The Age of Dentistry
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Out in the World
Every Thursday, Tillman takes five third-year Tufts dental students into the community to conduct oral health and cancer screenings on senior citizens. They go to a different location each week, visiting senior centers, churches, homeless shelters and senior day care centers around Greater Boston. They see about 200 patients each year, and 90 percent of them need dental work.
At one outreach session in Roxbury, Mass., several men and women have come for the screening. The students feel the lymph nodes in the neck, and check the tongue and palate for sores. They evaluate the dentures and partials, and even demonstrate the right way to brush.
One of the seniors takes her dentures out of a handkerchief in her pocket. Although the dentures are less than two years old, she never wears them because they are painful. "I'm ashamed to open my mouth," she says as she lets one of the students examine her. Bony protrusions in her mouth are causing part of the problem. The possibility of surgery comes up. "Do surgery? I'm too old for that," she says. But she says she is willing to visit the Tufts clinic, where she can have a full exam and X-rays.
Rattanjit Kamboj, D10, screens another woman and finds two decayed molars. "When you lose those, you really lose your ability to chew," he says later. "It's a huge quality-of-life problem. I told her to come in [to the clinic], and we'll at least tell her what needs to be done. She says she's having difficulties right now; she's taking care of her mother, who is dying. I understand where she is coming from, but … right now it's a savable tooth. But if she lets it keep going, it's going to become a hopeless tooth. I gave her my card and a pamphlet. I hope she comes in."
The work can be difficult, even heart-breaking. Tillman remembers an outreach visit to a nursing home, where the Tufts students approached a woman who was clearly edentulous and asked if she would like to have some teeth made.
"She looked at us with a straight face and said, 'I've been put here to die. What do I need teeth for?' " Tillman says.
They continued with their screenings, making plans for several of the other seniors to come to Tufts for treatment. Tillman recalls: "By the time we were ready to go, the woman called to us and said, 'Where are all these people going?' I said, 'They are going to Tufts—would you like to come?' 'I think I might.' Well, she did come to Tufts, and we did make dentures for her. And it was an important point for her. All of a sudden there was light at the end of the tunnel. Because somebody cared, someone thought her life mattered."
Braces at 80
Senior citizens today visit the dentist more often than their parents did, so there is the assumption that as the baby boomers age, they will bring with them an awareness of the importance of oral health. Tillman wants to see more patients like the one Caitlin White, D09, worked with in the Tufts clinic.
At age 84, he still has 28 of his own teeth and is determined to keep them. "He really takes pride in them," White says. "He was very curious and wanted to review little things no one had ever gone over with him before." White was glad to oblige, and the two struck up a relationship that has lasted long after White's weeklong rotation in geriatric dentistry. "He brings in newspaper clippings for me and wants to know which mouth rinse is the best," says White.
In addition to discussing medications (he brought her an itemized list), they talked about lifestyle concerns such as diet and nutrition and manual dexterity. Though he was in good overall health, he did have one or two teeth he was in danger of losing. Because of his age, White wanted to avoid putting him through extensive dental work. With her coaching and his careful attention to her hygiene lessons, the pair was able to keep the area of concern healthy.
Now when he comes in for his follow-ups, he brings White a detailed list of his oral hygiene routine. "I know he cares about it," says White, "and that makes me feel good."
A common assumption—among both young and old—is that once the skin starts to sag and the hair starts to gray, people shouldn't invest time or money in their appearance. "If somebody says to me, 'I don't care how I look,' that's not what they mean," Tillman says. "I say, 'Everybody cares. Why wouldn't you care?' And they usually smile. Of course they care."
An 80-year-old may choose to get braces to straighten a smile; a 90-year-old can opt for implants. "There is no reason why not," Tillman says. "Age is not an issue."
And even when longevity is in question, dental care should not be neglected. Tillman recalls a geriatric patient who had a malignancy. His prognosis was not good, but he needed new dentures. The student working with him asked Tillman for advice. "I said we'll make him new dentures," she says. "Whatever comfort he gets out of that, it's valuable. None of us can look in the crystal ball and see how long we can live." She is not sure how long he was able to enjoy the dentures, but that wasn't the point. "It's important to have them feel that we think their life has value," she says, "and that we're going to fight with them to the end."
Story by Julie Flaherty and Jacqueline Mitchell, senior health sciences writers in Tufts Office of Publications
Photos by Laura Barisonzi
This story ran online on Mar. 23, 2009. It originally appeared in the Winter 2009 issue of Tufts Dental Medicine.