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Ins and outs of treating older patients focus of toolkit

October 06, 2017

By Michelle Manchir



Dr. Gregory Folse grew up in Southern Louisiana — Bayou Country — occasionally accompanying his grandfather, a physician, on house calls, driving down dirt roads to visit older adults, many who had special needs.

As a teen, Dr. Folse witnessed his grandfather’s gentle touch and natural grace with the vulnerable patients, recognizing now, he said, as an adult and a dentist who has  dedicated his career to practicing in long-term care  and treating older patients for more than 25 years, that his grandfather “had the gene.”

The expression, he said, is well known in the world of special care dentistry to describe health care professionals drawn to treating patients with special needs and/or in long-term care facilities.

Recognizing that not all dental professionals who want to and can work with this population may intuitively know the skills it takes, the National Elder Care Advisory Committee, which previously reported to the Council on Advocacy for Access and Prevention, has developed the Dentistry in Long-Term Care Toolkit, an online resource featuring articles, expert interviews and online CE that aim to help dental professionals expand their knowledge and comfort level in addressing the oral health needs of older adults. Developing a long-term care dental training program, expanding dental practices into long-term care, regulatory requirements, getting paid through incurred medical expense reimbursement and other relevant issues are also addressed in the multifaceted kit.

CE course

Perhaps the centerpiece of the toolkit is an online, self-paced course offering 10 hours of CE called Dentistry in Long-term Care: Creating Pathways to Success, said Dr. Paul Glassman, chair of the National Elder Care Committee and director of community oral health at the Arthur A. Dugoni School of Dentistry. The course answers crucial questions for dentists who may be new to considering involvement in long-term care, Dr. Glassman said. Topics covered include how long-term care facilities are organized, how to work with patients with complicated health issues in the structure of long-term care institutions and how the dental team can be involved.

 “Many clinicians don’t feel adequately trained to work with patients who have medical problems,” said Dr. Glassman. “The CE modules and the toolkit can help familiarize dental professionals in that respect.”

But the course also has useful information for dentists already engaged in long-term care, such as financial considerations and an update about the current scientific literature, Dr. Glassman said.

Treating older adult patients is on the minds of many in dentistry as baby boomers age. About 1.3 million nursing home residents in the U.S. “face the greatest barriers to accessing dental care of any population group,” the toolkit says, and the number is expected to increase.

One way the toolkit can help established dentists, Dr. Glassman said, is introducing ways to make it feasible to follow and continue to treat aging patients when they can no longer visit the dental office. To be sure, he said, working in long-term care facilities does not have to be a full-time endeavor.

“Dentists can go occasionally see some of these patients in long-term care facilities and keep that relationship going,” Dr. Glassman said.

The course is $250 for ADA members, and dentists can register up to three of their nondentist team members at the reduced tuition of $150 per person.

Dr. Folse’s approach

Many of the other resources associated with the Long-Term Care Toolkit are no cost for members, including a video on the toolkit’s webpage that features Drs. Glassman and Folse. In it, Dr. Folse discusses and shows video clips of his work with older patients with special needs.

In the videos, Dr. Folse treats patients with cognitive impairments, including one whose body twitches because of a stroke.

“The part that takes some getting used to is patient approach,” Dr. Folse explains in the video. “How I talk to them; get them to open up to us.”

Dr. Folse said making eye contact, showing the patient he cares about them and then providing gentle and appropriate care once he gains their trust is essential — calling the method, “eyes, heart and treat.”

In one of the video clips, after the patient with spastic movements expresses relief following a tooth extraction, she and Dr. Folse share smiles and a happy moment together.

“The struggles that you may have are miniscule compared to the good that you do and the rewards that you receive as a professional,” Dr. Folse said.

To watch the video featuring Dr. Folse, register for the CE course or explore the toolkit’s other elements, visit  ADA.org/LongTermCareToolkit.

Delivering dental care to older adults in nursing homes is one of eight initiatives of the ADA’s Action for Dental Health, a community-based movement that aims to provide care to people who suffer from untreated dental disease and bring disease prevention and education into communities.

For more information about the Action for Dental Health initiatives, visit ADA.org/Action.