Geriatric patient

With the increase in the life span, Chronic

diseases play a significant role and the
dental diseases are the most prevalent
chronic condition.
Diagnosis and treatment planning for the
elderly must include considerations of the
biological , psychological , social and
economic status of the patient in
addition to the obvious dental problems .
Dentist is concerned with the emotional and
psychological state of the elderly patient, for
it is an essential component of treatment, and
the success or failure of the treatment often
depends on the emotional state of the patient.
Dentists may:
consider dental treatment successful when they
meet appropriate technological standards.
However patients evaluate the treatment from
the point of view of their own satisfaction.
 Body Image
Body Loss
Aetiology for development of
psychological and emotional
disturbances
 Life cycle is

Body Loss Growth, Strength, Activity

Decline, Decay, Death

Most people resist change in their appearance. Thus, body loss
and change in body image can result in anxiety, depression or
both and can affect a patient’s response to any therapy.
 Body Iimage
It,s the normal amount of pride or
narcissism (self-love) attached to
one’s own body and organs
Most people resist change in their appearance. Thus, body loss
and change in body image can result in anxiety, depression or
both and can affect a patient’s response to any therapy.
Thus, body loss and change in body image
can result in anxiety , depression or both
and can affect a patient’s response to any
therapy.
Emotional aspects of tooth loss
Tooth loss can be disabling and a handicap. It has a profound impact
on the lives of people.
The emotional effect of tooth loss can range from bereavement,
lowered self-confidence, altered self-image, dislike of appearance, an
inability to discuss this taboo subject.
A concern about prosthodontic privacy, behaving in a way that keeps
the tooth loss secret, altered behaviour in socialising and forming close
relationships and premature ageing. This group of patients tends to
restrict food choice, enjoy food less and may avoid laughing in public.
Psychological and emotional disorders usually seen by the dentists

1. Anxiety: Everyone is anxious to some extent

with anything new happening. Some degree of
anxiety will be seen in most of the patients in
the dental surgery.
Psychological and emotional disorders usually seen by the dentists

2. Depression: This is often disguised as a somatic

complaint such as pain, bad taste or an inability
to adjust to dental treatment.
Psychological and emotional disorders usually seen by the dentists

3. Conversion hysteria: By this means, people convert the

anxiety from emotional conflicts into somatic symptoms
such as pain, muscle weakness, or sensory disturbances, or
they reproduce a symptom which they had at some time in
the past.
Psychological and emotional disorders usually seen by the dentists

4. Body image disturbance: The mouth is the most emotionally

charged area of the body and therefore frequently involved in
body image disturbances. Any alteration to the patient’s mouth
is a body change to which they must adapt. Until they do,
anxiety will be present.
Factors that influence the patient’s response

I. Parental influences: Parents obviously have a profound

influence on the way their children perceive themselves
and the world.

Anxiety or phobias about dentistry, which affect 12% of the older population, can
seriously impede the search for treatment.
Factors that influence the patient’s response

II. Sibling’s influence: The behaviour of siblings also has a

strong influence on the dental attitude developed by
patients.

Anxiety or phobias about dentistry, which affect 12% of the older population, can
seriously impede the search for treatment.
Factors that influence the patient’s response

III. Peer group: A person is influenced

to some extent by his peer group.

Anxiety or phobias about dentistry, which affect 12% of the older population, can
seriously impede the search for treatment.
Factors that influence the patient’s response

IV. Symbolic significance: The more common symbolic

significance of tooth loss are ageing, loss of femininity,
loss of virility, loss of attractiveness and vitality and
body degeneration.
Factors that influence the patient’s response
Smaller lateral Incisors make your smile look more feminine, while larger lateral incisors
(more similar in size to the front two teeth) make your smile look more masculine.
IV.that
Lateral incisors Symbolic
are tiltedsignificance:
slightly toward The moreand
the middle common
tucked insymbolic
slightly behind the
middle teeth look more feminine,
significance while loss
of tooth straighter lateral incisors
are ageing, loss oflook more masculine.
femininity,
Lateral incisors
lossthatofhave rounded
virility, edges
loss of and are shorter than
attractiveness andthevitality
middle teeth
andlook more
feminine, while lateral incisors that are the same length as the middle teeth look more
masculine.
body degeneration.
Lateral incisors that are more triangular in shape (narrower at the gumline) look more
feminine, while side teeth that are squarer in shape look more masculine.
Factors that influence the patient’s response

V. Current life circumstances: Where one’s life is already

seriously disrupted, additional traumas such as tooth loss
may impair the ability to cope and increase the probability
of a maladaptive response.
1) Be agreeable
Courtesy, politeness and accommodation.
Cost nothing.
2) Be a good listener
Cultivate the habit of listening and not merely
remaining silent while the other person speaks.
Must be a good conversationalist, an
enthusiastic educator, and a good listener.
3) Avoid arguments
It must be remembered that verbal force has
never been a successful means of selling a
different opinion.
It is possible to win an argument but lose a patient.
4) Criticise tactfully
Criticism places people on the defensive
position; it makes them feel foolish and silly. It
can open deep wounds that never heal.
 5) Don’t be Egoistic
It is important to wait for the others to
appreciate the effective dental service that
you provide.
Appreciate the patient for the co-operation and positive attitude that they have
shown in your surgery.Compliment the patient for following your instructions and
for being optimistic about your treatment.
6) Remember names and faces

Remembering names and faces and addressing

patients by their name gives a feeling of being
at home.
7) Be interested in others
By the very nature of the work, dentists may become
introverted. For this reason, they should try to acquire
more characteristics of the extrovert by developing an
other than- self-attitude.
All attempts to influence people will meet with failure unless
the dentist uses terms the patient can understand. Technical
words and phrases are all right for dental meetings but they
should be carefully avoided when talking to patients. People
hate to admit that they do not understand; rather than asking
for clarification, they tend to reason it out on their own way
and often arrive at the wrong conclusions.
There is a huge difference between what
people want and what they require. The
role of dentist is to make the patient realise
their needs, and make people want what
they need.
 Most people pride themselves on being careful purchasers. In
giving a choice between two or more plans, a patient can be
diverted from a question,
‘shall I or shall I not have this work done’ by placing emphasis
on ‘which’ treatment plan will best suit his/her needs.

More success if you called the best plan the ‘ideal’ one, then offer a ‘compromise suggestion’ and possibly an alternative plan. Then after
explaining the various options.Dentist can help the patient come to a decision by asking, ‘Which plan do you feel will best suit your needs?
Study from Sweden showed that even when financial barriers are
removed, visits to dentists do not increase proportionately. In fact, the
relationship between patient and dental care provider is also influenced
by the behavior of both parties. People generally are prompted to seek
dental care by oral problems that cause pain or discomfort, and there
are some who believe that tooth loss is an inevitable consequence of
aging and postpone treatment until they are ready to replace all of their
remaining natural teeth with complete dentures. In any event, poor
rapport with dental professionals typically leads to a disregard for
professional advice and missed dental appointments.
Sterberg et al 1995
Proper medical history must be taken.
Appointment should be given according to their comfort.
Maximum treatment should be done in minimum appiontment.
Semi supine position of chair should be preffered,
Supine position can aggravate pulmonary problem.
Diabetic patient should not be starved.
Dentist and his staff must be calm and pilot.