How should senior patients be treatment planned?
This question has no simple, cookie cutter answer. Careful consideration of a particular patient's over all health, their ability to sit through treatment, and their finances are necessary. I try to avoid complicated restorative treatments for senior, but that approach is not always what they really want.In our new age people are living longer. Due to advances in medicine, for most seniors their seventies are the new sixties and this should be kept in mind when treatment planning.
Five years ago an 87 year old family friend came to me for treatment. She had recently moved to NYC and needed a new dentist. She is delightful and is a good conversational list but has an impaired short term memory. She often doesn't remember conversations we had five minutes before and often asks me the same questions. It's a little like having multiple "ground hog's day" conversations with her. I try to mix it up by changing my answers to her same questions.
She is a good patient and has no real problem sitting for treatment. After discussions with her daughter we decided to keep her treatment simple. I should clean out cavities that could be restored with fillings, but not necessarily work on teeth that may require multiple lengthy appointments. This resulted in me ignoring decay on teeth (a watchful waiting approach) that already had crown and would need root canals, cores and new crowns to save them. I believed this would be her best approach over the next five years.
This seemed to be working well, at least until yesterday, when during a cleaning visit I took some radiographs and it turned out that two or three teeth would probably would require extraction ( she is now 92 years of age). When I explained this to her and her daughter both now seemed to want to save broken down teeth if that would keep her from loosing them.
We decided to schedule multiple short visits and see what could be done. I have been using miracle mix flouride restorations as much as possible and they have been working, but I believe that couple of her teeth are hopeless. Others will surely require removing or preparing crowns and possible root canal treatment .
Thankfully, finances are not her issue, and I have decided to treat one tooth at a time and see how it goes. Since some of the teeth will require multiple longer appointments to restore, I will start by fixing teeth that require simple fillings and on subsequent visits tackle teeth that are more complicated to restore. Hopefully I will be able to gauge how well treatment is tolerated before I undertake any of her more complicated procedures. Her treatment may still involve visits to the Oral Surgeon but first I will attempt to clean out each affected tooth, before making the referral to my Oral Surgeon. If she is willing and able to sit through longer sessions I will attempt to salvage any of teeth that can be saved.
Is this the "best treatment plan" for her? Time will tell, but for most of my most senior patients, one of the most important reasons to have dental treatment is to improve the quality of their lives. It can be demoralizing to be denied the kind treatment that a younger self had come to expect. If they are in good enough health to have longer appointments and desire them, why not do the type of procedures they need to keep their teeth? There is no "cookie cutter" approach for treatment planning the elderly patient. Careful consideration must be given on an individual basis.
from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/05/how-should-senior-patients-be-treatment.html - http://lspindelnycdds.blogspot.com/
Five years ago an 87 year old family friend came to me for treatment. She had recently moved to NYC and needed a new dentist. She is delightful and is a good conversational list but has an impaired short term memory. She often doesn't remember conversations we had five minutes before and often asks me the same questions. It's a little like having multiple "ground hog's day" conversations with her. I try to mix it up by changing my answers to her same questions.
She is a good patient and has no real problem sitting for treatment. After discussions with her daughter we decided to keep her treatment simple. I should clean out cavities that could be restored with fillings, but not necessarily work on teeth that may require multiple lengthy appointments. This resulted in me ignoring decay on teeth (a watchful waiting approach) that already had crown and would need root canals, cores and new crowns to save them. I believed this would be her best approach over the next five years.
This seemed to be working well, at least until yesterday, when during a cleaning visit I took some radiographs and it turned out that two or three teeth would probably would require extraction ( she is now 92 years of age). When I explained this to her and her daughter both now seemed to want to save broken down teeth if that would keep her from loosing them.
We decided to schedule multiple short visits and see what could be done. I have been using miracle mix flouride restorations as much as possible and they have been working, but I believe that couple of her teeth are hopeless. Others will surely require removing or preparing crowns and possible root canal treatment .
Thankfully, finances are not her issue, and I have decided to treat one tooth at a time and see how it goes. Since some of the teeth will require multiple longer appointments to restore, I will start by fixing teeth that require simple fillings and on subsequent visits tackle teeth that are more complicated to restore. Hopefully I will be able to gauge how well treatment is tolerated before I undertake any of her more complicated procedures. Her treatment may still involve visits to the Oral Surgeon but first I will attempt to clean out each affected tooth, before making the referral to my Oral Surgeon. If she is willing and able to sit through longer sessions I will attempt to salvage any of teeth that can be saved.
Is this the "best treatment plan" for her? Time will tell, but for most of my most senior patients, one of the most important reasons to have dental treatment is to improve the quality of their lives. It can be demoralizing to be denied the kind treatment that a younger self had come to expect. If they are in good enough health to have longer appointments and desire them, why not do the type of procedures they need to keep their teeth? There is no "cookie cutter" approach for treatment planning the elderly patient. Careful consideration must be given on an individual basis.
from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/05/how-should-senior-patients-be-treatment.html - http://lspindelnycdds.blogspot.com/
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