Gerodontology

Question 1

What % of mortality worldwide is as a result of chronic disease?

Answer 1

63%

Question 2

How can frailty with age alter a pts mastication ability?

Answer 2

1. difficulty eating hard or tough foods
2. inability to chew all types of food

Question 3

How can frailty with age alter a pts swallowing ability?

Answer 3

• decreased ability to swallow solid foods
• decreased ability to swallow liquids
• overall poor swallowing function

Question 4

How can frailty with age alter a pts oral motor skill ability?

Answer 4

• impaired tongue movement
• speech or phonatory disorder

Question 5

How can frailty with age alter a pts salivation ability?

Answer 5

hyposalivation or xerostomia

Question 6

What factors would contribute to an older person having a good quality of life?

Answer 6

• good social relationships
• maintaining social activities & retaining a role in society
• positive psychological outlook
• good health & mobility
• enjoy life & retain independence

Question 7

What factors are typically deemed important by the relatives of people receiving end of life care?

Answer 7

• cleanliness
• free of pain
• have family present
• dignity maintained

Question 8

What effectes does xerostomia have on patients?

Answer 8

Difficulty with:
- speech
- nutritional function & intake
- social interaction
- protective features of saliva lost

Question 9

Give examples of common medical concerns in older people:

Answer 9

• frailty
• polypharmacy
• continence
• falls
• bone health
• nutrition & weight loss
• dementia
• parkinsons

Question 10

What is the prevalence of older people (>65 y/o) falling per year?

Answer 10

1 in 3

Question 11

What does A.R.T dental treatment refer to?

Answer 11

Atraumatic restorative techniques
- eg spoon excavator to get rid of caries & restore with GI

Question 12

What is the prevalence of older people (>80 y/o) falling per year?

Answer 12

1 in 2

Question 13

Why do people tend to fall more as they age?

Answer 13

Intrinsic = postural hypotension

Extrinsic = trip hazards (less likely to see/save themselves)

Question 14

What are the dental implications of falls?

Answer 14

• dental trauma
• sitting pts up slowly
• manual handling

Question 15

What is the prevalence of osteoporosis at 50 years old? (approx)

Answer 15

2% (approx.)

Question 16

What is the prevalence of osteoporosis at 80 years old? (approx)

Answer 16

25%

Question 17

What is the phenotype of frail people?

Answer 17

• exhaustion
• reduced grip strength
• weight loss
• low activity
• slow gait

Question 18

What medication groups affect the function of the immune system?

Answer 18

• corticosteroids
• DMARDs
• chemotherapy
• immunomodulatory treatment

Question 19

What are some factors associated with frailty?

Answer 19

• falls
• immobility
• delirium
• incontinence
• susceptibility to side effects

Question 20

What adjustments may need to be made to pt care in patients with diabetes?

Answer 20

• large written font size
• mobility aids (if peripheral vascular disease involved)
• compromised wound healing
• difficulties with fasting before general anaesthesia

Question 21

At what HbA1c level can any type of dental treatment be carried out within dental clinic?

Answer 21

<7%

Question 22

At what HbA1c level can only emergency dental treatment be carried out within dental clinic?

Answer 22

9% (surgical procedures should be undertaken in a hospital setting)

Question 23

At what HbA1c should all procedures be postponed until glycaemic control is achieved?

Answer 23

> 12%

Question 24

What risks are associated with pts suffering from diabetes?

Answer 24

• hyperglycaemia
• hypoglycaemia
• fatigue
• increased risk of infection
• poor wound healing
• increased periodontal disease risk
• vascular complications (eg poor OH due to vision problems etc)

Question 25

What are some signs & symptoms associated with a stroke?

Answer 25

• limb weakness
• facial weakness
• slurred speech
• cranial nerve deficits
• gait disturbance
• confusion
• loss of consciousness

Question 26

What are some risk factors associated with a stroke?

Answer 26

• smoking
• alcohol
• physical inactivity
• congestive heart failure
• older age
  etc.

Question 27

How might a stroke affect dentistry?

Answer 27

• difficulty with access to care
• poor OH due to cognitive & visual/motor defects
• capacity concerns due to confusion & memory loss
• communication difficulties
• loss of protective reflexes (eg swallowing)
• care with medication prescription

Question 28

How can you improve communication with a stroke patient?

Answer 28

• don’t wear a mask
• face pt
• speak slowly
• clear & simple language

Question 29

What is aphasia?

Answer 29

Communication impairment from brain damage (ability to process language).
- Difficult with reading, writing, comprehension & expression
- Worse when tired/under pressure

Question 30

In patients with dysphagia, what management techniques can you suggest to them?

Answer 30

1. Thicken consistency of food
2. no oral feeding with NG
3. tuck chin to chest when swallowing to allow epiglottis to cover larynx
4. exercises to strengthen suprshyoid muscles

Question 31

What dental advice can you give to patients with dysphagia with regards to oral hygiene?

Answer 31

• brush teeth upright with suction
• low foaming toothpaste
• remove excess water on toothbrush
• rub toothpaste into tootbrush before use

Question 32

What are some symptoms of parkinson’s disease?

Answer 32

• dyskinesia
• bradkinesia
• akinesia
• hypominia
• shuffling gate
• resting tremor

Question 33

What dental implications are associated with Parkinson’s disease?

Answer 33

• difficulty with access to services
• xerostomia
• anxiety increases tremor
• movement, drooling & head positioning can make use of instruments hazardous