Special Patient Care New York, NY
Dealing with Alzheimer’s Disease
Currently 5.3 million Americans are afflicted with Alzheimer’s, often leaving family members to make sure that their health and welfare are maintained. It’s very important not to underestimate the severe toll this disease leaves on close relatives and loved ones. Despite recent advances in confirming an Alzheimer’s diagnosis, definitive treatments are still years away. Only five drugs are currently in late stage clinical trials according to Dr. Paul S. Aisen, director of the Alzheimer’s Disease Cooperative Study and professor of Neuroscience at UC San Diego. Many companies have targeted this disease however, Eli Lilly alone, has a pipeline of seventy molecules in some stage of development.
As health care providers dentists face special challenges because of continuously diminishing patient cooperation in the chair, decreased efforts at home care, difficulty in communicating pain and sensitivity, or informed consent issues. Navigating these issues requires a big picture approach. In fact our entire model of care may need re-evaluation. Dentists typically practice under the “surgical” model; meaning that if something needs repair, we fix it. The medical care model involves disease management. Under the “medical” model, the benefits of invasive dental procedures need to be weighed against risks of sedation or general anesthesia, which are necessitated because patients’ dementia renders them incapable of cooperation otherwise.
Results Of Patient Care
If patients are eating well, have no pain or swelling; leaving dental disease that would otherwise be considered treatable may be the best medical decision. For this not to be considered neglect, consultations with treating physicians and family must be obtained along with documentation explaining the treatment rationale. Medical management may include preventive care, palliative treatments, and education for home or institutional care givers. This medical management can include fluoride varnish, high fluoride toothpaste, casein phosphopeptite (CPP) and amorphous calcium phosphate (ACP) application, frequent hygiene visits, glass ionomer restorations, and eugenol based temporaries. A dedicated, supportive dental team is integral for successful hygiene appointments, and nutritional education of caregivers.
When intervention is necessary, and traditional topical and local anesthetics are insufficient means for restorations, or extractions; some form of sedation may be necessary. My experience has been that very small dosages of sedatives can be extremely efficacious in the geriatric population because of generally reduced anesthetic requirements. Small dosages of oral midazolam (.1mg/kg) or triazolam (.125mg for a 70kg adult) in combination with nitrous oxide is all that is required in most cases for limited procedures. Determining a reasonable treatment plan is the key to success.
Many people on the autistic spectrum have a difficult time dealing with dental environment. This is partly due to differences in how people on the spectrum experience, understand and interact with the world in general. For most people, dental visits often require patience with a process that can be noisy, intrusive or restrictive for anyone. New sights, smells, sounds and emotions can add to the challenge.
The question is: what can be done to help patients and caregivers navigate this process with a minimum of angst?
Understanding the Patient
In our office, we’ve found that gaining the best possible understanding of the patient is the most critical ingredient for success. People on the autistic spectrum are unique individuals, with specific likes, dislikes, and things they will tolerate. It’s important to spend the time with the patient and caregivers, to determine their needs, and establish rapport. Preventive dental care and maintenance is emphasized so that patients need the least amount of invasive procedures possible.
Many patients simply require introducing new dental experiences at the patients own pace to allow for accommodation to changes in routine. Other patients may require some sedation to allow for better quality dental care. Sedation can be given by a pill or an elixir; or intravenously, depending on the extent of the dental care, the patients medical history, and the degree of cooperation the patient is able to provide. Whichever technique is required, patients will be made comfortable and monitored for their safety. Treatment decisions are made in consultation with parents, physicians, and our team to ensure that all the patients needs are considered.