Q & A : An Aging World With Better Teeth
This week is Senior Smile Week, as proclaimed by the American Dental Assn. The U.S. Census Bureau projects that within five years, 22% of the population will be 55 or older. That’s nothing. Dr. Robert K. Shimasaki’s dental practice is already 30% senior citizens and growing. We visited Shimasaki, 52, in his Pasadena office, where he talked about treating seniors.
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Question: Do senior citizens pose any special problems?
Answer: Their tooth decay builds rapidly on the root surface--that location is a bear to treat. . . . We thought implants were going to be the answer for our senior population, but you can’t put them in older people. The bone won’t accept implants. I’m having to invent tooth designs as I go along.
Q: So dentures are no longer the major dental ordeal?
A: When I went through dental school over 20 years ago, the assumption was that when you reached 60, you were going to lose your teeth--which is a total fallacy. So a lot of time was spent making partials and dentures in my school. These days I make maybe two dentures a year.
Q: Is your course of treatment different for seniors?
A: I used to say to myself maybe we should do something temporary because they’re old. What the heck kind of thing is that? Who am I to decide? . . . Just because you’re old doesn’t mean you want less. I don’t ever want to treat geriatric patients differently than anyone else.
Q: What about gum disease?
A: I don’t see that as much. If 80-year-olds have hung on to their teeth, then they’re pretty solid.
Q: Dry mouth is a particular problem for seniors.
A: Medication dries out their mouth. They think the [lack of] saliva is normal. The only reason we know is because of rampant decay. If we’ve seen patients for 10 to 15 years and they’ve been doing splendid--maybe three to four cavities--and all of a sudden they’ve got six to seven horrendously large cavities, then we know they have dry mouth.
Q: What can they do at home for dry mouth?
A: Rinse with fluoride gels. About 50% of our senior patients are on fluoride gels.
Q: Any other home maintenance programs that you advise?
A: Most of them have lost some dexterity so they cannot floss anymore or do a simple thing like brush teeth. So they have to go to a mechanical device with an electrical rotary brush. That way they don’t have to move their hand up and down or flex their wrists. Also, it’s a lot easier for the person that’s helping them. We’re having them use a Water Pik device too.
Q: Do you need to tailor the appointment scheduling for seniors?
A: They’ve lost their independence--a lot of then can’t drive anymore--so we have to make leeway for them. They want you to do as much as you can in one sitting because they’re dependent on other people for rides.
Q: If you could make changes to your office, what would you do right now?
A: If I had to do it all over again, I would make each room and the entrances bigger. Within the next 10 years the whole setup is going to have to change because more of my patients will have special needs and we’re going to have to accommodate. I don’t consider 60 and 70 years as old anymore. In a few years, they are going to move up.
Q: What do you do when someone has to use a wheelchair?
A: The hygienist will sit down on the other side [of the wheelchair], but that’s hard. We don’t do as good a job. The ones that can move from the wheelchair, the challenge is how to move them without banging anyone around. The dentist chair has a little bar, a fixed metal piece. You have to pick the patient up, lift him over that arm, then hurdle into the chair.
Q: How have you physically altered the office?
A: Things aren’t in the way anymore. Everything in the room is mobile except for the dentist chair. We’re negotiating to put up a rail outside. I put in a couple of chairs in the waiting area that are easier on seniors. I used to have low-slung chairs but some patients would sit down and they couldn’t get out.
Q: What if someone can’t get to the office?
A: I treat [one patient] at home a lot. I’ve talked to my wife, Bonnie, about the wisdom of doing that because I just really can’t do as well there in his house. . . . Most people don’t ask this favor. They think you’re too busy. Most dentists that I know, if you asked them, they’d do it.
