Gerodontology for General Dental Practitioners

This blog post is based on a talk by James Shaw, a Geriatrician who spoke at the East Midlands CDS BDA Study Day.

In Geriatrics there are 3 main complexities:

1. Frailty - where multiple body systems lose their inbuilt senses. Can physical or cognitive. 
2. Polypharmacy
3. Multimorbidities 

5Ms of Geriatrics

According to the British Society of Geriatrics, there are 5Ms every health care professional who deals with geriatric patients needs to know:

Multi-complexity - multiple morbidity

Mobility - impaired gait and balance. Falls risk

Mind - dementia, delirium, depression

Medicine - polypharmacy, adverse medication effects

Matters Most - an individual's own meaningful health outcomes and care preferences

Top tips when Prescribing in Polypharmacy 

• Obtain an accurate medical history
• Use the BNF
• Assume reduced renal function in the elderly 
• Be aware of side-effects and interactions e.g. warfarin and miconazole 
• If you are in doubt, call their GP or pharmacist 
• Be aware of anticoagulants/antiplatelets
• Avoid NSAIDs in over 80s as around 50% will get GI side-effects
• Use the smallest dose co-codamol when prescribing 
• Avoid dihydrocodeine and tramodol as high risk of constipation 
• Antibiotics which start with C (clindamycin, clarithromycin, co-amoxiclav) have increased risk of developing C. Difficile when prescribed in the elderly

Dry Mouth

This can be as a result of the increased prescription of anti-muscarinics for over active bladders. These increase the risk of dry mouth. Of course there can also be other factors such as polypharmacy, side effects of many medications or immunosuppression. 

If the effect is profound following prescription of anti-muscarinics, it may be worth referring back to their GP as in fact only around 50% of cases these drugs are effective in managing over active bladders. 

Some clinical tips in managing these patients include:

• Prevention of caries is essential in these patients. Regular recalls, hygiene visits, fluoride applications and prescription of high fluoride toothpaste are recommended
• Biotene oral gel used appropriately can help alleviate dry and sore tissues
• Saliva sprays, gels, pastilles are options to help with symptoms but many patients prefer to manage with frequent sips of water or use of sugar-free chewing gum 
• Consider referrals to their GP or oral medicine to investigate where appropriate

Osteoporosis

Osteoporosis should cue warning flags for dentists... we all know about MRONJ and it's association with dentistry. 

Oral alendronic acid taken once weekly has a very low incidence of MRONJ <0.01%, whereas IV bisphosphonates such as as zolendronate have an increased risk. IV bisphosphonates are more clinically effective and in some cases patients prefer zolendronate as instead of a tablet taken once a week (which is often forgotten), is a annual infusion IV. 

To read more about MRONJ and guidelines in dentistry see my previous post here. 

Team photo with the delegates from the day

A huge thank you to James for his talk and Charlotte Waite for organising the day. Look out for future posts summarising other talks from the day...

Do you treat geriatric patients? What challenges do you come across? Let me know in the comments below. 

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Align Bleach and Bond. Another Awesome Raffle Prize with IAS Academy

Another incredible raffle prize won at the Make a Dentist summer party...

My raffle prize was a free place on the first day of the Align, Bleach, Bond (ABB) course with IAS Academy's Tif Qureshi in London.

Who are IAS Academy?

IAS Academy are an orthodontic training academy to help train GDPs in varying orthodontic systems to allow dentists to treat their patients with a range of appliances. They continue to support the dentists they train through an online forum with support from other GDPS, specialist orthodontists and technicians. 

The ABB course is essentially one of the first courses the academy recommend for beginner GDP ortho - and they don't refer to GDP ortho as 'Short-Term Ortho', rather 'Anterior Alignment Ortho'. With the correct case selection, AAO can help align teeth in as little as 6-16 weeks!

The first day taught us about ClearSmile clear aligners and the Inman Aligner. The Inman can move teeth faster and the lab bill is cheaper than clear aligners but patients may prefer wearing clear aligners. 

Benefits of Early Orthodontic Intervention

• Better aesthetics
• Prevent further crowding which worsens with age
• Avoid expensive corrective treatment later in life
• Prevents uneven tooth wear that accelerates with age

Movements possible with Inman Aligner and ClearSmile aligners

Both devices focus on movement of the anterior teeth only. 

• Tipping
• Rotations
• Very minor bodily movements
• Very minor intrusions/extrusions
• Minor expansion

What Ortho records do I need?

1. 13-15 Orthodontic photos
2. Study models
3. OPG/PAs

IAS also run a photography course. 

The day was structured as theory in the morning and in the afternoon we had the chance to get some practical skills with hands on doing IPR (interproximal reduction) and bonding a fixed retainer. I have been on other GDP ortho courses before, but I felt the background and theory Tif taught gave me more understanding of assessment and treatment planning rather than just relying on a lab or ClinCheck. 

The advantage with IAS is not only a strong support network, but also the chance to enhance your skills by enrolling on some of the more advanced courses. If any GDP is looking to start an ortho journey, IAS will give a solid foundation of knowledge. 

Check out the highlights video of the day!

Have you been on an IAS course? What did you think? Let me know in the comments below. 

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Guest Post featuring Dentists Of Insta

A few months ago I was featured on @dentistsofinsta and this post is an interview with the founder Dr Jabir Kazi...

Hi I'm Dr Jabir Kazi and I just graduated from Newcastle Dental School. Coming out of dental school and engaging with people on social media I have been surprised by the current low morale amongst my fellow professionals in the UK. There are many valid reasons for the current mood: the GDC, UDA contracts, lawsuits and rising indemnity costs. 

This got me thinking and I consider myself a fairly social person so I started reaching out to people across social media in other countries to see what their experiences were like and how it tallied against the situation in the UK. 

This led me to start an Instagram page called @dentistsofinsta, which some of you may have come across as we are growing on a daily basis! On this page I give everyone from the dental world an opportunity to introduce themselves and impart some knowledge to the rest of the community. 

I'd like to invite anyone reading this to come and get involved!

But the story doesn't stop there....eventually this all lead to setting up a website with a friend who was running a dental joke page on Facebook. On our site, I feature all the people who have been on the Instagram page. Plus using my skills on Photoshop, we have developed a range of dental joke memorabilia... Check it out here!

In the future we are looking to add some resources for dental students but we don't know exactly what that will look like at this point in time. 

So if you're ever in the market for a gift for a colleague or friend, make sure you stop by and check us out before you head anywhere else... I'll promise you a laugh (or a groan) from our jokes!

To check out my feature on Jabir's site click here. 

Have you been featured on Dentistsofinsta? Let me know in the comments below. 

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