Treatment of an Ageing Population with New and Emerging Technologies

The aim of this study was to assess treatment of elderly patients in a general dental practice and their acceptance of some of the new technologies introduced over a two year period. Previous studies have shown that a patient’s anxiety can be affected by a number of criteria; for example, the ‘dental’ smell of a practice waiting room and treatment area, the level of noise, or the degree of explanation and understanding of a procedure can have a great influence on the perceived level of pain. Other studies have show that the dental profession should also look ways of reducing the anxiety of not only the patient, but those who accompany the person or persons to be treated as anxiety can be transferred from one individual to another. Studies have tended to focus on the young patient, as the early memories of dental treatment can have a profound effect on the long term dental care needs and costs for an individual. In this study, in a general dental practice, the impact of new technologies was examined to see if there were any negative aspects of introducing new and emerging technologies into general dental practice. The dental profession has a number of relatively new technologies that are not universally found in dental practices. The computer is one, the intra-oral camera another. Other examples are computerised local anaesthetic giving systems, vibration attachments for the traditional syringe, air abrasion, new high-dose fluoride-releasing filling materials, the DIAGNOdent, and the HealOzone. 100 patients over the age of 65 who had attended for more than 2 years were asked to fill in a questionnaire. 97 filled this in fully, and 3 partially filled in their form. Patients over the age of 65 were chosen for this study, as this group will have seen the greatest changes in dental care. The age range was from 65 to 93, with a mean age of 73.8 (SD 6.4). The entry criteria for this study were attendance for dental examination and care. The following new and emerging technologies were chosen; computers, intra-oral camera, DIAGNOdent, air abrasion, and the HealOzone. The 4 last technologies form the core of the treatment protocol with the new ozone technologies in a group of dental practices in the UK. Patients expressed the opinion that computerisation demonstrated that a practice was keeping in touch with technology. Some commented that this would allow easy access to their records so past problems were easy to track. Others appreciated that the practice used their computer system to keep in regular contact with news, appointments and reminders. We found that in general all those questioned appreciated being shown the problem with the camera system. This allowed them to discuss the various alternatives offered and the cost implications. Patients appreciated that new DIAGNOdent diagnostic systems allowed them to ‘see’ the severity of the problem in a non invasive way, and did not necessitate radiological examination. In this particular practice, the x-ray room is on the second floor, and many expressed anxiety climbing up and down a flight of stairs with the risk of falling and injury. They were especially pleased that the dental profession had a way to reverse the effects of decay without the need to drill and fill at last. Where tooth preparation was necessary, air abrasion was very popular, as local anaesthetic in the majority of cases was not required. In general, this study showed that the elderly are very appreciative of new technologies. It does not seem to have made this group of patients more anxious. Indeed, it has reduced the levels of anxiety. In several instances, patients had attended with the expectation of having to have teeth removed. After treatment, they were very pleased that the new technologies had avoided tooth removal, that they had not had to have injections, and that the treatment was fast and pain free. Many commented on the speed and efficiency of treatment with the HealOzone. This study has shown that new technologies have a positive influence on the perception of the practice’s level of investment and this is frequently compared to their last dental practice. The new technologies discussed in this study have resulted in shorter treatment times. For example, treatment with the HealOzone is measured in seconds, whereas conventional treatment can be measured in half hour sessions. The cost of treatment has also fallen; fillings in the elderly tend to be larger, so failure can result in the necessity for a crown or implant. If the decay can be reversed before it reaches this stage, the potential cost is much reduced. The conclusion is that the new technologies examined had a positive influence on the elderly. This group of patients appreciated that investment had allowed them to keep their own teeth for longer, and that treatment was faster, pain free and predictable. Cost did not seem to be an important factor. Julian Holmes, September 2003.