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Senior Adult Dental Health Week?
LETTERS TO THE EDITOR T H E JO U RN A L devotes th is s e c tio n to co m m en t by readers on to p ics o f cu rre n t in terest to den tistry. T h e ed ito r reserves th e righ t to ed it all co m m u n ica tio n s to fit a v a ila b le sp a ce and req u ires th a t all let ters be sig n ed . P rin ted co m m u n ica tio n s do not n ecessa rily reflect th e o p in io n or o ffic ia l p o lic y o f the A sso cia tio n . Y o u r p a rticip a tio n in th is s e c tio n is in vited.
S en io r ad u lt d en tal h ealth w eek? □ For more than 30 years, the dental profession has talked about Children’s Dental Health Week (lately changed to Children’s Dental Health Month 1981), and the preventive aspects of modern dentistry. Little has been said, or done, about the other end of the “spectrum of life,” the senior adult years. How about considering a week in the fall of 1981 as Senior Adult Dental Health Week? The senior adults in your practice belong to a lost generation, as far as preventive dentistry is concerned. They were in their 20s or 30s when fluoridated water was introduced. Their dental experiences dealt mainly with mouth rehabilitation and clear ing up the effects of neglect. More re cently, they have been introduced to a new regimen of plaque control. T h e se n io r a d u lts need d en tal knowledge. They are anxious to hear more about dentistry from disinter ested persons. Most of the time, they do not know why an involved dental procedure was performed on them. Either the dentist did not spend too much time in the explanation, or the patient was unable to comprehend it. The stereotype of the senior adult, in the minds of some, is a denture wearer whose only interest is to know how to make his dentures function properly and how to keep the dentures clean. This is a wrong concept! The follow ing con clu sions were drawn after four presentations of den tal health education at four different senior-citizen centers: Many of the newer generation of senior adults have retained a good part of their original dentition. They are very concerned about m aintaining their dental health and appearance. The emphasis for the senior adult is doing all the things that will improve and m aintain physical and mental 8 ■ JADA, Vol. 102, January 1981
health. The outlook is “upbeat” and sophisticated. Good medical and den tal hygiene, as well as good nutrition and exercise, are important parts of the monthly programs at adult centers. Health (medical and dental) is on the upgrade. Question and answer periods showed that the four senior citizen centers had a very keen interest in every phase of dentistry for the senior adults, and for their ch ild ren and grandchildren. They were very inter ested in dental care as part of a wider program of self-improvement. These older adults have reached a time of life where they have the time, th e in tere st, and, freq u en tly , the m o n e y to i n v e s t in t h a t s e l f improvement. The senior adults may be part of your dental practice. At times, they may present a negative picture to the dentist. They may say that they do not have many years to live, so why spend the money and time? These negative attitudes should be broken down in a careful fashion after a thorough examination of the dental and medical health of the patient. One very important conclusion from the four talks is that the informal pre sentation of dental facts from an inter ested dentist made an impression on these senior adults. Let us consider a week in the fall of 1981 as Senior Adult Dental Health Week. Such an event would give den tists the opportunity to present infor mal talks at the many senior adult cen ters throughout the country. ALAN A . A X E LBA N D , DDS N EW Y O R K
D iagnostic judgm ent in su rg ica l p ro ced u res □ The Journal (April 1980) reported “a consensus development conference
on the removal of third molars was held at the National Institute of Health. A number of well-defined criteria for the removal of third molars emerged. They include infection, nonrestorable carious lesions, cysts, tumors, and de struction of adjacent teeth and bone. Less morbidity is associated with the removal of the teeth in younger pa tients.” Drs. Bruce, Fredrickson, and Small (August 1980) concluded “when it has been determined that the mandibular third molar must be removed, the op eration should be performed on the young adult.” In the same issue, Drs. Hind and Frey also reinforced the consensus: “Expeditious extraction of embedded third molars is clearly indicated in the follow ing situations providing that o v e r r id in g c o n t r a in d ic a tio n s to surgery do not exist: development of a follicular cyst, pericoronitis or another infection, peridontitis caused by and exacerbated by third molars, nonres torable caries or internal resorption, destruction of alveolar bone, resorp tion of roots of other teeth, or both, in terference with prostheses in edentu lous arches, facilitation of orthodontic treatment, preradiation therapy and traumatic involvement or presence in line of fracture.” There followed a well-prepared and thorough analysis relevant to the re sults and hazards involved in the ex traction of third molars in 15 patients all older than 40 years. In summariz ing, this analysis stated that “surgical difficulties and postsurgical com plica tions and m orbidity that occurred would have been greatly reduced if these teeth had been removed earlier in life.” Inadvertently, or otherwise, as Dr. Dubrow’s letter (November 1980) in dicates , the finger points directly at the general practitioner who should never
S en io r ad u lt d en tal h ealth w eek? □ For more than 30 years, the dental profession has talked about Children’s Dental Health Week (lately changed to Children’s Dental Health Month 1981), and the preventive aspects of modern dentistry. Little has been said, or done, about the other end of the “spectrum of life,” the senior adult years. How about considering a week in the fall of 1981 as Senior Adult Dental Health Week? The senior adults in your practice belong to a lost generation, as far as preventive dentistry is concerned. They were in their 20s or 30s when fluoridated water was introduced. Their dental experiences dealt mainly with mouth rehabilitation and clear ing up the effects of neglect. More re cently, they have been introduced to a new regimen of plaque control. T h e se n io r a d u lts need d en tal knowledge. They are anxious to hear more about dentistry from disinter ested persons. Most of the time, they do not know why an involved dental procedure was performed on them. Either the dentist did not spend too much time in the explanation, or the patient was unable to comprehend it. The stereotype of the senior adult, in the minds of some, is a denture wearer whose only interest is to know how to make his dentures function properly and how to keep the dentures clean. This is a wrong concept! The follow ing con clu sions were drawn after four presentations of den tal health education at four different senior-citizen centers: Many of the newer generation of senior adults have retained a good part of their original dentition. They are very concerned about m aintaining their dental health and appearance. The emphasis for the senior adult is doing all the things that will improve and m aintain physical and mental 8 ■ JADA, Vol. 102, January 1981
health. The outlook is “upbeat” and sophisticated. Good medical and den tal hygiene, as well as good nutrition and exercise, are important parts of the monthly programs at adult centers. Health (medical and dental) is on the upgrade. Question and answer periods showed that the four senior citizen centers had a very keen interest in every phase of dentistry for the senior adults, and for their ch ild ren and grandchildren. They were very inter ested in dental care as part of a wider program of self-improvement. These older adults have reached a time of life where they have the time, th e in tere st, and, freq u en tly , the m o n e y to i n v e s t in t h a t s e l f improvement. The senior adults may be part of your dental practice. At times, they may present a negative picture to the dentist. They may say that they do not have many years to live, so why spend the money and time? These negative attitudes should be broken down in a careful fashion after a thorough examination of the dental and medical health of the patient. One very important conclusion from the four talks is that the informal pre sentation of dental facts from an inter ested dentist made an impression on these senior adults. Let us consider a week in the fall of 1981 as Senior Adult Dental Health Week. Such an event would give den tists the opportunity to present infor mal talks at the many senior adult cen ters throughout the country. ALAN A . A X E LBA N D , DDS N EW Y O R K
D iagnostic judgm ent in su rg ica l p ro ced u res □ The Journal (April 1980) reported “a consensus development conference
on the removal of third molars was held at the National Institute of Health. A number of well-defined criteria for the removal of third molars emerged. They include infection, nonrestorable carious lesions, cysts, tumors, and de struction of adjacent teeth and bone. Less morbidity is associated with the removal of the teeth in younger pa tients.” Drs. Bruce, Fredrickson, and Small (August 1980) concluded “when it has been determined that the mandibular third molar must be removed, the op eration should be performed on the young adult.” In the same issue, Drs. Hind and Frey also reinforced the consensus: “Expeditious extraction of embedded third molars is clearly indicated in the follow ing situations providing that o v e r r id in g c o n t r a in d ic a tio n s to surgery do not exist: development of a follicular cyst, pericoronitis or another infection, peridontitis caused by and exacerbated by third molars, nonres torable caries or internal resorption, destruction of alveolar bone, resorp tion of roots of other teeth, or both, in terference with prostheses in edentu lous arches, facilitation of orthodontic treatment, preradiation therapy and traumatic involvement or presence in line of fracture.” There followed a well-prepared and thorough analysis relevant to the re sults and hazards involved in the ex traction of third molars in 15 patients all older than 40 years. In summariz ing, this analysis stated that “surgical difficulties and postsurgical com plica tions and m orbidity that occurred would have been greatly reduced if these teeth had been removed earlier in life.” Inadvertently, or otherwise, as Dr. Dubrow’s letter (November 1980) in dicates , the finger points directly at the general practitioner who should never