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[Group of elderly people have gathered and are socializing outside.]
[Narrator:] We all know people like these: former neighbors, old friends, relatives.
Three are so many of them, so many chronically ill and aged in this country.
Almost six million invalids.
Many of them without ordinary and often vitally-needed dental care.
Fortunately more and more attention is now being focused on their plight
and dentists are discovering that the principle difference between routine treatments
and invalid treatments lies in the management of the patient.
Dentists' experience shows that treatment of the homebound and infirm
requires no highly specialized training and only a minimum of easy-to-carry portable equipment.
No more on each trip than needed for the case at hand.
By properly positioning the patient at the side of a hospital bed
or with a partial back rest on a regular bed, and placing the hand equipment
on a table found in the patient's own room, ease and convenience of operation is assured.
For this case, note that the dentist is using a portable high-speed air turbine, powered by a small bottle of CO2.
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Who are the chronically ill?
They can be simply defined as people with long-term disabling illnesses,
including arthritis, diabetes, multiple sclerosis, heart disease, palsy, and many other diseases.
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Most chronically ill and aged people can, with assistance, visit a clinic or office for dental treatment.
In such cases, with regular office equipment
and the dentist's own dental assistant, there are only minor differences between
treating most chronically ill patients and routine patients.
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With patients who cannot visit an office or clinic, the need for portable equipment is obvious.
To help dentists meet the needs of such patients, portable equipment was studied along with other aspects of dental care for the chronically ill,
in a four-year research program by the United States Public Health Service.
The study disclosed that complete and satisfactory dental care can be given in the home
with various types of currently available portable equipment.
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For example, this completely self-contained luggage case unit
weighing less than 40 pounds and powered from a standard hundred and ten volt wall outlet,
includes a standard speed motor, aspirator, compressed air water spray, and gooseneck lamp.
Such units have wide versatility.
In this case the unit is supplemented by a headrest that can be clamped on an ordinary chair.
The dentist takes with him on home calls
only a minimum of instruments and supplies carried in any handy carrying case that can be laid out
conveniently on a small table found in the patient's own home.
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This is a typical home care situation. In practically every instance, by using available furniture,
equipment and instruments can be located as conveniently as in office situations.
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The dentist knew in advance that this patient would require local anesthesia,
so disposable cartridge and needle were included in the kit of instruments for this call.
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As in the office, the dental assistant acts as a second pair of hands for the dentist,
helping reduce the time required to treat the patient.
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All that remains now is the preliminary trimming of the restoration
and of course polishing at the next visit.
The completed restoration is fully comparable to work done with standard office equipment.
Total time elapsed from setting up to leaving the house, 30 minutes,
only slightly longer than the office time for similar work.
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Other types of dental treatment can be provided equally well in the home.
In this case the dental hygienist is completing a prophylaxis with portable equipment
that clamps directly to the wheelchair, headrest, motor, and gooseneck lamp.
After the prophylaxis she will show the patient how to brush his teeth properly
and suggest dietary considerations to help him maintain a good dental health.
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At a later visit the dentist comes prepared for an extraction with just the equipment and instruments required.
The headrest is clamped on the wheelchair and for convenience in this instance
the dentist uses a headlight instead of a clamp-on gooseneck light.
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The needed sterile instruments are laid out on a table found in the patient's room
alongside the aspirator that's plugged into a wall outlet.
The assistant removes blood and moisture with a portable surgical aspirator as in office chair-side assistance.
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After the extraction the used instruments are carefully wrapped in
putting the carrying case for return to the office where they will be sterilized.
Again the entire procedure has been little different from office methods
except for the use of the minimum of portable equipment required for the visit.
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The full range of dental treatment is possible in home care cases
This patient has had 12 extractions, alveoloplasty, impressions,
and vertical [?] while confined to her bed,
a hospital-type bed, as is the case with many long-term chronically ill patients.
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On this visit her dentures will be inserted.
Dentures are important to this patient for more than health reasons.
Most people confined by chronic illness greatly need the lift attention gives them.
The feeling that somebody cares.
The pleasure of eating a variety of foods.
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In addition the dentures will do much to restore her self-confidence
and help her enjoy the company of her family and friends.
The equipment for adjusting her dentures is simple.
In this case the dentures are relieved with a standard stone and a portable hand-motor tool.
And to achieve proper occlusion,
the tooth surfaces are ground and polished with the same motor tool using a standard dental wheel.
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Each step in the making of this patient's dentures was performed in her home:
extractions, impressions, bite registration, and of course fitting of the completed dentures.
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Prosthetics, extractions, restorations, oral surgery, periodontal treatment...
a complete range of dental care can be administered to the chronically ill in their homes
with only slight modification of the operating techniques used in the office.
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Where then are the differences?
Primarily in the management of the patient and in evaluating her dental needs.
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Whether the patient is in her home or more commonly in the dentist's own office or in the clinic,
dental care is generally a special event to the chronically ill.
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Good rapport can usually be obtained by making the patient feel the appointment is a special event for the dentist too.
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The chronically ill and aged often have a lower tolerance to pain and discomfort.
By allowing patients to rest frequently and breaking up the treatment
into shorter periods, undue fatigue and tension can be avoided.
It is also important to bolster the patient's confidence, complimenting her generously on each accomplishment.
This approach is applicable of course to any patient of any age group.
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However, younger chronically ill patients are often more conscious of the extra effort that dentist must make to treat them.
And therefore more obviously appreciative.
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But no matter what the patient's age, the reassurance that the dentist personally cares enough
to provide the treatments helps lighten the heavy emotional burden of chronic illness.
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Many chronically ill patients will also be receiving medical treatment
and the dentist may wish to consult with a patient's physician.
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It is important to have at least a brief medical history so the need for consultation can be judged.
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A typical medical history should include medical diagnosis of the patient's illness,
medication, and the name of the patient's physician.
With general questions covering fainting, excessive bleeding, reactions from penicillin or anesthetics,
sores that heal slowly and other general symptoms that might require consultation.
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Medical consultation is indicated particularly for heart patients
or for patients on anticoagulant drugs when extractions or deep curettage are required.
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Patients receiving corticosteroids for conditions such as rheumatoid arthritis,
ulcerative colitis, or a blood dyscrasia may be susceptible to post-operative infections.
For such patients, prophylactic use of antibiotics may be indicated.
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Medical consultation is usually necessary for diabetic patients before even minor dental procedures.
So routine but necessary precautions may be taken.
Although most patients can be treated in the office or home,
hospitalization is sometimes required for patients
with severe circulatory diseases, diabetes, and extensive oral malignancies.
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Criteria for treatment must be evaluated along with several other aspects of the patient's condition.
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One such factor is the patient's general physical health.
For example when long-term systemic disorders
have lowered general resistance, dentures may cause deterioration of the oral mucosa and tissues.
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In other patients periodontal disease may have reduced
supporting bone structures so the denture success is questionable.
Severe periodontal disease is not uncommon with the chronically ill and aged, since their oral hygiene is often poorly maintained.
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The psychological attitude of the patient is very important.
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If the patient has adjusted well to chronic illness, as this patient has, his positive attitude may override many adverse indications.
The most important consideration is the potential benefit to the patient.
As can be seen, the portable equipment is light enough for easy handling.
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The responsibility for providing the chronically ill and aged with dental care falls on the entire community.
It is shared by the aged and chronically ill who must make an effort to obtain care.
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It is shared by the dentist who must be prepared to treat the chronically ill and aged.
It is shared by the professional schools that must prepare
future dentists and hygienists to treat the chronically ill as a routine part of dental practice.
Whether in the office or in the home.
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The University of Kansas City School of Dentistry, for example, participated in the Public Health Service study of dental care for the chronically ill.
The classroom training of dental and dental hygiene students was supplemented by practice in private and nursing homes.
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The result?
Dental care for many people who otherwise would not have been treated,
and training for the students in situations significantly different from the clinic or standard dental office.
We asked Dr. Hamilton B.G. Robinson, Dean of the School of Dentistry at the University of Kansas City,
for his evaluation of the training program. Dr. Robinson.
[Dr. Robinson:] Our dental students and our dental hygiene students have both benefited greatly from this program.
They used the portable equipment. They learned to handle the patients,
and above allthey learned the great need that these patients have for dental care.
In cooperation with the Public Health Service, we are incorporating treatment
of the chronically ill and aged in the curricula of our dental and dental hygiene schools.
This means expanding our present courses in home care
and may involve auxiliary training centers at nursing homes willing to cooperate with us.
Other dental schools of course are working on similar plans,
and we would like to feel that within the next five or six years, every new dentist
and every new dental hygienist will enter practice prepared to take care of the chronically ill and aged.
And that they will also expect that they will have patients who require complete dental care in their own homes.
[Narrator:] In the meantime, it remains for the dentists of today to add a new dimension to their general practice of dentistry.
Many of the chronically ill an aged fit into normal office routine.
The Kansas City project and other studies reached several clear conclusions.
Among them, the chronically ill and aged can be treated at home or in the office with no highly specialized training
and with only slight modification of operating techniques, treatment criteria, and equipment.
Management of such patients requires a heightened sensitivity of a patient as an individual.
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Chair-side assistance can of course help speed the dentist's work in both home and office treatment.
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The dental hygienist can perform prophylaxis, give oral hygiene instruction
and devise adaptations and modifications of standard devices that enable the patient to maintain better oral hygiene.
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Most types of treatment can be administered either in the office or home.
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When there is a choice, treatment should be given in a dental office or clinic.
But sometimes there is no choice and the dental service must be taken to the patient.
Home care patients can be given the same complete dental care as office patients, using portable equipment.
Such equipment might be obtained by the local Dental Society Health Department
or other agencies for the use of all dentists.
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Although dental care for the chronically ill and aged may involve a little extra time and effort.
It yields a deep and rewarding satisfaction, for the burden of chronic illness and age
is a burden of loneliness and isolation filled with problems and worries unfamiliar to most of us.
Lack of dental care should not be one of these worries.
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It is not only practical and feasible to provide the aged and chronically ill with dental care.
It is the ethical and moral obligation of the dental profession.
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