CDA Essentials 2019 • Volume 6 • Issue 4

I ssues and P eople 25 Issue 4 | 2019 | Geriatric Dentistry Research at UBC Cutting-edge research bolsters UBC’s commitment to provide the best dental care possible for our aging population. Why do specific dental challenges and outcomes occur in a frail, aging population? How do medical, social, financial and family factors influence dental care decisions for the elderly? What are successful dental treatments for geriatric patients? Using scientific evidence from recent studies, UBC’s Geriatric Dentistry Program (GDP) is answering some of these questions while further exploring others. Research results will not only enhance UBC’s geriatric dentistry curriculum, but will deepen students’ knowledge applied in clinical rotations. In the late 1990s, UBC Dentistry geriatric research focused on oral disease and prevention, such as caries in older patients, examining the links between oral health and a patient’s overall health. Today, the GDP is researching dental challenges and outcomes, trying to document and understand variable conditions that will determine which treatments will best serve a frail geriatric patient, says UBC Dentistry professor Dr. Chris Wyatt. Dr. Wyatt directs the GDP at 27 long-term-care facilities. Some of their elderly residents were the subjects of a 2017 pilot study that examined the survival rate of dental restorations in frail older adults. Dr. Wyatt and Dr. Chayanee Chatvanichkul, a visiting scientist from Thailand, wanted to know: How long do dental restorations last in frail older adults? If they last longer than average in a very challenging geriatric dental situation, why is that? What successes can the GDP document? In their small patient group, Drs. Wyatt and Chatvanichkul found that 64% of dental restorations had survived over a six-year period. They now plan to add their 2003-to-2016 data to draw conclusions from broader statistical analysis. The resulting knowledge will help justify specific treatments of patients. Wyatt says: “That’s where the future is on the research end: [to determine] what treatment is best based on the longevity of a restoration.” In another 2017 study, Dr. Wyatt and Dr. Diego Ardenghi, an MSc graduate student in prosthodontics, conducted semi-structured inter- views with 12 family members of frail, elderly patients. They wanted to explore the impact of UBC’s Geriatric Dentistry Program on patients’ relatives. They discovered that although patients’ relatives were worried about their loved one’s oral health, families reported that the GDP reduced their stress by providing easily accessible dental care. UBC Dentistry associate professor Dr. Mario Brondani is a core member of a new team whose research results will enhance how geriatric research is conducted at UBC and both provincially and nationally. Representing Dentistry, he’ll join UBC researchers from Nursing, Family Practice, Sociology, Social Work, Kinesiology, Occupational Science, Health and Exercise Sciences, and other specialists to examine the topic: “Re-Imagine Aging: Creating Interdisciplinary Connections for Research Collaboration and Training.” Their goal is to create a virtual, supportive, interdisciplinary environment that elevates aging research beyond what is possible within only a single discipline. This will likely involve online shared resources and a planning meeting over the next year to include other UBC researchers, says Dr. Brondani. They will apply their research results to help develop a healthy aging strategy for BC and to give input into Canada’s national seniors strategy. As part of his PhD completed in 2007, Dr. Brondani wanted to understand the impact of oral disorders on the life of elders. He explored what values, beliefs and behaviours older adults held in relation to their oral health. He held focus group discussions among 42 residents, ages 64 to 93, at retirement homes and seniors’ centres. Based on data analysis, he concluded that participants had their own views on what a healthy mouth entails and adjusted their expectations and sought social support to accept some oral impairment and disability. For example, patients found that missing teeth did not always disrupt daily functioning; therefore, a full set of new dentures might not always be an ultimate goal. A 2002–2007 study by the GDP followed 139 older patients in long- term-care facilities (i.e., 17% of residents) for five years. Treatment was recommended for 97% of them, but only 60% consented to receive care. Wyatt wants to know, simply: why? What factors influence whether families will consent to complex dental treatment for their elderly relative? Economic pressures could be at play, but sometimes the family simply concludes that getting a bridge, for example, is not appropriate for someone who’s 90. “There’s something other than money at stake there,” he says. In the same five-year study, the GDP found that 40% of caries-free patients developed caries over the five years. During the same period, 43% of patients developed periodontal disease. Future research studies will explore this, Dr. Wyatt says. “This [research] is something that we want to build upon.” UBC Dentistry’s ongoing research will continue to enrich new geriatrics curricula and students’ clinical rotations. Alumni will be well equipped to provide the best oral care for all generations.  Dr. Nicholas Tong, supervising dentist on the day at Simon K.Y. Lee Seniors Care Home, listens to an elderly patient. He is currently an MSc candidate undertaking geriatric dentistry research.