Changing Focus

The wants and needs of patients may change based on the treatments they value at each stage of their life. Cosmetic dentistry may be a priority at one stage of retirement, whereas in later years restorative and prosthetic dentistry may take priority.

There may come a time when the patient can no longer care for him or herself and the dental plan that was created must be shared with their caregiver. It is important the caregiver respects the patient’s treatment desires and wishes. The treatment plan and oral hygiene needs created prior to their incapacitation should be addressed as indicated by the patient. Prevention should be stressed to avoid dental emergencies.

Mobility issues and cognitive changes that can occur with aging may limit a person’s self-care ability. Caregivers may need to intervene before self-neglect becomes dangerous and dental complications arise due to the inadequate self-care.26

An Advanced Care Plan/Directive can be created for the individual for use by nursing home staff if the patient becomes unable to care for him or herself. It should indicate the patient’s health care representative (the person who is responsible for making health care decisions while a person is incapacitated) and what tasks should be provided by his or her caregiver while in the nursing home setting. The oral hygiene tasks may include toothbrushing, interdental care (floss, proxy brush, stimudents) and administration of pH balancing medicaments and/or oral probiotics.

Caregivers and patients should be aware oral diseases become more complex and costly over time and early intervention is beneficial. Dental complications such as fractures and decay can cause pain, which in turn can create malnutrition due to the discomfort and communication issues due to tooth loss. Tooth loss, an affliction many individuals feel is an inevitable effect of aging, can cause discomfort, problems with occlusion, trauma to adjacent teeth, spaces that cannot be effectively cleaned and dental decay, including root caries. Social issues may develop due to halitosis as well.