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Dental treatment planning for life and for the end of life

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Throughout a practising life contributions are made to a pension fund as we plan for our later years. If you are like me, each day has a little plan for a visit to the gym or some sporting activity; once again protecting health for the later years. Patients’ treatment planning should be similarly considered?

My practicing life was spent in general practice but also providing domiciliary care for the house-bound and bed-bound elderly. Now, partially retired, domiciliary care is all I provide.

In the early days, my patients, almost without exception, required full dentures. Suddenly it seems that they all have some, or all, of their natural teeth but generally the standard of oral health is very poor. Treatment plans require extractions far too often now.

As a GDP I helped people keep their teeth into old age, sometimes by complex restorations but unfortunately as soon as regular attention stops, oral disease has destroyed much of this work, leaving patients requiring complicated treatments when illness, mental and physical, makes it very difficult.

The challenges of my patients now begin with communication because of the rapid rise in the numbers with Alzheimer’s disease who cannot speak reliably of their symptoms and certainly cannot give consent.

Deteriorating physical ability and memory loss cause a rapid deterioration in oral health. Complex polypharmacy which includes drugs such as Alendronic Acid and the new generation of anticoagulants make treatment planning increasingly challenging.

Just as we plan continuously for our final years, there is a need to start considering how life might be in the final years when advising patients on treatment plans. Pain or infection under a complex bridge supported on implants is the nightmare scenario for a dentist who cares for the elderly in a domiciliary setting. All treatment planning regardless of complexity should consider this.

At the first signs of senility, a new treatment plan should be designed to remove, as far as possible, the risks for what could be twenty years of poor mental health; a valuable investment in the future.

Author Joe Sullivan

Posted by Gemma

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