Caring for ageing teeth

Dentists getting special training to better look after needs of elderly patients

Ms Seow is 80 but is still meticulous about the care of her teeth. At least, she would be, if her ability to clean her teeth had not been affected by her medical conditions.

She has had three strokes, each of which resulted in some sensory deficits. She is at risk of tooth decay and gum problems as she has poor sensation of food stuck in certain parts of her mouth. Her motor skills are also weaker.

"Sometimes, she misses certain spots as her fingers are stiff. The dentist will show us where the spots are using a mirror. He tries to get her to do it herself," said her relative, Mary (not her real name), who is her caregiver.

 

Fortunately, Ms Seow is fond of her dentist, Dr Tay Chong Meng, said Mary, and is happy to do what he tells her.

Specially trained dentists like Dr Tay, an assistant professor at National University of Singapore's dentistry faculty and associate consultant at the university dental cluster, National University Hospital (NUH), are best at handling patients suffering from physical and functional limitations due to geriatric conditions.

Geriatric and special needs dentistry is a relatively new field that is expected to become more important here, given the rapidly ageing population.

 

Singapore welcomed its first geriatric and special needs dentists in 2012. That year, Dr Tay returned from his postgraduate training in Australia to work at NUH.

He is one of six recipients of postgraduate scholarships from the Ministry of Health (MOH) in geriatric and special needs dentistry, and the first of four who have returned from their training to work in Singapore. MOH began offering such scholarships in 2008.

All six will be with these four hospitals - NUH, Tan Tock Seng Hospital (TTSH), Khoo Teck Puat Hospital and Ng Teng Fong General Hospital, said an MOH spokesman.

By October, Dr Tan Mei Na, a prosthodontist undergoing advanced training in geriatric dentistry in the United States, will return to work at NUH, said Dr Tay.

The National Dental Centre of Singapore (NDCS), which now has two visiting geriatric and special needs dentists, plans to send two to three dentists overseas for such training, said Dr See Toh Yoong Liang, deputy head of its Geriatric Special Care Dentistry Clinic.

NDCS started this clinic last September, but has yet to launch it officially.

Currently, the Dental Specialists Accreditation Board is looking into whether geriatric and special needs dentistry should be a recognised speciality.

"Complex dental problems in our geriatric patients are mainly managed by prosthodontists (who help restore or replace missing teeth), while many adult special needs patients are cared for by paediatric dentists and some general dentists," said an MOH spokesman.

Dr See Toh said NDCS has seen more elderly patients over the past few years, including those with Parkinson's or Alzheimer's disease, or who have age-related mobility issues.

Patients with Parkinson's disease or dementia may have food remnants left in the mouth for longer periods due to reduced effective movement of their cheeks or tongues, said Dr Ang Kok Yang, a special needs dentist at TTSH.

This puts them at risk of tooth decay. The resulting loss of teeth may limit the variety of food that they consume and their speech.

Geriatric and special needs dentists have "an arsenal of tools and tricks to make dentistry easier for these patients", said Dr See Toh.

Take, for instance, patients with Parkinson's, which can cause trembling in the hands, arms, legs and face, stiffness and slow movement.

They are taught to use adaptive aids with enlarged toothbrushes, which allow them to continue caring for themselves.

In treating patients with Alzheimer's disease, the progressive nature of the condition must be taken into consideration.

While planning their dentures, the dentist considers the spacing so that more teeth can be added to the denture if more of the patient's teeth are extracted, said Dr Tay. The patient can then continue using the same denture, with some new features added.

More dentists will be exposed to this field as the six scholarship recipients will provide regular training and upgrading courses for general dentists and oral health therapists, said the MOH spokesman.

A version of this article appeared in the print edition of The Straits Times on March 01, 2016, with the headline 'Caring for ageing teeth'. Print Edition | Subscribe