L1 - part 2

Question 1

geratiac / adult patients should have tx plan based on?

Answer 1

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

Question 2

2035?

Answer 2

65, 000 over 65+

Question 3

2035?

Answer 3

65, 000 over 65+

Question 4

*poverty rate by age

Answer 4

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.

Question 5

median income for elder families now

Answer 5

more than doubled since 60’s

Question 6

who would likely be most valuable on ‘team list’ in treating the geriatric patient?

Answer 6

nurse usually - or who takes care of them the most

• in regular - would probably be the patient - listen to their needs

Question 7

‘team list’ in treating the geriatric patient?

Answer 7

physician 
dentist
physician assistance
nurse
health aid
dental assistant 
social worker 
family 
theraptist 
pharmacist 
patient 
hygenist

Question 8

% edentulous in 1989? 1994? 1999? 2015? 2019?

Answer 8

57. 5
58. 2
59. 9
60. 8
61. 3

Question 9

% edentulous in 1989? 1994? 1999? 2015? 2019?

Answer 9

57. 5
58. 2
59. 9
60. 8
61. 3

Question 10

why did cement not adhere to molar?

Answer 10

existing decay beneath

sectioning and extracting molar and making partial

Question 11

nesbit or single distal extension

Answer 11

remove and say – at risk for aspirtion / choking on this with a medically comprimised patient

Question 12

fail in the prosthesis

Answer 12

short post

force of occlusion can force out

Question 13

percision attachment partial? fail why

Answer 13

intra coronal retention on tooth with no abutment - cantilever / pontic – will rock out of mouth every time

Question 14

two major quetions to ask

Answer 14

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

Question 15

common theme of all failures presented

Answer 15

poor planning

all comes down to the plan

Question 16

pt missing #7

Answer 16

wax up

send to lab

Question 17

9 fracture on crown

Answer 17

composite - added to it

worst case - will fail again

Question 18

recurrent decay on gold crowns

Answer 18

not going to re- do them

used ketac molar

Question 19

missing lower anteiror with decay surrounding - tx he showed

Answer 19

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

Question 20

t had complete upper and partial lower with hader bar (30+ years old) - consider?

Answer 20

disability
- frailty
comorbidity

Question 21

influenza rate?

Answer 21

increased – lead to increased in mortality rate indirectly – explained by aging us population

Question 22

mortality rate in 85 vs 65-69

Answer 22

over 85 it is 16 greater

Question 23

median length of hospital days

Answer 23

50-64 = 6 days

over 75 = 8 days

Question 24

stress reduction protocol

Answer 24

morning appointment
short wait times
short appointments
nitrous oxide sedatino if appropraite

Question 25

extraction of teeth in compromised pt?

Answer 25

requires inpatient hospitilization

high risk of complications

Question 26

no extractions in compromised?

Answer 26

no need for hospitilization

monitor the teeth

ability to deliver a new partial denture faster

Question 27

aging is part of the disease process?

Answer 27

MYTH

• patients do not lose teeth because of age but because of
• perio disease
• tooth loss
• tooth decay (root caries)
• xerostomia

Question 28

fact about adults over the age of 65

Answer 28

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

Question 29

barriers geriatri patients face when trying to obtain health care?

Answer 29

access

finances

level of disability

perceive lack of need by patients (and dentists)

Question 30

private practice strategy
for healthy independent older adults**

vs the reciprocal effect

Answer 30

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