A MINIMALISTIC MANAGEMENT APPROACH FOR THE COMPROMISED ELDERLY PATIENT
is the acquired para-function by poor prosthetic
restorations and creating serious obstacle for
the stability of the new dentures. Anyway when
considering an adapted treatment planning for
the old-old patient, this asymmetric factor must be
taken under consideration.
Satisfaction with Complete dentures:
In the cohort of elderly there is an important group
who constantly has great difficulty in adjusting and
wearing dentures. Therefore they have a low quality
of life and are dissatisfied to cause considerable
problems to the dentists. Identifying these patients
prior the treatment will give the practitioner the
possibility to modify the approach and to help
the patient to adopt more realistic expectations.
There is a great variety of factors involved in the
dissatisfaction14 :
1. Past denture experience is more related to
denture satisfaction that the age.
2. Comfort is a decisive factor, because the patient
keeps comparing the new dentures to the old
ones, in terms of the design of the dentures, the
occlusal system, the free-way space and phonetics.
3. Usually the criteria for conventional dentures
are: accepted esthetics, good retention and
stability,the ability to chew properly, and acceptable
phonetics. A failure in one of these conditions will
led to a pitfall of all the oral rehabilitation.
4. Switching roughly from an old denture to a new
one is often a reason of destabilization for the geriatric patient. In this situation the patient will never
accept the new restoration.
5. This underlines the importance of the psychological aspects in the treatment of the elderly pa-
tient.
In the same way the influence of the systemic
condition and medication have an impact on the
tolerance of dentures.
6. Only a step by step treatment plan, with
evaluation possibilities is recommended. These
transitional steps are the condition sine qua non
for comprehensive and tolerated changes.
Conclusion
The description above brings a specific approach
to the elderly/frail patient. It is a fact that ageing
is a process which absolutely affects the patients
differently. Chronological age is not the only
indicator of the geriatric status. There is tremendous
variability in the biological and psychological
aspects between the patients. Consequently there
should be an individual and specific approach for
each individual. The treatment of these patients
asks for a realistic risk-benefit evaluation. One
of the most important challenges is adapted
management.
To avoid useless stress situations and important
economic burden, it is recommended to proceed
by a step by step schedule so as to be able to do
a constant revaluation. It requests first palliative
treatment and then transitional or intermediary
restorations.When considering the permanent
or final stage it should be essential to act in a
preventive perspective, giving always a possibility
for a repair or a transformation of the Prosthetic
devices.
To summarize this non-conventional approach
the Minimal Invasive Management is highly
recommended.
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