Medical Barriers to care

1. Medical Barriers to care Alicia Galvan, DDS, FAAHD Geriatric Dental Group of South Texas December 2, 2011

2. BACKGROUND • UTHSCSA Dental School 2002 • 2 Yr. GPR Residency at UTHSCSA Dental and University Health System • Fellow of the American Association of Hospital Dentists • 2004 – 2010 AEGD and GPR director UTHSCSA Dental Postgraduate Dept. • 2010 – present, associate at Geriatric Dental Group of South Texas

3. Course objectives • Describe systemic health issues which are common to the geriatric patient • Describe how these systemic health issues may present an obstacle in providing dental treatment for the geriatric patient • Methods for overcoming common obstacles to dental treatment

4. Introduction • When the baby boom generation enters its senior years, between 2010 and 2030, it is projected that one in five Americans will be over 65 • Major health issues affecting geriatric patients include cardiovascular disease, kidney and endocrine disease, psychiatric illnesses, Alzheimer’s, malignancies, musculoskeletal issues and gastrointestinal disturbances. • Thus according to a surgeon general report recently released, a patient in a long term care facility like a nursing home is on an average of 8 medications. • All of these conditions may adversely affect geriatric oral health via the course of the disease itself or the treatment modalities for the disease, similarly oral health may negatively impact these disease processes as well.

5. Barriers to care • As people live longer, disease processes become chronic conditions to contend with in attempting to achieve systemic and oral health for these patients. • Unfortunately there are many obstacles that geriatric patients must overcome in order to receive healthcare. • Among these are education (other hcp’s do not know the importance of oh) and awareness, poor systemic health of these pts., poor OH, lack of preventative services as well as a shortage of dentists with an adequate comfort level in treating these patients.

6. According to James S. Marks, M.D., M.P.H., Director of the National Center for Chronic Disease Prevention and Health Promotion • ".... Research has shown that poor health does not have to be an inevitable consequence of growing older. Death is inevitable, but, for many people, it need not be preceded by a slow, painful, and disability- ridden decline. Our nation will continue to age -- that we cannot change -- but we can delay and in many cases prevent illness and disability."

7. Patient stability in tolerating dental treatment in an office setting is of extreme importance and medical consults with the pt’s physicians are warranted. • In this way the dentist can be aware of medical conditions and polypharmacy that may require the need for antibiotic prophylaxis, cause bleeding issues, delayed healing time, overgrowth of oral tissue and increased caries risk.

9. Education • This lack of training and experience begins in dental school where courses in geriatric dentistry is sparse. • This unfortunately leads to a decreased competency not only in treating patient’s with these illnesses but also in communicating with the pt’s physician’s when additional information for treating the patient is necessary.

11. EDUCATION • Medical consults should be a way of a physician and dentist communicating each others concerns for the patient’s health. • The dentist should be knowledgeable about medical issues that may preclude a patient from being treated safely in a dental operatory such as unstable angina, uncontrolled seizures or brittle diabetes.

13. education • The bottom line is that the general dentist needs to grow professionally and learn more about clinical medicine so that this increasing group of patients can be treated safely and in a complete manner. • By doing this the general dentist may also find that there are some patient’s that they cannot treat in a safe manner and may need to be referred to specialists or other dentists who have credentials to treat the patient in an OR setting if necessary.

15. OTHER solutions • Comprehensive 4-year curriculum • Interdisciplinary instruction • Didactic and clinical components • Virtual aging patient CD CD-ROM • Extramural rotations • Residencies and Fellowships • www.dhs.wisconsin.gov/rl_dsl/training/OrlCrPwrPnt.pdf

16. Getting Comfortable • So how does a general dentist increase their comfort level in requesting medical consults and providing care to these these patients? • Continuing education courses that focus on treating medically compromised individuals • AEGD or GPR residency • Geriatric Dentistry Fellowships

17. QUESTIONS?