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Geriatric Dentistry: Before You Call 911

Course Number: 586

Initial Assessment

As quoted by Louis Pasteur, “where observation is concerned, chance favors only the prepared mind.”20 We are expecting participation from every member of the dental team with best possible intentions. Even some of the minor details can potentially be helpful in making vital changes in treatment options. The earliest assessment of the patient starts as soon as they walk into the dental clinic. The front desk personnel are the primary visual help for the entire dental team. They are the first point of contact with all new and re-visiting patients. Besides providing necessary guidance to the patient and their family in scheduling and insurance coverage, they must be trained in evaluating the patient as soon they step inside the clinic. Anything unusual should be brought to the attention of the dental staff for consideration and update in the patient’s medical record for future reference. The front desk personnel are not expected to provide diagnosis or judge an individual in any capacity; however, a quick assessment can help the dental team consider any relevant factors in effective treatment planning. Some of the more easily observed physical characteristics the reception staff may observe but are not limited to include:

  • Gait: How a patient walks can provide a trained mind with initial clues in identifying the overall well-being of the patient. In an article in the New York Times (2012), the author mentions an elderly person’s gait appears to be an early indicator of cognitive impairment; including Alzheimer’s disease.21 Their walking pattern can also mirror physical conditions such as arthritis, osteoporosis, Parkinson’s disease, etc. and manifests differently in both males and females.

  • Dressing: Apparel is no longer considered to be a solo reflection of an individual’s financial stability. They act as part of non-verbal communication. Along with the monetary picture, the mode of dressing can also be indicators of an individual’s mental or psychological status.24 In the case of the elderly patient an unkempt appearance can also prove to be a red-flag as this may be suggestive of cognitive decline or even abuse that definitely requires further investigation.25

  • Hair: Hairstyles can suggest many finer details regarding the character and behavior of the elderly patient. Financial, social, physical health along with some medications can have direct or indirect impact on the patient’s hair. Details as minute as unkempt hair or heavy dandruff can be sufficient to alert the team to the patient’s level of stress, depression, nutritional deficiencies or even conditions like eczema and psoriasis.23

  • Nails: Our body has a tendency for letting us know when something is not right, and our nails are no exception. Their shape, texture, color, and overall form can be sufficient in raising suspicions to the trained eye. In one study, the authors clearly indicated the co-relation between nail care in the elderly and underlining physical conditions.26 These conditions can range from fungal infections, chronic renal failure, liver cirrhosis, congestive heart failure, diabetes mellitus, and even Hodgkin’s lymphoma that can contribute to early diagnosis.

  • Speech: Slurred speech observed during interaction with family members or staff can provide insight on any history of stroke, apraxia22 or even side effects of medications.

Some of the other indicators may include skin tone and texture, color of the sclera and breathing pattern that can be crucial and should be explored by the dental team.