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Author: Hilde Tillman, D.M.D.

1. Objectives

  • To render comprehensive oral health care and teach prevention to a dynamic, diverse and rapidly growing elderly population. Since chronology does not always equal physiology, younger patients with significant medical, physical, mental disabilities and sensory deficits are eligible for treatment in Geriatric Dentistry.
  • Third year students will learn the complexity of aging, patient management and the importance of dentistry in total patient care. The dentist is a key member of the health delivery team. Oral health can be maintained and restored throughout life; a unique contribution of dentistry to the quality of life, and extension of the Health Span.
  • In the three clinic sessions, students evaluate their patients holistically, which includes medical history, nutritional assessment, medications, diagnostic radiographs, and prevention. A comprehensive treatment plan is developed; treatment is started and is to be completed in the general practice clinics.

2. General Information and Schedule

Clinic Sessions Monday, Wednesday, and Friday 3 hours
Seminar Tuesday 3 hours
Outreach Thursday 3 hours

2.1. Procedures to be Completed in Clinic Session

  • Medical History
  • Blood pressure in both arms
  • Radiographs
  • Charting and Probing (with premedication if needed)
  • Study Models (with premedication if needed)
  • Denture interview form to be completed prior to prosthetic consult
  • Periodontal consult prior to completion of XMRT
  • All necessary consults prior to treatment plan
  • Treatment can be started

If patient has a State Health Card, please make a copy of it and a copy of the treatment plan, if patient needs full dentures or partials.

3. Special Charges for Geriatric Patients

1 - XMRT and radiographs (full mouth intra-orals or panoramic): $25.00
2 - Prophylaxis (full mouth): $32.00
Quadrants scaling: $16.00 per quadrant (two quadrants allowed)
3 - Perio Recall: No Charges
4 - Fill out adjustment forms for:
  • Comprehensive Exam
$25.00
  • Radiographs
No Charge
  • Prophylaxis
$32.00
  • Quadrant Scaling:
$16.00 per quadrants (two quadrants allowed)

4. Objectives for Geriatric Seminar

The objective of the geriatric seminar is to study the scope of medical problems, review medications as they affect dental management, present psychosocial and environmental factors in relation to dental management, and differentiate normal or usual aging affected by disease. We will also assess the relationship of chronological and physiological age.

4.1. Outline For Presentation

I. Demographics:
Name, Age, Living Status, and Ethnicity.
II. Medical History:
Medical Findings, nutritional status, functional status, assess disabilities in relation to activities of daily living (Barthel Index), and instrumental activities of daily living.
III. Mental Status:
Assess cognition: long term and short term memory. Signs of depression, signs of dementia, behavioral changes.
IV. Medications:
Dosage, side effects, interactions and the affect on dental management.
V. Oral Health Status:
Chief complaint, oral findings, patient's expectations, and treatment plan.
VI. Impacts:
Impact of Medical, psychosocial, mental, physical, and financial statuses on restoration of oral health and maintenance of oral health.

5. Objective For Geriatric Outreach

To teach prevention and perform oral health screening and cancer screening for diverse social and ethnic populations in a variety of settings: subsidized housing, assisted living sites, senior centers, churches, and senior day care centers in the Greater Boston area. Transportation is provided by the City of Boston, Division of Elder Affairs.

6. Dental Screening Sheets / Annotated Mini Mental State Examination (AMMSE)

Click on link below to access PDF copy of first document.

7. Barthel Index

7.1. Activities of Daily Living

Activities With Help Independent
Feeding 1 10
Moving from wheelchair to bed and returning 5-10 10
Personal toilet (wash face, comb hair, shave, brush and floss teeth) 0 5
Getting on and off toilet 5 10
Bathing self 0 5
Walking on level surface 10 15
Unable to walk, proper wheelchair 0 5
Ascend and descend stairs 5 10
Dressing 5 10
Controlling bowels 5 10
Controlling bladder 5 10

8. Assessment of Instrumental Activities of Daily Living

Assess whether the person can accomplish each activity necessary to manage his or her living environment independently or whether he or she is dependent on others?

Within the Home Cooking
Housecleaning
Laundry
Management of Medications
Management of Telephone
Outside the Home Shopping for food, clothing, drugs, etc.
Use of transportation traveling to necessary and desired activities. (E.G., physician's appointments, religious and social events, etc.).

9. Growth and Development Theory: Human Life Cycle

9.1. Concept by Major Theorist Eric H. Erikson

Life Cycle Stage Age/Reason Relationships Major Developmental Task
Infancy 0-1 Maternal Person Trust vs. Mistrust
Early Childhood 2-3½ Paternal Person Autonomy vs. Shame, Doubt
Play Age 4-7 Basic Family/School Initiative vs. Guilt
School Age 7-12 Neighborhood/School Industry vs. Inferiority
Adolescence 13-20 Peer Groups/Models of Leadership Identify, Repudiation vs. Role Diffusion
Young Adult 20-30 Partners in Friendship, Sex, Competition, Cooperation Intimacy-Solidarity vs. Isolation
Adulthood 30-60 Work, Home, Family Generativity vs. Self-Absorption, Stagnation
Mature Age 60+ My Kind, Human Kind Integrity vs. Despair

10. Nursing Home and Assisted Living Patient Procedures

  1. To schedule appointments, call the nursing home or assisted living site directly and speak to the nurse in charge of your patient. Since ambulance transportation is arranged by the nursing home, make the appointment in advance, trying to schedule the same time every week. Do not change any appointments without a week’s notice.
  2. Always confirm the appointment the day before. Call between 7:00 A.M. and 3:00 P.M.
  3. Make follow-up appointments for your nursing home patient in the geriatric clinic on Monday, Wednesday and Friday. Check for chair availability. When patient arrives, MAKE SURE THAT YOU ARE WAITING FOR THEM.
  4. Immediately after seating the patient, call the ambulance chair car service to schedule a pick-up time. This should never be later than 11:30 A.M. Always call the ambulance chair car directly. Do not make pick-up arrangements with the drivers when they drop off the patient. The driver that drops them off is not always the driver that picks them up.
  5. Dental progress notes must be filled out and sent back with the patient to the nursing home after each visit. There are four progress notes included in this packet. Please make copies for subsequent visits.
  6. You must stay with your patient until he or she is picked up by the ambulance service. Give the progress notes to the ambulance driver.
  7. Any changes or delay in treating a nursing home patient should be fully discussed with Dr. Tillman.

11. Dental Progress Notes

Patient:

Date:

Record number:

Nursing Home:

Student:

Student Phone #:

Recommendation/Treatment Plan:

Comments:

Referrals:

Next Appointment:

Signature: