Practice Management

Geriatric Oral Health Care: A Challenge and an Opportunity to Private Practice


Ron Weintraub


February 23, 2016

February 23, 2016

According to the Ontario Dental Association (ODA), Ontario seniors are the fastest growing patient population with frail seniors as the most vulnerable to oral disease and the attendant systemic consequences of poor oral health. Currently, there are more patients over 65 than under 25 years old. It is projected that in a few short years, in certain areas of the Greater Toronto Area, there will be a growth in population of elders of 26.5 per cent. The growth of the demographic needing dental services will soon meaningfully affect conventional dental offices as well as institutions offering senior care. In addition to retirement home residents, the cohort of seniors who are attempting to stay in their homes with assistance as they age, supported by government health care agencies, contribute to the influx of people needing dental services.

CHALLENGES ASSOCIATED IN TREATING A SOMETIMES FRAIL POPULATIONMany challenges are associated in treating the geriatric population, some of whom are frail. Until recently, very few practitioners concentrated on the special needs of this demographic. Growing evidence shows that lately some practitioners are focusing on andproviding appropriate facilities to treat the geriatric population who seek treatment. Among those challenges include the following:

Some valued patients, who have spent many years in our practices, find that the office may not be equipped to allow safe entrance to the operatory and transfer to the dental chair from a wheel chair or other device.A number of patients may present with complex pre-disposing medical histories requiring investigation and interfacing with physicians, family members, or caregivers.The nature of geriatric oral health care has evolved as a result of the expectation that many seniors will retain a mostly intact dentition for the rest of their lives; therefore, they require more comprehensive procedures than removable dentures represent.The population may require increased time allocations for particular procedures as well as more supportive clinical involvement. This entails the complication of potentially dealing with the patient as well as the family and/or the caregiver in addition to Powers of Attorney that can strain existing resources.

POTENTIAL BENEFITS OF INCLUDING GERIATRIC FOCUS• As the aging of Canada’s population accelerates and the ratio of dental practitioner to total patient potential pool increases, seniors automatically become a more important source of treatment opportunities for the dental team.

• As geriatrics exceed paediatrics with its lower treatment opportunity demands, the focus will inevitably shift to an older demographic

SOME REASONS FOR GERIATRICS’ POTENTIAL IMPORTANCEAmong the reasons for including a focus on patients over 65 are the following: They are

Least likely to have visited a dentist in the last year (58.6 per cent* visited the dentist);Most likely to have lost teeth in the last year due to caries or periodontal disease (9.6 per cent*);Least likely to cite cost as main reason for not visiting a dentist (6.4 per cent*). This group is significantly focused on their personal dental health issues. Many seniors have the personal financial resources and desire to look after their individual oral health needs.Reflects the greatest growth of total population. In 2006, over nine years ago, 500 million people were 65 years old or older. This trend is proportionately greater in the developed world and certainly in our North American jurisdiction.Financial responsibility: The ODA special fee guide developed specifically for disabled and medically complex seniors seeks to ameliorate the increase in time and resources required to treat the special needs of this population by assessing an enhanced fee for increased degree of complexity. No office, therefore, would be negatively affected financially by welcoming this group into the general patient population in our offices.Geriatric patients, in general, are less time constrained than other demographics, and they put less pressure on the office to “take me right on time”. However, their needs have to be respected based on the schedule imposed on them by their dietary and medical requirements.*Statistics are courtesy of Public Health Ontario

A MODEL OF EXCELLENCE: BAYCREST HEALTH SCIENCE CENTREAs a profession, we would do well to embrace the Baycrest Health Science Centre’s vision as they embark on a significant rebuild of their geriatric dental facility. Baycrest, the Canadian Centre for Aging and Brain Health Innovation, has an international reputation for geriatric care. Their Vision Statement provides sound guidelines:

Vision StatementThe Baycrest Dental Centre aims to be the pre-eminent dental facility in Canada; addressing the needs of frail, disabled, cognitively impaired and medically complex older adults in a compassionate setting, and being the leading training centre for evidence based geriatric dental care.

The described patient population will expect and demand sophisticated dental procedures to replicate the intact dentitions with which they matured. Full dentures are not an acceptable solution for them. When aging patients who have been treated for many years present needing specialized care beyond the resources we can offer in-house, it is good to note that we can refer them to facilities like Baycrest Centre with confidence.

As we look forward to the inevitability of our dental practices having to adopt and shift some priorities, we should keep a close eye on our ability to serve this newly emerging, important demographic. Our economic viability may, in fact, be influenced by how seriously we embrace the challenge and the opportunity.