There is also decreased muscular activity due to the loss in response to the usual stimulus in the gastrointestinal tract. This decreased peristalsis in the colon frequently results in constipation with hemorrhoids. DENTIST’S RESPONSIBILITY: (1) Do not prescribe narcotics for pain since they increase constipation. (2) Have soft cushion for patients with hemorrhoids to sit on. (3) Most medications prescribed will take longer to take effect, but may persist longer due to decreased peristalsis. In some elderly patients the usual medication may not be effective due to vascular and enzyme changes added to the decreased response from neurons. (4) Check all medications before prescribing. Response from drugs in aged patients is very unpredictable. VI FACT: GENITOURINARY SYSTEM: -The aging process involves loss of nephrons consequently a diminished glomular filtration rate. The urinary bladder loses its capacity to hold urine resulting in nocturia, frequency, dysuria and a tendency toward urinary incontinence. The male prostate gland hypertrophies with age (BPH) and this accentuates the above symptoms. In the aging female a common physiological finding is a prolapsed uterus. DENTIST’S RESPONSIBILITY: (1) Have patient void prior to treatment. (2) If patient needs to void during treatment, quickly approve. If patient feels weak or pale, send dental assistant with patient to restroom. (3) When prescribing medication, remember the aging process will slow renal secretions. VII FACT: MUSCULOSKELETAL SYSTEM: -The aging process changes the composition of bone. There is usually an increase in the mineral content, but a decrease in the organic matrix resulting in brittle bones. Older bones have irregular margins and spurs which result in restricted motion in the senior patient. There is frequently excessive bone around joint margins resulting in osteoarthritis. The geriatric patients skeletal muscles lose their efficiency and fatigue sets in faster. The muscle fibers degenerate with age and are replaced with fibrous connective tissue which reduces muscular strength. DENTIST’S RESPONSIBILITY: (1) Do not force mandible to open mouth. This may result in subluxation or dislocation of the condyles in the TMJ. (2) Do not keep patient’s mouth open for extended periods of time. (3) Allow patient to rest (close mouth) periodically during treatment as the aged patient develops muscle fatigue early and often. (4) Extreme care doing extractions as the aging process leaves brittle bone just waiting to fracture from dental trauma. (5) Extraction sites (sockets) will heal much slower in the geriatric patient. (6) Post-treatment trismus is common following extended procedures. VIII FACT: IMMUNE SYSTEM -In the aged the antibody response to an antigen is significantly reduced. Cellular immunity is decreased. Autoantibodies and abnormal immunoglobulins increase. DENTIST’S RESPONSIBILITY: (1) Be aware of oral and facial infections because of increased susceptibility. (2) Wear clean, new mask and gown with each senior patient. (3) Use sterile gloves, only autoclaved instruments and as clean an operatory as possible. (4) A decrease in aerosols and treatment time can minimize infection. (5) Examine closely the facial skin, and hard and soft tissue intraorally -a compromised immune system is considered a major factor in neoplastic proliferation. The aging process will vary from patient to patient. Some patients will look their chronological age while others will appear younger or even much older, but con10 Virginia Dental Association
sidered healthy. Within the individual some systems may age faster than others. Almost all dentists have seen healthy teeth and alveolar bone on one side of the mouth and just the opposite on the other side. All healthcare professionals have heard their patients say “all my diseases are on this side of my body”. In conclusion, geriatric dentistry will always be more time consuming, challenging, gratifying, and maybe financially rewarding. If you are fortunate dear colleague, you will some day be the healthy senior patient sitting in a dental chair with your mouth wide open! (Not too wide). *Formerly: Lecturer, Physiology and Anatomy, University of Virginia, George Mason College, Fairfax, Virginia -1968, 1969 Adjunct Professor, Medical Physiology, The American University, Washington, DC -1979 -1988 Clinical Professor, Oral and Maxillofacial Surgery, MCV School of Dentistry, Virginia Commonwealth University, Richmond, Virginia -1984-1990
OSHA Standards
Dr. Henry M. Botuck, Component 8 Chair, Infection Control & Environmental Safety To the editor of the VDA Journal: I have noticed a trend in dentistry to ignore some basic OSHA standards, and both VDA and ADA publications seem to advertise this as the norm. I reference the July, August, September 2010 VDA Journal cover, and page one of the ADA News of June 21, 2010. Both feature our colleagues helping the disadvantaged by donating their time and expertise at a MOM project. Also noticeable are the bare arms of the dentists and assistants at these events. The OSHA bloodborne pathogens standard requires sleeves to be long enough to protect the forearms when the gown is worn as PPE (i.e., when spatter and spray of blood, saliva, or OPIM to the forearms is anticipated). We do need to advertise the good works of dentists all over the country. But, I cringe when we also advertise our ignorance and the flaunting of OSHA regulations designed for our own protection and the protection of our staff.