Subject

Gerodontology

  • code 10464
  • course 5
  • term Semester 1
  • type OB
  • credits 3

Main language of instruction: Spanish

Other languages of instruction: Catalan, English

Teaching staff

Head instructor

Dr. José Manuel RIBERA - mribera@uic.es

Office hours

Monday at 15 p.m. By appointment via e-mail to the lecturer: mribera@uic.es

 

Introduction

Gerodontology is the area of dentistry concerned with the ageing of the oral cavity. The discipline deals with the various methods for preventing, detecting and treating bucodental disease and for promoting oral health among the elderly.

 

Pre-course requirements

 There are no prerequisites.

 

Objectives

 General objectives

A. To provide the student with the knowledge, skills and aptitudes required for the prevention, diagnosis and treatment of anomalies and diseases of the teeth, mouth, maxilla and tissues of the elderly patient.

B. To train the student in the scientific method applied to the study, evaluation and solving of dental health problems.

C. To prepare the student for future professional self-development.

D. To train the student towards eventual specialisation, research or teaching.

Intermediate goals

The intermediate goals of Gerodontology may be summarised as follows:

1. To acquire the skills and attitudes needed for the clinical screening of the elderly patient. To obtain and assess clinical, radiographic and complementary data of the elderly patient and undertake a diagnostic, prognostic and therapeutic approach to the patient’s bucodental health condition.

2. To distinguish the characteristics of the diagnosis and therapeutic approach in personalised dental care for the elderly patient.

3. To identify and describe the etiological and risk agents of oral diseases in elderly patients.

4. To train students to perform the main treatment methods and techniques, and in the control and prevention of oral diseases collectively for elderly patients.

5. To master the individual and community educational techniques for elderly patients.

6. To train the student to describe the oral health condition and the dental treatment needs of the different groups of elderly patients.

7. To know and describe the different groups of elderly patients pursuant to their capabilities, their degree of dependency, their social environment and their place of residence.

8. To know the different public health programmes designed for the dental care of the group of elderly patients.

9. Know the management of anxiety through drugs and sedation with nitrous oxide in the elderly patient

Competences / Learning outcomes of the degree programme

  • 04 - Understanding and recognising the social and psychological aspects that are relevant in terms of treating patients.
  • 15 - Being familiar with the general pathological characteristics of the illnesses and disorders that affect organic systems, specifically those which have dental repercussions.
  • 20 - Obtaining and creating a medical record containing all the relevant information.
  • 21 - Knowing how to undertake a full dental exam, including the necessary X-ray and complementary exploratory tests, as well as obtaining suitable clinical references.
  • 23 - Establishing a diagnosis, prognosis and suitable treatment planning for all the different clinical areas of Dentistry, being competent in terms of the diagnosis, prognosis and writing up the dental care plan for patients who require special care, including medically compromised patients (such as diabetics, those with hypertension, a depressed immune system or are anticoagulated, etc) and patients with disabilities.
  • 25 - Being aware of and applying basic treatment for the most common dental pathology in patients of all ages. The treatment procedures must be based on the concept of minimally invasive surgery and an overall and comprehensive focus on dental treatment.
  • 28 - Acquiring clinical experience under suitable supervision.
  • 41 - Being aware of the behavioural and communication sciences which facilitate dental practice
  • 47 - Educating and motivating patients in the area of oral and dental diseases, controlling pathogenic oral habits,
  • 59 - Knowing the oral manifestations of systemic diseases
  • 60 - Knowing about general and clinical pharmacology for dental practice
  • 63 - Having knowledge of human nutrition, particularly the connection between nutritional habits or diet with the maintenance of good health and the prevention of oral and dental diseases
  • 64 - Undertaking basic oral and dental pathology treatments for patients of all ages. The treatment procedures should be minimally invasive and based on a comprehensive and integrated approach to oral and dental treatment
  • 72 - Appropriate medical prescriptions, while being aware of their guidelines and warnings, systemic effects and repercussions on other organs
  • 92 - Pre-professional practicums, in a rotational dental clinic with a final evaluation of competences, which allow for the incorporation of professional values, healthcare communication competences, clinical reasoning and management, and critical judgement. This must also include clinical work by the students on patients of all ages and conditions, in a comprehensive manner and under suitable supervision.
  • 05 - Knowing how to apply the correct principles to control anxiety and stress in oneself, in patients and in other memebers of the dentistry team.
  • 61 - Knowing the pharmacological grounding for the various anaesthetic techniques, both local and general, as well as the role of sedation and general anaesthesia in terms of managing dental patients

Learning outcomes of the subject

General objectives:

UNIT 1. DIFFERENTIATING ELEMENTS OF THE CLINICAL RECORDS OF ELDERLY PATIENTS

By the end of this unit, students shall be able:

  • To understand the concepts of “healthy ageing” and “active ageing”.
  • To assess the macroscopic and microscopic differences at tooth, periodontal, TMJ, oral mucosa, sensory organ and salivary gland level between elderly and non-elderly patients.

UNIT 2. SKIN AND MUCOSAL LESIONS IN THE ELDERLY

                UNIT 2.1. MUCOSAL LESIONS

By the end of this unit, students shall be able:

  • To understand the variants of normality in mucosa in elderly patients
  • To differentiate between the morphology of mucosal elementary lesions
  • To distinguish the lesions produced by mechanical iatrogenic agents or by ill-fitting dentures
  • To distinguish the lesions produced by smoking, alcohol and medication in the mucosa of the elderly
  • To distinguish the most common viral, bacterial or fungal lesions in the elderly

To be familiar with the most prevalent cancerous and pre-cancerous lesions

        By the end of this unit, students shall be able:

UNIT 2.2. ORAL MYCOSIS

  • To be familiar with the different types of pathogenic action that fungi can develop
  • To know which factors generally benefit the growth of fungi in the elderly, and specifically for oral candidiasis
  • To understand the clinical expression and forms of oral candidiasis. Denture stomatitis
  • To understand the diagnostic approach and treatment for oral candidiasis

UNIT 3. PHYSIOLOGY OF AGEING

By the end of this unit, students shall be able:

  • To understand concepts related to health:  disease, health, well-being and life quality, disability
  • To understand the biomedical, social and biopsychosocial models of disease
  • To understand the concepts related to the life cycle:  maturity, ageing, life expectancy, longevity
  • To understand the main theories which explain ageing
  • To assess the requirements of “physiological” ageing compared with “pathological” ageing
  • To understand the repercussions of physiological ageing on the different body systems

UNIT 4. OROFACIAL PAIN IN THE ELDERLY

By the end of this unit, students shall be able:

  • To classify oral pain
  • To identify the characteristics of the different kinds of oral pain with the greatest prevalence among the elderly

UNIT 5. FUNDAMENTALS OF GERIATRICS

By the end of this unit, students shall be able:

  • To understand the basic features of elderly patients
  • To situate the evolution of geriatrics in the clinical record
  • To identify the major symptoms of geriatrics
  • To assess the atypical signs of diseases
  • To conceptualise the comprehensive geriatrics approach process
  • To understand the advantages of the comprehensive geriatrics approach and the instruments for implementing it
  • To understand the fragility and risk criteria, and the assessment scales for measuring them

UNIT 6. PRINCIPLES OF PHARMACOLOGY IN THE ELDERLY 

By the end of this unit, students shall be able:

  • To understand the differentiating elements in drug use by the elderly
  • To assess the action of the drugs in the bodies of elderly patients
  • To understand the factors which change the response, distribution, absorption, metabolism and elimination of the drugs
  • To understand the adverse drug reactions (ADR), their types and the main producers
  • To recognise the most common manifestations of ADR in the elderly
  • To assess the meaning of the drug interactions
  • To understand the general principles of drug prescription for the elderly and the ways of administering them

UNIT 7. PSYCHOGERIATRICS AND PSYCHOPHARMACOLOGY

By the end of this unit, students shall be able:

  • To understand the types and treatments of anxiety disorders
  • To understand the characteristics of affective disorders in old age
  • To understand the characteristics of cognitive disorders in old age
  • To understand the characteristics of paranoid personality disorders in old age
  • To understand the characteristics of dyskinesia and its repercussions
  • To assess the faculties that may affect the development of dental treatment
  • To understand the repercussions of substance abuse
  • To understand the repercussions of insomnia in the elderly
  • To understand and assess antidepressants and their effects
  • To understand and assess the effect of anxiolytics and hypnotics
  • To understand and assess the effect of neuroleptics
  • To understand the specific features of dental treatment in patients with dementia

UNIT 8. SURGERY FOR ELDERLY PATIENTS

                UNIT 8.1. ORAL CANCER

By the end of this unit, students shall be able:

  • To understand the epidemiology of oral cancer in the elderly
  • To assess the most significant aetiology and triggers in elderly patients
  • To recognise the most prevalent oral pathologies that can lead to cancer in the elderly
  • To assess the clinical and pathological manifestations of oral cancer
  • To understand the therapeutic approaches for the elderly

 

                UNIT 8.2. IMPLANTS FOR THE ELDERLY

By the end of this unit, students shall be able:

  • To understand the specific features of the use of implants in elderly patients
  • To assess the influence of age in the prognosis, indications and contraindications, results and complications in relation to managing implants

UNIT 9. THE SOCIOLOGY OF AGEING

By the end of this unit, students shall be able:

  • To understand the heterogeneity of age group classification for the elderly
  • To understand the demographic features of old age in Spain
  • To assess the problems related to the economy, retirement and financial aid systems for the elderly
  • To conceptualise “active ageing”
  • To assess the crosscutting determinants related to the health, behavioural, personal and physical environment systems in active ageing
  • To recognise the challenges for society produced by an ageing population

UNIT 10. CARIES IN THE ELDERLY

By the end of this unit, students shall be able:

  • To understand the epidemiological characteristics of caries in the elderly
  • To assess the factors related to the aetiology of root caries and the positive or associated predictors of the same
  • To describe the ways of diagnosing and classifying root caries
  • To differentiate between active and inactive root caries
  • To understand the criteria and indexes of root caries population diagnostics
  • To know the action mechanisms of dental caries

UNIT 11. PREVENTIVE DENTISTRY IN THE ELDERLY

By the end of this unit, students shall be able:

  • To describe the population characteristics of the elderly
  • To analyse the current situation for an elderly population
  • To understand the aspects of a preventative programme targeting the elderly
  • To prepare a prevention programme for the elderly
  • To follow-up on the programme

UNIT 12. INSTITUTIONALISED ELDERLY PATIENTS

                UNIT 12.1. ORAL CARE PROGRAMMES FOR INSTITUTIONALISED PATIENTS

By the end of this unit, students shall be able:

  • To describe the population characteristics of institutionalised elderly patients
  • To understand the guidelines for designing comprehensive dental care programmes for institutionalised elderly patients           

                UNIT 12.2. THE PUBLIC HEALTH SYSTEM

By the end of this unit, students shall be able:

  • To understand the care models provided through the public health system 
  • To understand the “Catalan care model” and its structure, provisions and organisation
  • To understand the scope of the public provision for gerodontology and special patients in Spain

UNIT 13. DENTURES IN THE ELDERLY

By the end of this unit, students shall be able:

  • To understand the data provided from epidemiological surveys conducted with elderly patients wearing dentures
  • To understand the recommendations which, for the elderly, have an effect on national health surveys
  • To assess the clinical, technical and developmental elements of removable dentures for the elderly
  • To assess the clinical, technical and developmental elements of fixed dentures for the elderly
  • To assess the clinical, technical and developmental elements of implant-supported dentures and overdentures for the elderly

UNIT 14. RESTORATIVE DENTISTRY FOR ELDERLY PATIENTS

By the end of this unit, students shall be able:

  • To understand the specific features for preparation in elderly patients
  • To understand the specific features of the pulp and periapical pathologies in the elderly and their treatment
  • To understand the implications of iatrogenic factors and wear from bruxism in elderly patients
  • To understand the clinical and treatment-related aspects of importance for endodontic treatment in elderly patients

UNIT 15. PERIODONTICS FOR ELDERLY PATIENTS

By the end of this unit, students shall be able:

  • To understand the most prevalent periodontics pathologies for the elderly
  • To understand the essential aspects of periodontitis in the elderly
  • To understand periodontal changes in the elderly
  • To diagnose and treat periodontitis for elderly patients

UNIT 16. XEROSTOMY

By the end of this unit, students shall be able:

  • To understand the physiopathology of saliva
  • To assess factors that change salivary flow
  • To understand salivary changes based on age
  • To assess the salivary changes induced by drugs
  • To describe the drugs that most often produce xerostomy
  • To understand the diseases associated with xerostomy
  • To understand the clinical practice and diagnostic tests for xerostomy
  • To treat xerostomy symptomatically and specifically

UNIT 17. APPLIED PHARMACOLOGY FOR ELDERLY PATIENTS 

By the end of this unit, students shall be able:

  • To understand the handling and interactions of the main drugs used by elderly patients
  • To assess the major side effects of the most common drugs used by elderly patients
  • Know the pharmacological management of anxiety and sedation techniques with nitrous oxide

UNIT 18. AGING AND NUTRITION

By the end of this unit, students shall be able:

  • To understand the implications of the variations in the body composition of elderly patients
  • To understand the physical changes which create the conditions for a different diet
  • To understand the influence of physical activity and the psychosocial and health changes
  • To understand the minimal nutritional requirements of the elderly
  • To understand the nutritional requirements of the elderly in specific pathological situations

 

Syllabus

 ACADEMIC PROGRAMME

Split into three main sections: Introduction to the subject, geriatrics and gerontology, and the prevention and treatment of oral diseases in elderly patients.

 

BLOCK I. INTRODUCTION

 

  1. THE DEMOGRAPHIC AND SOCIOLOGICAL ELEMENTS OF AGEING
  2. NORMAL AGEING

 

BLOCK II. GERIATRICS AND GERONTOLOGY

 

  1. MEDICAL PATHOLOGY FOR THE ELDERLY. BASICS OF GERIATRICS  
  2. PHARMACOLOGY FOR THE ELDERLY. PSYCHIATRY AND PSYCHOPHARMACOLOGY
  3. INSTITUTIONALISED ELDERLY PATIENTS.  PUBLIC GERIATRIC DENTISTRY 

BLOCK III. GERODONTOLOGY

 

  1. DIFFERENTIATING ELEMENTS OF THE CLINICAL RECORDS OF ELDERLY PATIENTS 
  2. DENTAL CARIES IN ELDERLY PATIENTS:
  3. PERIODONTAL PATHOLOGIES IN ELDERLY PATIENTS 
  4. ORAL CANCER IN ELDERLY PATIENTS 
  5. SALIVARY DISORDERS AMONG ELDERLY PATIENTS 
  6.  ORAL MYCOSIS IN ELDERLY PATIENTS MUCOSAL LESIONS
  7. OROFACIAL PAIN IN ELDERLY PATIENTS
  8. CONSERVATIVE DENTISTRY IN ELDERLY PATIENTS
  9. DENTURES FOR ELDERLY PATIENTS
  10. SURGERY FOR ELDERLY PATIENTS IMPLANTS 
  11. INTEGRATED DENTISTRY FOR ELDERLY PATIENTS
  12. PREVENTIVE DENTISTRY FOR ELDERLY PATIENTS
  13. NUTRITION AMONG THE ELDERLY  

 PRACTICAL PROGRAMME

It will be developed at the University Dental Clinic in an integrated way.

 

Teaching and learning activities

In person

 Master classes:Themes with computer-based support shall be posted prior to lectures on the Intranet.

 

Practical seminars:Attendance shall be mandatory.Attendance shall be recorded.Only two JUSTIFIED absences are permitted.Clinical case studies shall be debated in a participatory manner.The seminar will be attended with a laptop, tablet or mobile

Introduction:Students, in groups of four, must prepare a communication that will be submitted along with the corresponding report to the Spanish Gerontology Society Congress or other scientific venue, chosen along similar lines.In the final seminars, the summary or abstract of the communication shall be presented and explained to the group.  

At the beginning of the course, a list of topics and tutors-lecturers in the field shall be provided, and these tutors shall follow the progress of the work.


Integrated clinical practice:Students will develop skills at the University Dental Clinic through the care of elderly patients integrated with general clinical care.

 

Evaluation systems and criteria

In person

MASTER CLASSES: The exam shall  consist of 40 test questions and answers 5 correct one. Subtracted 0.20 points for each answer incorrecta.Se continuous assessment shall check without warning at the time of the seminars. These exams will consist of 15 questions given so far, both theory and seminars and will be corrected with the same criteria as the final exam

PRACTICAL SEMINARS:  The exam consist of 10 multiple choice questions with five answers and the correct one. 0.20 points deducted for each wrong answer. Only you can examine this part who has attended class with a maximum of 2 excused absences. The justification is given at most the next week of absence

The EXAM represents 50% of the mark.

The evaluation of the communications represents 20% of the mark.

The evaluation of the activity at the University Dental Clinic will represent 30% of the mark.


Bibliography and resources

Gerodontologia . Societat Espanyola de Gerodontologia SEGER 2012 . Coordinadors Dr.J.López , Dr E.Chimenos , Dr M.Ribera
Oral Health care in geriatric patiens . Ship J. 2005 .Editorial Decker
Clinician's guide to common geriatric oral conditions  2006 . Ship J. 2006 . Editoral Decker
Odontogeriatría . Rehabilitaciónoral del paciente adulto mayor . Cuervo J 2012 Editorial Impresión Médica
Cuidado de la salud bucal y el anciano frágil . Una perspectiva clínica . Mac Entee M 2012. Editorial Amolca .

Tesis Oral Health Survey of a population living in nursing homes in Catalonia.Dra. Rosa Moreno López Department of Gerodontology and Special Care Dentistr Dental School (Facultad de Odontología)UniversitatInternacional de Catalunya. February 2014.

Text book of geriatric dentistry. Holm -Pedersen 1996 . Editorial Muksgaard

Principios de geriatría y Gerontología : José C. Millán 2006 . editorial Mcgraw Hill

Medicina Geriátirca  . P.Abizanda . Editorial MAsson 2012

Odontoestomatologia geriàtrica . P.Bullón Fdez E.Velasco . SmithKline Beecham 1996

Timira PaolaS . Bases fisiològiques de l'envelliment i Geriatria . Masson Barcelona 1981

Evaluation period

E: exam date | R: revision date | 1: first session | 2: second session:

  • E1 14/01/2019 15:00h A01
  • E1 14/01/2019 15:00h A02
  • R1 23/01/2019 19:00h A06
  • E2 17/06/2019 15:00h A01
  • R2 27/06/2019 17:00h A05

Teaching and learning material

      Material
            DISTRIBUCION HORA Y FECHA PRESENTACION Grupos M1 comunicaciones . 2018-19 distribucionhorayfechapresentaciongruposm1comunicaciones.2018-19.docx 
            DISTRIBUCION HORA Y FECHA PRESENTACION Grupos M2 comunicaciones . 2018-19 distribucionhorayfechapresentaciongruposm2comunicaciones.2018-19.docx 
            DISTRIBUCION HORA Y FECHA PRESENTACION Grupos M3 comunicaciones . 2018-19 distribucionhorayfechapresentaciongruposm3comunicaciones.2018-19.docx 
            instrucciones para la presentación y el trabajo de Gerodontología instruccionesparalapresentacionyeltrabajodegerodontologia.docx 
            plantilla 10 seminarios  plantilla10seminarios.jpg 
            plantilla 10 teoria  plantilla10teoria.jpg 
            TEMAS COMUNICACIONES 2018-19 temascomunicaciones2018-19.xlsx 
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