L1 - part 2 Flashcards
geratiac / adult patients should have tx plan based on?
OVERALL CONDITION --- NOT their age 1. psychological 2. social 3. medical condition
example - like 39 - medical condition – treated like special needs older adult
then 80’s could still hvae implants
2035?
65, 000 over 65+
2035?
65, 000 over 65+
*poverty rate by age
1960’s– poverty rate was highest in 65 year olds
as move forward – school aged kids have the highest
and GERAITRIC HAVE LOWEST NOW –> LIKELY DUE TO social secutiry, 401k’, 350b’’s etc.
median income for elder families now
more than doubled since 60’s
who would likely be most valuable on ‘team list’ in treating the geriatric patient?
nurse usually - or who takes care of them the most
- in regular - would probably be the patient - listen to their needs
‘team list’ in treating the geriatric patient?
physician dentist physician assistance nurse health aid dental assistant social worker family theraptist pharmacist patient hygenist
% edentulous in 1989? 1994? 1999? 2015? 2019?
- 5
- 2
- 9
- 8
- 3
% edentulous in 1989? 1994? 1999? 2015? 2019?
- 5
- 2
- 9
- 8
- 3
why did cement not adhere to molar?
existing decay beneath
sectioning and extracting molar and making partial
nesbit or single distal extension
remove and say – at risk for aspirtion / choking on this with a medically comprimised patient
fail in the prosthesis
short post
force of occlusion can force out
percision attachment partial? fail why
intra coronal retention on tooth with no abutment - cantilever / pontic – will rock out of mouth every time
two major quetions to ask
do you have any pain?
do you have any trouble eating?
usually if yes to one of these questions – there is a need to treat
common theme of all failures presented
poor planning
all comes down to the plan
pt missing #7
wax up
send to lab
9 fracture on crown
composite - added to it
worst case - will fail again
recurrent decay on gold crowns
not going to re- do them
used ketac molar
missing lower anteiror with decay surrounding - tx he showed
removed decay and added a tooth and bonded with ortho wire
- used a denture tooth
- took it out of occlusion
did NOT want a flipper
t had complete upper and partial lower with hader bar (30+ years old) - consider?
disability
- frailty
comorbidity
influenza rate?
increased – lead to increased in mortality rate indirectly – explained by aging us population
mortality rate in 85 vs 65-69
over 85 it is 16 greater
median length of hospital days
50-64 = 6 days
over 75 = 8 days
stress reduction protocol
morning appointment
short wait times
short appointments
nitrous oxide sedatino if appropraite
extraction of teeth in compromised pt?
requires inpatient hospitilization
high risk of complications
no extractions in compromised?
no need for hospitilization
monitor the teeth
ability to deliver a new partial denture faster
aging is part of the disease process?
MYTH
- patients do not lose teeth because of age but because of
- perio disease
- tooth loss
- tooth decay (root caries)
- xerostomia
fact about adults over the age of 65
have the LOWEST proportion of dental expenses reimbursed by private dental insurance
- only 10%
adults over 65 have HIGHEST proportion of dental expenses that are SELF PAY - 79%
compared to ALL other age groups
barriers geriatri patients face when trying to obtain health care?
access
finances
level of disability
perceive lack of need by patients (and dentists)
private practice strategy
for healthy independent older adults**
vs the reciprocal effect
esthetics
function
comfort
reciprocal effect
- strategy for treating the frail medically compromised patient that is in a long term care setting (or homebound) STARTS WITH COMFORT and function and concludes with esthetics
1. comfort
2. function
3. esthetics
function stays the same
