlands. An explorative study]. / Vergrijzing en mondzorg in Nederland. Een verkenning.

In order to investigate which initiatives are being taken in The Netherlands to anticipate a change in oral health care demands as a result of ageing, 9 experts in the field of oral health care for the elderly were interviewed. The experts were selected because of their varied expertise and involvement in geriatric dentistry. Those interviewed were unanimous in the opinion that the demand for oral health care among the elderly will increase in the years to come. National initiatives to improve oral health care for the elderly appear to be limited. This situation can be changed by getting professional homecare more involved in oral health care for the elderly, and by regular dental checkups, stimulated by more actively operating general dental practitioners. For those in homes for the elderly and nursing homes, there appears to be no national policy with regard to oral health care. Several initiatives have been undertaken to improve dental health care, but those differ from institution to institution. According to the interviewed experts, financing, government prioritization, and health care laws are major bottlenecks on the road to the improvement of oral health care for the elderly.

Principles of geriatric dentistry and their application to the older adult with a physical disability.

The older adult living with a physical disability faces many daily challenges. Limited hand function or impaired cognition often has profound effects on activities of daily life including oral hygiene. This article explores age-related changed in dentition and common causes of pathology of the oral cavity with special emphasis in populations with impaired hand function or cognition. This article will also assist the treating physician as it relates to oral diagnosis and patient management.

[Oral health care in nursing and old people's homes and institutions for the mentally handicapped]. / Mondzorg in verpleeg- en verzorgingshuizen en instellingen voor verstandelijk gehandicapten.

Staff members and residents of nursing homes and old people's homes were interviewed about the facilities and provision of oral health care. Clinical examinations were performed to obtain data about the oral health status of the institutionalised elderly. Results show that in most cases the oral health care facilities were insufficient to give care to persons with natural teeth. Of the edentulous elderly 43% reported that the retention of the lower denture was insufficient.

Abordagem Sistemática para o atendimento odontológico em instituiçöes geriátricas / Systematic approach for dental attendance in geriatric institutions

A abordagem sistemática apresentada é um programa que propöe uma perspectiva metodológica para monitorar a saúde bucal, prevenir doenças bucais e também tratar aqueles problemas orais e dentais acumulados. O objetivo deste trabalho é propor uma metodologia para tratamento de idosos institucionalizados. O estado de saúde bucal e o estado geral, médico e comportamental dos indivíduos säo usados como indicadores de uma cronologia de atençäo primária, secundária e terciária de atendimento odontológico

Disposistivo de aislamiento absoluto flexible y descartable: dique de goma monoblock / Flexible and disposable absolute isolation device: monoblock rubber dam

Se presenta un prototipo de dique de goma compuesto por una hoja de goma dique adherida entre dos aros de goma sintética, para constituir una unidad atraumática, plegable y descartable

Disposistivo de aislamiento absoluto flexible y descartable: dique de goma monoblock / Flexible and disposable absolute isolation device: monoblock rubber dam

Se presenta un prototipo de dique de goma compuesto por una hoja de goma dique adherida entre dos aros de goma sintética, para constituir una unidad atraumática, plegable y descartable (AU)

Practice guidelines and quality: is there a connection?

Yes! Practice guidelines are clearly connected to quality. To characterize that connection adequately, however, is a more formidable task and is the subject of this paper. This paper will capture, in a few words, the essence of my perspective and experience related to quality issues and then attempt to establish a connection between practice guidelines and quality from two perspectives: first, by suggesting a series of assumptions that would lead to a decision on what should be the focus of an appropriate guideline for an older adult, since there are many possibilities and agreeing on assumptions is a logical first step; and second, by suggesting a framework for the content of such guidelines.

Consideraciones geriátricas en periodoncia / Geriatric considerations in periodontics

El consenso de opiniones profesionales es que el paciente geriátrico con pérdida moderada de hueso alveolar tiene un mejor pronóstico que el paciente más joven con la misma cantidad de destrucción gingival y ósea, y además que aunque existan cambios anatómicos y fisiológicos en el periodoncio que envejece, el significado clínico de estos cambios es desconocido. Los pacientes geriátricos presentan varios grados de complicación periodontal. Muchos pueden ser tratados con sólo cuidados caseros y alisamiento radicular, casos tipo I y II (gingivitis e inicio de periodontitis). La mayoría de casos parece que pertenecen a periodontitis moderada, casos tipo II a III (inicio de periodontitis a periodontitis moderada), en los que las instrucciones en cuidados caseros, la fase inicial de preparación y algunas correcciones quirúrgicas necesitan ser realizadas para controlar la enfermedad periodontal. Un pequeño porcentaje de pacientes de edad, se presentan con periodontitis avanzada y gran movilidad dental, casos tipo IV (periodontitis avanzada). Algunos de estos dientes no tienen esperanza de conservación, mientras que otros requieren el tratamiento combinado periodontal restaurador. Muchos de los pacientes geriátricos se presentan con dientes fracturados, ya sea por la presencia de restauraciones previamente existentes y/o debido al incremento de la fragilidad de esas piezas dentarias. Habrá necesidad de realizar procedimientos quirúrgicos de alargamiento de la corona. Se ha observado clinicamente que la cicatrización postquirúrgica es similar a la de otros grupos de edades, y en algunos casos parece tener una naturaleza más rápida. Hay una especulación con respecto a estos pacientes, en el sentido que no tienen horario o actividades de tensión, no trabajos estresantes, no han sido fumadores exagerados; todo esto puede influenciar en la respuesta de cicatrización periodontal; estos individuos son sobrevivientes tanto en su salud general como en su dentición remanente. Los pacientes geriátricos tienen el tiempo para ser sometidos a terapia periodontal y pueden tener los medios económicos para soportar un tratamiento moderado a extenso

Meeting the oral health needs of institutionalized elderly.

Numerous impairments cause suffering to the institutionalized elderly person. The medically compromised or severely demented patient, especially one with swallowing difficulties, presents a challenge to the dental practitioner. This paper summarizes typical geriatric dental problems that caregivers in a long-term care (LTC) facility should find recognizable. It also describes palliative and preventive treatment modalities that help improve the quality of life for such institutionalized patients.