How much treatment should an octogenarian (or Nanagenerian) have?

The answer is, It depends. It is dependent on a combination of factors that include : their health, their desires and their overall finances. While some can afford more complicated dentistry, they may not want to get involved with lengthy treatment plans, even though their health is good enough to allow them. Others may be quite ill, but still desire to keep their teeth in tip top shape.  Some have finances that dictate keeping treatment plans simple. Ultimately "a one size fits all " approach is not appropriate. Each  elderly patients should be handled with an individualized approach, one thaty should developed with their dentist's help.

Often when faced with a tooth that may require significant treatment to save or a tooth that needs an extraction and replacement, I ask them what sort of result do they desire? Do they want "ideal treatment" regardless of their age or do they want some simplified version; one that will allow them to go about their lives comfortably but without a lot of visits, and money spent in  order to complete their treatment?

Sometimes, for health reasons, I have to talk them out of extended treatments and other times I have to talk them into a more expensive treatment plan than they desire. If their health and finance allow an ideal treatment but their psychological state is not ideal this can be the case. I commonly hear from them "Why should I fix this . After all how long do I have to live? "If they are healthy and their finances permit, I encourage them to try to be optimistic and "bet on themselves".  After all a healthy person in their early eighties may very well live another ten years or more. Why not fix their tooth properly?

The issues become more complicated for even older patients (85 and up) who are not in good health or have limited finances. Some want very much to fix their teeth an ideal (non compromised way) but their circumstance dictate that the "keep it simple rule" should apply to their treatment plans. Usually I try to institute simplified treatment plans that take place over a limited number of visits and I keep their appointments short. It is not uncommon for some of these patients to have some degree of dementia and often treatment plans are worked out first with family members and then explained to my patient. Often these patients don't remember all of my explanations or even remember from visit to visit why they are at my office.  For these patients complicated treatment plans are not ideal and should be avoided if possible.

I learned this the hard way a long time ago. One of my favorite patients, Jacob an elderly veteran of the Lincoln Brigade in the Spanish Civil War, has a wife whose teeth had broken down  and no longer looked attractive. He asked if I could fix them so that they would like nice again. He loved her and wanted her to have a nice appearance. After I met his wife it was apparent that she was a very pleasant woman with moderately advance dementia. After much arm twisting I agreed to do a full maxillary rehabilitation and since I am not the quickest dentist in NYC, her treatment took a good number of lengthy visits. During each visit she would smile at me a repeatedly ask " Why am I here?" I would answer and she would seem satisfied for about 20 minutes and then repeat her question. When I finally completed her treatment she had her nice smile back again but I felt like this wasn't a road I would like to travel down again in the future.



from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/02/how-much-treatment-should-octogenarian.html - http://lspindelnycdds.blogspot.com/

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