Implant Treatment for the Geriatric Patient: Necessity or Desire?
Modern Research in Dentistry , Volume 5, pp 490-495; doi:10.31031/mrd.2020.05.000611
Abstract: Eric Z Shapira* Professor of Geriatric Medicine and Dentistry *Corresponding author: Eric Z Shapira, Professor of Geriatric Medicine and Dentistry, USA Submission: February 17, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000611 ISSN:2637-7764Volume5 Issue3 Today, people are living longer and hopefully keeping their teeth longer. There are modalities of dental treatment that can correct tooth loss and bone loss with adequate substitutes that emulate “the real thing.” Bone loss, a disease symptom which can occur from multi-variants, can lead to subsequent tooth loss and an inability to replace these lost teeth. Dentists have long attempted to find ways of replacing missing teeth with endosseous, as well as subperiosteal implant techniques. Blade implants were the treatment of the 1950’s; whereby a small length-wise slit was made on the edentulous ridge to a depth conducive to “tapping” a stainless steel, flat fixture into the bone. Depending upon the width and depth of the surrounding bone, the blade implant could be used to hold single and/or multiple crowns. Trial and error led to the advent of the cylindrical, square, peg-shaped or rounded and oblong implants made of titanium and other osseo-integrative materials. Eventually, hydroxyl-appetite coated implants came into use and proved more successful than the standard blade type implant. The “coated” implants were more predictable and lasted longer, especially when coated with “plasma spray”. Older individuals with more discretionary income, who may have been conditioned and committed to saving their teeth, were the more obvious patients opting for implant tooth replacement. Many factors that figured into the equation of whether the implant would “take” or not had to be considered before an implant could be delivered as the treatment of choice. Today, in conjunction with these various factors of viability and disease, considerations for recommending an implant as a replacement for a missing tooth should be given the highest and priority as it has become the Standard of Care. Aging brings change to everything. Therefore, the human body is subject to many stressors, including stress itself, disease, time, the normal aging process, and physical injury of one kind or another. All of these aforementioned entities potentiate change and either allows the human body to adapt physiologically or forcibly exerts this change unconsciously or consciously depending upon the type of insult one is trying to cope with at the time. The older one gets, the more difficult this process is and the slower the process becomes. Patients on multiple drug therapies, patients with various systemic disease states, patients with emotional stress, one Dementia of another, personality disorders and various metabolic problems should be examined thoroughly, both dentally and medically, prior to any implant placement. One should go as far as getting a Medical Clearance for an elderly, medically compromised patient to have the surgical placement of an implant. The human body is susceptible to rapid changes that may be slow to expose symptoms which may be indicative of subliminal disease states. Many diseases today can and should preclude one from having a dental implant due to the high risk of potential failure. Some of these disease states might include: osteopenia, osteoporosis, diabetes, auto-immune diseases, diseases related to material allergies, xerostomia, stressrelated bruxism, chronic advanced periodontal disease and the loss of mental cognition, which would limit eventual home care and recall visits post implant placement; ultimately leading to failure. This author believes that our greatest challenge as dental practitioners is to get the patient, especially the older patient, who needs implant therapy to want an implant procedure; and for that matter, anything else that demands a choice in restoring a patients’ mouth to optimum health. That is: Our greatest challenge in dental practice is to get the patient to want what “we” think they need. All too often there remains a plethora of variables that can confound the choices we all make as patients. However, from experience, the biggest stopgap seems to be their abilities to afford implant therapy. There is no question in the mind of a person who for all their life has taken care of their mouth and the rest of their body, using self-efficacy as their guide, to want the best possible options to keep their dentition working in an ideal manner. There is no “hard sell” for the patient who knows what is best for themselves; but, for those patients who have difficulty making a decision for implant care, education seems to be at the core of this process. The question remains: Is it necessity, financial ability, rationalization through education or desire that helps in the process of getting to “yes?” Clinical examples can show how the prospective implant therapy for an elder can enhance their ability to function with embellished ability, a minimum of sideeffects and unnecessary angst about discomfort, ability to eat and other concerns (Table 1). Table 1: A step-wise system of learning. From Geriatric lectures of Eric Shapira, D.D.S. Avram King circa 1980’s©. In the 1980’s, a psychologist by the name of Avram  developed the Step-Wise System of Learning . This table shows how one comes to making a decision given information that they did not have before. The persons’ ability to choose is influenced by how the message is delivered of course, what kind of message it is e.g. didactive or guilt-inducing with judgment injected into the equation by the receiver. With the mixing of information, emotions, judgment and empathic or sympathetic words, a persons’ level of commitment is born. The commitment can be getting to “yes” or ending in “no.” This...
Keywords: emotions / Geriatric / implant / necessity / Eric / WISE / making a decision / Keeping / Shapira / Eventual
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