Dentistry Question
GERIATRIC SPECIAL PATIENT SUMMARY (USE BULLET POINTS) DATE OF PATIENT COMPLETION: March 7th, 2024 ➢ Caries risk / Systemic conditions/ List specific for patient: Traditional Adolescents Many factors can increase the chance of caries risk and root surface caries in older adult patients such as: ▪ Xerostomia, there is a high chance for patients getting Xerostomia if taking medication, radiation for cancer therapy (head and neck), autoimmune diseases, rheumatoid arthritis, and diabetes. ▪ Gingival recession can make the root exposed and easily get a cavity. ▪ Tobacco users are highly susceptible to root caries. ▪ Poor OHI can increase the chances or root caries. My geriatric patient ▪ Decay risk 5 scores 5/5 in Previsor; 8 watch teeth and not an appropriate home care. ▪ Moderate xerostomia is present due to anti-hypertension medications, losartan (ARB), and Hydrochlorothiazide (diuretics). ▪ Consuming tobacco can impact root caries. ➢ Typical OHI challenges / Periodontal risk / Mobility & Activities of Daily Living Traditional Adolescents ▪ Dexterity issues can cause Improper oral hygiene by a lack of performing oral health care. ▪ Some barriers can make geriatric people not like visiting dental clinics regularly. ▪ Most older adults are affected by periodontal disease by the presence of recession, alveolar bone resorption, mobility, tooth loss, and nutrition. ▪ Recurrent decay and open margins around dental restorations are prevalent issues in the geriatric population, significantly contributing to the risk of dental caries. ▪ . In dental care, limited mobility can impede access to dental appointments or hinder proper oral hygiene practices. ▪ Dexterity or compromised mobility affects an individual’s ability to perform self-care tasks, including oral hygiene practices, and their daily living will be more difficult and this affects adversely their oral hygiene at home (Chavez et al. (2018, p. 245). My geriatric patient ▪ My patient randomly brushes, and she skips flossing. She had moderate to heavy plaque, especially her molars teeth. The recommendation for her water pick used before bedtime regularly. ▪ My patient had 3 out of 4 periodontal risks because of losing more than 3 mm of bone on the radiograph mainly on the lower anterior and premolar, having light BOP due to tobacco, and having generalized 2-3 mm recession. The AAP classification was IIB, because the radiographic bone loss is around 35%, and patients suffering from hypertension and consuming tobacco. ▪ My patient had a hard time opening her mouth after a long time of treatment due to a surgery have had done time ago in her lower jaw. This is affecting her time for treatment in a dental clinic. ➢ Community loss/isolation from support / Transportation challenges Traditional Adolescents ▪ Lack of driving capability among geriatric patients often leads to transportation challenges. ▪ Dependence on public transport or services like Uber might not always be convenient or sufficient for elderly individuals (Ettinger et al., 2023, pp.320) Transportation challenges affect showing up to usual dental visits and following poor oral hygiene. ▪ The loss of friends or a spouse contributes to social isolation and impacts the mental well-being of geriatric patients. ▪ Social support plays a crucial role in overall health, including oral health, and the absence of this support due to the death of close companions can lead to feelings of loneliness, potentially affecting an individual’s motivation to seek healthcare, including dental services (Chavez et al., 2018, p. 255). Furthermore, dental professionals should recognize and address the emotional impact of such losses on elderly patients’ overall health. ▪ Most older adults are retired. Some don’t have partners due to divorce and their kids are grown, so their lives are impacted on their feelings and affect on their daily living. Caregiving responsibilities can divert financial resources and time, potentially leading to neglected oral health among elderly caregivers (Boyd et al., 2021, pp. 765). My geriatric patient ▪ My patient is likely to schedule at the early morning so it is easy for her to drive in that time rather than evening. ▪ The patient canceled the appointment twice due to the heavy rain that got damaged in of her home and she should care for this by herself since she lives lonely. Also, other cancellations due to hospitalization. On the day of the appointment, she was running a little bit late due to traffic as she stated. ➢ Access to dental care / Financial challenges ➢ Retirement/Fixed Income: ▪ The transition to a fixed income post-retirement often poses financial constraints, impacting geriatric patients’ ability to afford essential healthcare services, including dental care ▪ Limited financial resources after retirement can hinder older adults’ access to routine dental visits and necessary treatments, potentially compromising their oral health (Ettinger et al., 2023, pp.320). ➢ Lack of Medical Care/Insurance ▪ The lack of medical care or insurance coverage among geriatric individuals significantly affects their access to comprehensive healthcare, including dental services. ▪ . Inadequate medical insurance coverage may result in delayed or foregone dental treatments due to financial constraints, exacerbating oral health issues (Ettinger et al., 2023, pp.320). ➢ Raising Grandchildren/Childcare: Impact and Stress ➢ Geriatric patients raising grandchildren or providing childcare experience increased stress and financial strain, impacting their ability to prioritize personal healthcare needs, including dental care. My geriatric patient ▪ My patient ‘s insurance does not cover dental care and that affects her to visit the dental clinic in a basic manner and try to reach a free clinic to be able to care of her oral care and teeth. ▪ My patient had a fixed income, and she was not able to pay for dental care. ▪ Need medical clearance before visiting dental clinic due to stage 2 of hypertension. ▪ My patient is motivated to get a free dental clean. ➢ Key approach ➢ Listen, consider deficits, comfort in a chair Traditional Adolescents ▪ In providing dental care to geriatric patients, it is crucial to actively listen and consider deficits such as hearing impairment, visual limitations, and reduced manual dexterity. ▪ . The importance of adapting communication techniques and allowing extra time for patients to comprehend instructions due to sensory deficits (Boyd et al., 2021, pp. 450). ▪ Addressing these deficits enhances patient understanding and cooperation during dental procedures, improving oral health outcomes (Ettinger et al., 2023, pp.320). ▪ Ensuring patient comfort during dental procedures involves using supportive pillows and blankets and providing regular breaks. ▪ Optimizing the dental chair’s ergonomics with pillows or blankets enhances the comfort of geriatric patients, thus reducing anxiety and stress (Boyd et al., 2021, pp. 968). ▪ Utilizing a semi-supine positioning during dental procedures accounts for considerations like medication management and swallowing difficulties in geriatric patients. ▪ Semi-supine positioning aids in swallowing and minimizes the risk of aspiration, especially for patients with compromised swallowing reflexes due to medication side effects (Boyd et al., 2021, pp. 455). ▪ had unfavorable experiences before and nervousness can be a barrier to reaching the dental office for geriatric patients. My geriatric patient ▪ My patient has no problem with hearing impairment or visual limitations. ▪ my patient was not nervous from the dental chair. ▪ Local anesthesia was fine due to HBP stabilization and control. ▪ Due to the high blood pressure that the patient has and taking medication, I cared to put my patient up right position for 2 min in every time want to break into a void orthostatic hypotension. ▪ My patient needed a break to relieve her jaw and close her mouth with a little massage for her TMJ due to her surgery a long time ago. Reference Textbook: Wilkins, E. (2016). Clinical practice of the dental hygienist. 12th edition, Lippincott, Williams and Wilkins, Philadelphia, PA. include pages used: 824,831,450, 320, 968, 765. Peer-Reviewed Journal Articles (2 required): Leung KC, Chu CH. Dental Care for Older Adults. Int J Environ Res Public Health. 2022 Dec 23;20(1):214. doi: 10.3390/ijerph20010214. PMID: 36612536; PMCID: PMC9819414. Chávez, E. M., Wong, L. M., Subar, P., Young, D. A., & Wong, A. (2018). Dental care for geriatric and special needs populations. Dental Clinics of North America, 62(2), 245–267. https://doi.org/10.1016/j.cden.2017.11.005 Ettinger, R., Marchini, L., & Hartshorn, J. (2023). Consideration in planning dental treatment of older adults. Clinics in Geriatric Medicine, 39(2), 311–326. https://doi.org/10.1016/j.cger.2023.01.002 GERIATRIC SPECIAL PATIENT SUMMARY (USE BULLET POINTS) DATE OF PATIENT COMPLETION: Compare the following areas with your personal patient AND a traditional geriatric patient (based on your previous reports, experience and research). Caries risk / Systemic conditions/ List specific for patient: o Medications (side effects, oral implications – if none include N/A): Typical OHI challenges / Periodontal risk / Mobility & Activities of Daily Living Community loss/isolation from support / Transportation challenges Access to dental care / Financial challenges Key approach o Listen, consider deficits, comfort in chair References Textbook: Wilkins, E. (year). Clinical practice of the dental hygienist. (#) edition, (publisher) include pages used: Peer-Reviewed Journal Articles (2 required):
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