Omsorgstandpleje – en geriatrisk kasuistik
Der er forskellige kliniske behandlings- og fravalg ved oral rehabilitering af syge ældre. Her påvirker patientens almentilstand prioriteringen af odontologisk behandling. Alt efter anamnesen vælges kurativ eller palliativ behandling. En Alzheimer-dement patients orale sygehistorie beskrives. Den alvorlige demenstilstand med aftagende kognitive funktioner og reduceret mundhygiejne kombineret med en medicinsk betinget mundtørhed betyder dårlig prognose for protetisk behandling. Forebyggelse og behandling må tilpasses, mens avanceret protetisk behandling kan være uhensigtsmæssig.
Dental care – a geriatric case report: In geriatric dentistry it is even more important to consider the patient’s general health situation. Oral rehabilitation has a different perspective if the cognitive capacity is limited, and the physical resources, too. E.g. for patients with Alzheimer dementia, witch catches some 60% of all geriatric dementia patients. Any oral treatment to geriatric patients needs an analysis whether curative or palliative treatment is feasible. Standard solutions do not exist to the sick elderly. Sometimes it is the greatest challenge to the clinician to choose between treating the geriatric patient with the risk of producing iatrogenic disease, or not treating the patient with the risk of more damage occurring to the masticatory system. The clinician urges to prioritize in direct order: oral health – oral function – oral aesthetics. Thereby treatment – or lack of treatment – might be different from non-geriatric patients. Compromises are necessary and are only acceptable if the health benefit of the patient is greater than the damage. Acceptance of the patient or relatives is obligatory in dealing with geriatric patients with little compliance. A case story of an Alzheimer dementia patient is described. A severe dementia with declining cognitive functions and reduced oral hygiene combined with medical introduced dry mouth syndrome means poor prognosis for prosthetic treatment. Advanced prosthetic treatment might be inappropriate. Other oral treatments (e.g. choices of filling materials and extractions) and oral prevention (e.g. passive) might be preferred contrary to younger and healthier patients.
