Friday, July 31, 2015

Palliative Treatment for Frail and Older Adults (Article 4 of 4)

The goal of palliative treatment is to enhance the quality of life during a painful episode  or for someone with a terminal illness A dentist's role could greatly enhance patient comfort and quality of life as the mouth is often the first site on pain.

  The first step in  palliative oral care is establishing good communication with the patient. With a good understanding of the patient's health circumstance, conducting a thorough oral exam  and asking for symptoms, severity and frequency is very important to determine the most bothersome issue and dealing with it promptly.

The most common oral complaint is dry mouth  If possible increase water consumption or use ice chips if choking is not a concern.. Foam swabs are helpful with providing moisture although not effective for plaque removal.  The swabs can be soaked  in warm salt water or an alcoholfree mouth rinse prior to swabbing the inside of patient's mouth.
 Daily oral hygiene is essential with modifications as needed for the palliative patient. An ultra soft  small toothbrush head can be used to promote comfort.

Candidiasis or fungal infections are common in palliative patients.  Anti fungal gels can be applied if patient cannot rinse.  Dentures can be scrubbed with soap and water and antifungal gel applied on the under surface of denture.

Preserving dignity is important part of palliative care. Maintaining a satisfactory facial appearance may be important to some patients and dentures, if needed should be made.

This concludes the series on dental care for the older adults.  Call 909 627 6699  or visit for more information.

Friday, July 24, 2015

Treatment Planning for Frail Older Adults (Article 3 of 4)

 Treatment planning  for frail and dependent patients should meet the objectives of preventing pain and infection, maintaining function, preventing systemic complications and improving or maintaining quality of life.

Frail adults live in the community but have varying degrees of functioning limitations.Their treatment options are guided by their level of dependency- no dependency, medium dependency or high dependency status.

For medium dependency adults, the recommendation is to treat teeth conservatively. Restore carious lesions using atraumatic techniques and floride releasing restorative materials. Dentures or removable teeth replacements should be designed to facilitate hygiene and easy removal.

Dependent older adults typically live in long term care settings and are home  bound. For homebound and long term care residents, recommendations include managing discomfort and infection and performing  only procedures necessary for social interactions and normal function.

Early in the interactions with frail or dependent patients, it is important to gauge the patients ability to comprehend treatment recommendations and independently make competent decisions. Patient's financial resources, general health, cognition and  capacity for home care must be taken into account. The benefit from the proposed treatment must be weighed very carefully against the physical discomfort and mental anguish a particular patient may experience.  The focus is to address the patient's primary concern.

For more information call 909 627 6699 or visit

Friday, July 17, 2015

Prevention and Disease Management for Older Adults( Article 2 of 4)

The rapid growth of population that is 65 and older will profoundly affect dental care in a number of ways.
Risk assessment for this vulnerable group  will help develop the most appropriate prevention plan and treatment strategy.


Majority of older patients suffer from hyposalivation or Drymouth

Simple preventative remedies  to alleviate drymouth include-

Regular sips of water throughout the day
Limiting number of alcoholic beverages and beverages
Limiting beverages high in sugar and caffeine particularly sodas,juices and sweetened coffee and tea
Avoid spicy and salty foods
Caution using mouth washes containing alcohol
Using  salivary substitutes  such as Oralbalance gel, Biotene Moisturing spray, liquid mouthspray etc
In extreme cases, a salivary stimulant may be prescribed which does require consulting with patient's physician. 
Discussion with physician and or pharmacist regarding substitution of medicines causing dry mouth can also be an option.

For patients with an increased risk of caries or dental decay, an oscillating tooth brush is best.  Automated toothbrushes remove more plaque than manual brushing alone. It is particularly helpful for patients with limited dexterity and arthritis.

Use floridated toothpaste daily and floride rinses
 Periodic topical application of 5% sodium floride varnish in severe cases of caries.
  This mode is inexpensive, non invasive and shown to reduce decay.

As the old adage goes " an ounce of prevention is worth more than a pound of...."

Visit or Call 909 627 6699 to contact our office. We are more than happy to help you with your question.

Friday, July 10, 2015

Dentistry for the Elderly (1st of the series)

The aging population is the most important demographic trend.  Nearly 20% of the U S population will be older than sixty five by the year 2030.  As the age of the older adult is upon us, the services rendered should be age appropriate and have lasting value. 

Older adults have the most diverse clinical and physical presentation than any other age group. We could see fully functioning independent adults, frail older adults characterized by numerous medical conditions that impair mobility and dexterity and those who are dependent on help to carry out the normal daily activities.

.  Age is often a primary consideration when developing a treatment plan but it is important to assess each patient’s individual needs and capacities instead of relying on stereotypes of aging. 

The rapid growth of the elderly population affects dentistry in a number of ways. 
1/ the elderly are retaining teeth longer than the previous generation

        Approximately 90% of the seniors who have their natural teeth have    experienced decay with 64 % suffering from periodontal or gum disease.

2/ the body changes that occur with aging often make treatment planning more complex.

3/ medical problems and medications complicate and in some cases exacerbate dental disease.

Limitations in frail older adults create barriers to achieving and maintaining optimum oral health. 

 Visit our website or Call 909 627 -6699 for more information.

Revisit this site next week for more on prevention and disease management of this vulnerable group.