REVIEW ARTICLE
Year : 2020 | Volume
: 16 | Issue : 3 | Page : 130--132
Geriatric dentistry during COVID-19 pandemic
Gaurav Singh1, Kiran Kumari2,
1 The Family Dental Center, Aligarh, Uttar Pradesh, India
2 Department of Biotechnology, All India Institute of Medical Sciences, New Delhi, India
Correspondence Address:
Dr. Gaurav Singh
The Family Dental Center, Station Road, Center Point (Opp. Jalali Gazak Wale's), Aligarh, Uttar Pradesh
India
Abstract
Geriatric patients have different oral healthcare needs than young individuals; they need special infrastructure and training to deal with. During this ongoing pandemic, the geriatric patients' oral healthcare needs take a back seat because of the lockdown and because of the frail health status of the individuals. There is a need to find ways to deal with geriatric patients' unique oral healthcare needs during these testing times and tailored to individual needs.
How to cite this article:
Singh G, Kumari K. Geriatric dentistry during COVID-19 pandemic.J Indian Acad Geriatr 2020;16:130-132
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How to cite this URL:
Singh G, Kumari K. Geriatric dentistry during COVID-19 pandemic. J Indian Acad Geriatr [serial online] 2020 [cited 2023 Apr 2 ];16:130-132
Available from: http://www.jiag.com/text.asp?2020/16/3/130/309985 |
Full Text
Introduction
The WHO Report on World Aging and Health published in 2018?[1] states that by 2050, the world population above 60 years and older is expected to cross 2 billion. This report reiterates the need to build special infrastructure and institutions for specialized care to older individuals. The need to provide special healthcare facilities to the older adults is often overlooked and leads to dissatisfaction in the patients. The proportion of 80 years and older is rising due to the decline in death rates among older adults and better healthcare facilities.[1] Evidence suggests that older individuals are particularly susceptible to infectious diseases and the individuals suffering from one chronic infectious disease are especially vulnerable to additional disease.[2]
The emergence of COVID 19 pandemic in November 2019 in China and spread of SARS CoV -2 virus to different parts of the world with millions of infected patients and the high number of fatalities [3], leads to the implementation of complete lockdown in many countries to prevent further spread of the disease. The various preventive measures taken, causes disruption in healthcare facilities including dental clinics. All the elective procedures were stopped and only emergencies were taken care off.
During the lockdown and subsequent period, the geriatric patients suffered the most because of their frail health status and nonavailability of adequate treatment facilities, leading to undue stress and lack of security. In the initial stages of a pandemic, the number of fatalities was very high in the geriatric population because of the various comorbidities and decreased immune response. Geriatric patients with multiple comorbidities have been identified as the highest risk group for COVID-19 fatal clinical outcome?.[4] Pharmacologically, many geriatric patients suffering from diabetes, hypertension, and chronic kidney disease are on angiotensin-converting enzyme (A.C.E.) inhibitors and angiotensin-2 receptor blockers to manage. These medications may cause the overexpression of A.C.E. 2 receptors used by SARS-CoV-2 for attachment to host cells and put the patient at increased risk of COVID-19 disease?.[5]
Oral Health Problems in Older Adults
Geriatric patients have a separate set of oral health problems as compared to children and young individuals. They require specialized oral care pertaining to their age and oral healthcare status. Typical oral health problems associated with older adult patients are dental hard tissue-related, oral mucosal changes, xerostomia, periodontal condition, state of edentulism, and denture wearing?.[6] With age and continuous usage, teeth tend to wear, leading to attrition, abrasion, or erosion. Changes in the oral mucosa occur due to systemic diseases, long-term use of medications, poor nutrition, oral lichen planus, chronic smoking, and repeated trauma to cheek or tongue or simply due to age-related changes, leading to thinning of mucosa, and loss of elasticity causing decreased regeneration capacity, leading to delayed wound healing.
Older adult patients take certain medications such as tricyclic antidepressants, antipsychotics, atropine, and beta-blockers. The long-term use of these medications may cause xerostomia. Further, with age, salivary gland functions reduced due to acinar tissue atrophy and other degenerative changes in the major salivary glands and minor salivary glands, leading to dry mouth and higher incidences of caries, difficulty in chewing, eating, and communication, burning sensation to spicy foods, and candidiasis.
Incidence of periodontal problems is frequent in older adults because of long-standing periodontitis, lack of proper oral healthcare, teeth cleaning measures, and more plaque retention because of gingival recession and periodontal attachment loss. Edentulism is frequently seen in the older population worldwide and is usually associated with oral hygiene status and the socioeconomic status of the patient. Continuous denture wearing may cause denture stomatitis because of ill-fitting dentures, improper denture hygiene, denture use at night, and xerostomia. Chronic irritation by dentures may lead to traumatic ulcer and may induce mucosal hyperplasia.
Geriatric Dentistry during COVID Pandemic
Oral healthcare to older adults involves diagnosing, preventing, and treating problems associated with normal aging and age-related diseases. Because of this ongoing pandemic, various changes occurred in how the dental clinics work ranging from initial screening of the patients to changes in the clinic setup and introduction of new armamentarium. All these has been done to prevent cross contamination and subsequent infection of SARS CoV-2 from dental setup.
Besides following the latest practice guidelines for dental clinics, geriatric patients need certain specific modifications in managing their dental problems keeping in mind the cognitive and functional impairment, reduced mobility, and various other health-related impairments.
The older adults are more susceptible to SARS-CoV-2 infection.[4] They are also the ones who are more likely to require urgent dental care. It is advisable/advocated to use teleconsultations to avoid the patients' visit to dental clinics and avoid face-to-face contacts. The main goal is to delay any elective procedure and provide help via telephone so that the risk of disease transmission is eliminated or minimized.
With the easy availability of landline phones, mobiles phones, and other smart devices, teleconsultations can be used to assess the severity of the dental problem, for making the initial diagnosis, to provide counseling to the people who cannot attend dental clinics, and to give simple oral hygiene instructions, prescribing fluoridated toothpaste and necessary analgesics, if required.
Before a visit to a dental clinic is planned, phone triaging should be done. Still, it can be difficult for older patients with cognitive conditions such as Alzheimer's disease/dementia or for patients who cannot explain their problems, whether they have oral pain or not or any other oral health-related issues. These patients tend to under-report the severity of pain or discomfort, leading to improper diagnosis and management of the problem.
On arrival at the clinic, it is often challenging to guide geriatric patients about the continuous wearing of masks, touching, and coughing etiquettes – especially in reception and surgery areas.
Another problem frequently faced is that dental professionals and dental staff with personal protective equipment find it challenging to communicate with older patients and express emotions. Many of these patients have hearing and vision problems; communicating from a distance and wearing an N-95 mask with a full face shield can be futile.
Sometimes, it is very challenging to tell the older patients about the necessary preoperative mouth rinse and the continuous wearing of masks while inside the clinic.
It is recommended to use “Tell Show Do” technique with the older adults, to reduce the anxiety, and to show and teach what needs to be done and followed:
Tell me and explain the procedure.Show the procedureThe dental professional can then perform the patient's procedure, or if some technique is to be taught, the patient and the caretaker can practice the technique.
The patient's physical examination should specifically look for any facial swelling, broken teeth, and eating habits changes.
Few authors suggest the use of minimal intervention dentistry (MID) during this pandemic.[7] MID tries to ensure that teeth are kept functional for life and aims to preserve the sound and functional oral structures throughout life. Therefore, this term is not restricted to the management of dental caries but is also applicable to other areas of oral health, such as periodontology, oral rehabilitation, and oral surgery. Manual techniques or the use of low-speed micromotors for caries removal can be promoted and implemented. Antiretroviral therapy can be used at clinics or even at old age homes for patients who cannot visit dental clinics. High fluoride content mouthwashes are recommended for caries prevention; periodontal maintenance can be achieved by self-care, proper oral hygiene maintenance, and habit control. Another benefit of MID during this pandemic is that it generates a low or negligible amount of aerosols. Silver diamine fluoride can be used during this pandemic phase to arrest caries growth and is an alternative to routine caries restoration.
The aim is to provide a treatment that caters to the patient's complaint and avoids any invasive procedure.
Conclusion
The ongoing pandemic causes severe disruptions in specialized dental care being provided to geriatric patients. It also forces us to look for new avenues and new treatment modalities that will be beneficial not just to the dental professionals and the patients but also to the dentistry as a whole and prepare us to face and cope with any future scenarios. The dental professionals must remain updated on the latest information and act as a knowledgeable source for staff and patients alike. After this pandemic, the geriatric dental practice should be looked as a specialized branch, and the approach and treatment modalities should be set up for the future.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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| 2 | World Health Organization. Report on Global Health and Ageing; 2011. Available from: https://www.who.int/ageing/publications?/global_health.pdf.[Last accessed on 2020 Oct 05]. |
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| 4 | Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med 2020;Springer Nature Switzerland AG:1-8. |
| 5 | Patel AB, Verma A. COVID-19 and angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: What is the evidence? JAMA 2020;323:1769-70. |
| 6 | Razak PA, Richard KM, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: A review article. J Int Oral Health 2014;6:110-6. |
| 7 | Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal intervention dentistry for managing dental caries-A review: Report of a FDI Task Group. Int Dent J 2012;62:223-43. |
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