WEBVTT 00:00:00.000 --> 00:00:07.866 [This tape was transferred from a 16mm film original by Colorlab 00:00:07.866 --> 00:00:19.199 for the National Library of Medicine, February 2015, NLM call number HF 8344] 00:00:19.200 --> 00:00:39.633 [film leader countdown] 00:00:39.633 --> 00:00:48.866 [The United States Department of Health, Education, and Welfare] 00:00:48.866 --> 00:00:55.832 [Public Health Service, Division of Dental Public Health and Resources presents] 00:00:55.833 --> 00:01:04.133 [Dental Care for the Chronically Ill and Aged] 00:01:04.133 --> 00:01:16.333 [A training film on methods, procedures and equipment] 00:01:16.333 --> 00:01:36.099 [Music] 00:01:36.100 --> 00:01:45.033 [Narrator:] We all know people like these. Former neighbors, old friends, relatives. 00:01:45.033 --> 00:01:53.733 There are so many of them, so many chronically ill and aged in this country. 00:01:53.733 --> 00:01:58.799 Almost six million invalids. 00:01:58.800 --> 00:02:05.366 Many of them without ordinary and often vitally needed dental care. 00:02:05.366 --> 00:02:11.966 Fortunately, more and more attention is now being focused on their plight, and dentists are discovering that the principle difference 00:02:11.966 --> 00:02:17.599 between routine treatments and invalid treatments lies in the management of the patient. 00:02:17.600 --> 00:02:24.133 Dentists' experience shows that treatment of the homebound and infirm requires no highly specialized training 00:02:24.133 --> 00:02:34.299 and only a minimum of easy to carry, portable equipment, no more on each trip than needed for the case at hand. 00:02:34.300 --> 00:02:39.400 By properly positioning the patient at the side of a hospital bed, or with a portable back rest on a regular bed, 00:02:39.400 --> 00:02:47.133 and placing the hand equipment on a table found in the patient's own room, ease and convenience of operation is assured. 00:02:47.133 --> 00:02:56.699 For this case, note that the dentist is using a portable, high speed, air turban powered by a small bottle of CO2. 00:02:56.700 --> 00:02:59.366 Who are the chronically ill? 00:02:59.366 --> 00:03:05.366 They can be simply defined as people with long-term disabling illnesses, including arthritis, diabetes, 00:03:05.366 --> 00:03:14.266 multiple sclerosis, heart disease, palsy, and many other diseases. 00:03:14.266 --> 00:03:19.832 Most chronically ill and aged people can, with assistance, visit a clinic or office for dental treatment. 00:03:19.833 --> 00:03:25.766 In such cases, with regular office equipment and the dentist's own dental assistant, 00:03:25.766 --> 00:03:33.266 there are only minor differences between treating most chronically ill patients and routine patients. 00:03:33.266 --> 00:03:38.766 With patients who cannot visit an office or a clinic, the need for portable equipment is obvious. 00:03:38.766 --> 00:03:44.932 To help dentists meet the needs of such patients, portable equipment was studied, along with other aspects of dental care 00:03:44.933 --> 00:03:51.499 for the chronically ill, in a four-year research program by the United States Public Health Service. 00:03:51.500 --> 00:03:55.900 The study disclosed that complete and satisfactory dental care can be given in the home 00:03:55.900 --> 00:04:01.200 with various types of currently available portable equipment. 00:04:01.200 --> 00:04:06.633 For example, this completely self-contained luggage case unit, weighing less than 40 pounds 00:04:06.633 --> 00:04:12.933 and powered from a standard 110-volt wall outlet, includes a standard speed motor, aspirator, compressed air, 00:04:12.933 --> 00:04:16.399 water spray and gooseneck lamp. 00:04:16.400 --> 00:04:18.666 Such units have wide versatility. 00:04:18.666 --> 00:04:24.299 In this case the unit is supplemented by a headrest that can be clamped on an ordinary chair. 00:04:24.300 --> 00:04:30.033 The dentist takes with him on home calls only a minimum of instruments and supplies carried in any handy carrying case 00:04:30.033 --> 00:04:42.199 that can be laid out conveniently on a small table found in the patient's own home. 00:04:42.200 --> 00:04:45.533 This is a typical home care situation. 00:04:45.533 --> 00:04:57.233 In practically every instance by using available furniture, equipment and instruments can be located as conveniently as in office situations. 00:04:57.233 --> 00:05:01.966 The dentist knew in advance that this patient would require local anesthesia, 00:05:01.966 --> 00:05:07.866 so disposable cartridge and needle were included in the kit of instruments for this call. 00:05:07.866 --> 00:05:22.532 [ Music ] 00:05:22.533 --> 00:05:30.699 As in the office, the dental assistant acts as a second pair of hands for the dentist, helping reduce the time required to treat the patient. 00:05:30.700 --> 00:05:49.100 [ Music ] 00:05:49.100 --> 00:05:58.800 All that remains now is the preliminary trimming of the restoration, and of course polishing at the next visit. 00:05:58.800 --> 00:06:03.366 The completed restoration is fully comparable to work done with standard office equipment. 00:06:03.366 --> 00:06:12.699 Total time elapsed from setting up to leaving the house, 30 minutes, only slightly longer than the office time for similar work. 00:06:12.700 --> 00:06:18.700 Other types of dental treatment can be provided equally well in the home. 00:06:18.700 --> 00:06:23.700 In this case, the dental hygienist is completing a prophylaxis with portable equipment 00:06:23.700 --> 00:06:27.433 that clamps directly to the wheelchair; headrest, motor, and gooseneck lamp. 00:06:27.433 --> 00:06:32.799 After the prophylaxis she will show the patient how to brush his teeth properly and suggest 00:06:32.800 --> 00:06:38.166 dietary considerations to help him maintain good dental health. 00:06:38.166 --> 00:06:44.266 At a later visit, the dentist comes prepared for an extraction with just the equipment and instruments required. 00:06:44.266 --> 00:06:49.566 The headrest is clamped on the wheelchair, and for convenience in this instance, 00:06:49.566 --> 00:06:57.566 the dentist uses a head-light instead of a clamp-on gooseneck light. 00:06:57.566 --> 00:07:02.299 The needed sterile instruments are laid out on a table found in the patient's room, 00:07:02.300 --> 00:07:06.466 alongside the aspirator that's plugged into a wall outlet. 00:07:06.466 --> 00:07:17.232 The assistant removes blood and moisture with a portable surgical aspirator, as in office chairside assistance. 00:07:17.233 --> 00:07:22.666 After the extraction the used instruments are carefully wrapped and put in the carrying case for 00:07:22.666 --> 00:07:25.299 return to the office where they will be sterilized. 00:07:25.300 --> 00:07:28.633 Again, the entire procedure has been little different from office methods, 00:07:28.633 --> 00:07:36.133 except for the use of the minimum of portable equipment required for the visit. 00:07:36.133 --> 00:07:40.966 The full range of dental treatment is possible in home-care cases. 00:07:40.966 --> 00:07:47.099 This patient has had 12 extractions, a veloplasty, impressions, and vertical [?] 00:07:47.100 --> 00:07:55.966 while confined to her bed, a hospital-type bed, as is the case with many long-term chronically ill patients. 00:07:55.966 --> 00:07:59.799 On this visit her dentures will be inserted. 00:07:59.800 --> 00:08:03.966 Dentures are important to this patient for more than health reasons. 00:08:03.966 --> 00:08:10.532 Most people confined by chronic illness greatly need the lift attention gives them, a feeling that somebody cares, 00:08:10.533 --> 00:08:16.699 the pleasure of eating a variety of foods. 00:08:16.700 --> 00:08:23.966 In addition, the dentures will do much to restore her self-confidence and help her enjoy the company of her family and friends. 00:08:23.966 --> 00:08:27.399 The equipment for adjusting her dentures is simple. 00:08:27.400 --> 00:08:32.100 In this case, the dentures are relieved with a standard stone and a portable hand motor tool. 00:08:32.100 --> 00:08:39.600 And to achieve proper occlusion, the tooth surfaces are ground and polished with the same motor tool using a standard dental wheel. 00:08:39.600 --> 00:08:52.133 [ Music ] 00:08:52.133 --> 00:08:55.933 Each step in the making of this patient's dentures was performed in her home: 00:08:55.933 --> 00:09:03.366 extractions, impressions, bite registration, and of course fitting of the completed dentures. 00:09:03.366 --> 00:09:16.832 [ Music ] 00:09:16.833 --> 00:09:21.899 Prosthetics, extractions, restorations, oral surgery, periodontal treatment, 00:09:21.900 --> 00:09:28.066 a complete range of dental care can be administered to the chronically ill in their homes 00:09:28.066 --> 00:09:33.666 with only slight modification of the operating techniques used in the office. 00:09:33.666 --> 00:09:36.866 Where then are the differences? 00:09:36.866 --> 00:09:42.866 Primarily in the management of the patient and in evaluating her dental needs. 00:09:42.866 --> 00:09:49.066 Whether the patient is in her home or, more commonly in the dentist's own office, 00:09:49.066 --> 00:09:54.766 or in the clinic, dental care is generally a special event to the chronically ill. 00:09:54.766 --> 00:10:08.132 [ Music ] 00:10:08.133 --> 00:10:16.699 Good rapport can usually be obtained by making the patient feel the appointment is a special event for the dentist, too. 00:10:16.700 --> 00:10:21.333 [ Music ] 00:10:21.333 --> 00:10:25.666 The chronically ill and aged often have a lower tolerance to pain and discomfort. 00:10:25.666 --> 00:10:30.332 By allowing patients to rest frequently, and by breaking up the treatment into shorter periods, 00:10:30.333 --> 00:10:33.566 undue fatigue and tension can be avoided. 00:10:33.566 --> 00:10:40.199 It is also important to bolster the patient's confidence, complimenting her generously on each accomplishment. 00:10:40.200 --> 00:10:45.933 This approach is applicable, of course, to any patient of any age group. 00:10:45.933 --> 00:10:50.299 However, younger, chronically ill patients are often more conscious of the extra effort 00:10:50.300 --> 00:10:56.533 the dentist must make to treat them, and therefore more obviously appreciative. 00:10:56.533 --> 00:11:01.433 But no matter what the patient's age, the reassurance that the dentist personally cares enough 00:11:01.433 --> 00:11:07.699 to provide the treatment helps lighten the heavy emotional burden of chronic illness. 00:11:07.700 --> 00:11:15.966 Many chronically ill patients will also be receiving medical treatments, and the dentist may wish to consult with the patient's physician. 00:11:15.966 --> 00:11:22.766 It is important to have at least a brief medical history so the need for consultation can be judged. 00:11:22.766 --> 00:11:32.666 [ Music ] 00:11:32.666 --> 00:11:39.666 A typical medical history should include medical diagnosis of the patient's illness, medication, and the name of the patient's physician, 00:11:39.666 --> 00:11:45.699 with general questions covering fainting, excessive bleeding, reactions from penicillin or anesthetics, 00:11:45.700 --> 00:11:51.033 sores that heal slowly, and other general symptoms that might require consultation. 00:11:51.033 --> 00:11:58.866 [ Music ] 00:11:58.866 --> 00:12:06.199 Medical consultation is indicated particularly for heart patients or for patients on anti-coagulant drugs, 00:12:06.200 --> 00:12:10.633 when extractions or deep curettage are required. 00:12:10.633 --> 00:12:15.833 [ Music ] 00:12:15.833 --> 00:12:19.733 Patients receiving corticosteroids for conditions such as rheumatoid arthritis, 00:12:19.733 --> 00:12:26.299 ulcerative colitis or a blood dyscrasia may be susceptible to post-operative infections. 00:12:26.300 --> 00:12:32.633 For such patients, prophylactic use of antibiotics may be indicated. 00:12:32.633 --> 00:12:38.566 Medical consultation is usually necessary for a diabetic patient before even minor dental procedures, 00:12:38.566 --> 00:12:42.299 so routine but necessary precautions may be taken. 00:12:42.300 --> 00:12:47.066 Although most patients can be treated in the office or home, hospitalization is sometimes required 00:12:47.066 --> 00:12:54.899 for patients with severe circulatory diseases, diabetes, and extensive oral malignancies. 00:12:54.900 --> 00:13:01.100 Criteria for treatment must be evaluated along with several other aspects of the patient's condition. 00:13:01.100 --> 00:13:04.433 One such factor is the patient's general physical health. 00:13:04.433 --> 00:13:09.066 For example, when long-term systemic disorders have lowered general resistance, 00:13:09.066 --> 00:13:13.899 dentures may cause deterioration of the oral mucosa and tissues. 00:13:13.900 --> 00:13:20.200 In other patients, periodontal disease may have reduced supporting bone structures so the dentures' success is questionable. 00:13:20.200 --> 00:13:30.133 Severe periodontal disease is not uncommon with the chronically ill and aged since their oral hygiene is often poorly maintained. 00:13:30.133 --> 00:13:35.199 The psychological attitude of the patient is very important. 00:13:35.200 --> 00:13:42.700 If the patient has adjusted well to chronic illness, as this patient has, his positive attitude may override many adverse indications. 00:13:42.700 --> 00:13:47.300 The most important consideration is the potential benefit to the patient. 00:13:47.300 --> 00:13:53.100 As can be seen, the portable equipment is light enough for easy handling. 00:13:53.100 --> 00:14:00.100 Responsibility for providing the chronically ill and aged with dental care falls on the entire community. 00:14:00.100 --> 00:14:08.100 It is shared by the aged and chronically ill who must make an effort to obtain care. 00:14:08.100 --> 00:14:14.900 It is shared by the dentist who must be prepared to treat the chronically ill and aged. 00:14:14.900 --> 00:14:18.800 It is shared by the professional schools that must prepare future dentists and hygienists 00:14:18.800 --> 00:14:27.800 to treat the chronically ill as a routine part of dental practice, whether in the office or in the home. 00:14:27.800 --> 00:14:32.633 The University of Kansas City School of Dentistry, for example, participated in the Public Health Service study 00:14:32.633 --> 00:14:35.366 of dental care for the chronically ill. 00:14:35.366 --> 00:14:44.699 The classroom training of dental and dental hygiene students was supplemented by practice in private and nursing homes. 00:14:44.700 --> 00:14:50.133 The result, dental care for many people who otherwise would not have been treated 00:14:50.133 --> 00:14:56.733 and training for the students in situations significantly different from the clinic or standard dental office. 00:14:56.733 --> 00:15:01.233 We asked Dr. Hamilton B.G. Robinson, Dean of the School of Dentistry at the University of Kansas City, 00:15:01.233 --> 00:15:05.999 for his evaluation of the training program. Dr. Robertson. 00:15:06.000 --> 00:15:12.400 [Dr. Robertson:] Our dental students and our dental hygiene have both benefited greatly from this program. 00:15:12.400 --> 00:15:16.700 They used the portable equipment, they learned to handle the patients, 00:15:16.700 --> 00:15:23.233 and above all they learned the great need that these patients have for dental care. 00:15:23.233 --> 00:15:28.766 In cooperation with the Public Health Service,we are incorporating treatment 00:15:28.766 --> 00:15:35.332 of the chronically ill and aged in the curricula of our dental and dental hygiene schools. 00:15:35.333 --> 00:15:40.233 This means expanding our present courses in home care and may involve 00:15:40.233 --> 00:15:46.366 auxiliary training centers at nursing homes willing to cooperate with us. 00:15:46.366 --> 00:15:52.299 Other dental schools, of course, are working on similar plans and we would like to feel 00:15:52.300 --> 00:15:59.133 that within the next five or six years every new dentist and every new dental hygienist 00:15:59.133 --> 00:16:03.066 will enter practice prepared to take care of the chronically ill and aged, 00:16:03.066 --> 00:16:12.166 and that they will also expect that they will have patients who require complete dental care in their own homes. 00:16:12.166 --> 00:16:15.766 [Narrator:] In the meantime, it remains for the dentists of today to add a new dimension 00:16:15.766 --> 00:16:18.266 to their general practice of dentistry. 00:16:18.266 --> 00:16:23.099 Many of the chronically ill and aged fit into normal office routine. 00:16:23.100 --> 00:16:27.400 The Kansas City project and other studies reached several clear conclusions. 00:16:27.400 --> 00:16:32.333 Among them, the chronically ill and aged can be treated at home or in the office 00:16:32.333 --> 00:16:36.933 with no highly specialized training, and with only slight modification of operating techniques, 00:16:36.933 --> 00:16:39.666 treatment criteria, and equipment. 00:16:39.666 --> 00:16:45.432 Management of such patients requires a heightened sensitivity to the patient as an individual. 00:16:45.433 --> 00:16:48.666 [ Music ] 00:16:48.666 --> 00:16:55.966 Chairside assistance can of course help speed the dentist's work in both home and office treatment. 00:16:55.966 --> 00:17:01.732 The dental hygienist can perform prophylaxis, give oral hygiene instruction, and devise adaptations 00:17:01.733 --> 00:17:07.733 and modifications of standard devices that enable the patient to maintain better oral hygiene. 00:17:07.733 --> 00:17:11.033 [ Music ] 00:17:11.033 --> 00:17:16.399 Most types of treatment can be administered either in the office or home. 00:17:16.400 --> 00:17:20.900 When there is a choice, treatment should be given in a dental office or clinic, 00:17:20.900 --> 00:17:25.500 but sometimes there is no choice and the dental service must be taken to the patient. 00:17:25.500 --> 00:17:30.433 Home care patients can be given the same complete dental care as office patients, 00:17:30.433 --> 00:17:32.733 using portable equipment. 00:17:32.733 --> 00:17:42.366 Such equipment might be obtained by the local dental society, health department or other agencies for the use of all dentists. 00:17:42.366 --> 00:17:48.599 Although dental care for the chronically ill and aged may involve a little extra time and effort, 00:17:48.600 --> 00:17:54.766 it yields a deep and rewarding satisfaction, for the burden of chronic illness and age 00:17:54.766 --> 00:18:00.299 is a burden of loneliness and isolation filled with problems and worries unfamiliar to most of us. 00:18:00.300 --> 00:18:03.533 Lack of dental care should not be one of these worries. 00:18:03.533 --> 00:18:11.533 [ Music ] 00:18:11.533 --> 00:18:16.633 It is not only practical and feasible to provide the aged and chronically ill with dental care, 00:18:16.633 --> 00:18:25.899 it is the ethical and moral obligation of the dental profession. 00:18:25.900 --> 00:18:31.666 [The Public Health Service is grateful to Community Studies, Inc. the University of Kansas City School of Dentistry, 00:18:31.666 --> 00:18:36.299 and others who cooperated in the project.] 00:18:36.300 --> 00:18:43.266 [Script by Oeveste Granducci Inc.] 00:18:43.266 --> 00:18:51.466 [a Thomas Craven Film Corporation Production]