Internet Explorer and Edge browser users:
To download Word, Excel or PowerPoint files please right-click on the file you wish to download, and select 'Save target as...'

Special care dentistry: advice on the risks associated

Blog Author Len D'Cruz

Blog Date 23/09/2019

Helpful points to consider when treating elderly patients

Oral health deteriorates as patients age, with plaque and salivary factors contributing to most major issues. It is therefore important to consider minimal intervention techniques when managing these patients.

Photo credit: Getty Images

Practising dentistry in the UK, you will encounter many different types of patients requiring special care. From patients needing a wheelchair, to patients with early stages of dementia. Whatever the case may be, it is important to understand the risks related.

Prevention may involve:

  • methods to protect roots from exposure;
  • protection of roots once they become exposed to the oral environment by using various coating materials; and
  • the application of fluorides, CPP-ACP, and other materials to make them more resistant to dental caries. For older patients who are retaining their teeth for longer, this is an important consideration.

According to research published in the BDJ, key factors to consider when deciding on an approach are the "quality of the patient’s saliva as a source of ions for remineralisation, and the degree of access for plaque removal."1

The paper went on to suggest that when following a root caries arrest approach, "it is important to avoid damaging the surface by forceful probing with a sharp probe" and instead using a blunt periodontal probe applied with light force. Take into consideration the colour of the gums as a guide to the progress or stability of early root surface caries lesions.

While treating elderly patients,’ thought must be given to their ability to tolerate ‘on-site’ care, as well as their propensity to seek care. For example, when patients develop dementia, they may be difficult to operate on if they refuse to open their mouth or have oral hygiene care undertaken by dental staff. Once a patient has been labelled as being “difficult”, staff may simply stop offering regular oral hygiene advice and support, which then only perpetuates a cycle of oral neglect.

It is up to the practice owner to provide training for staff to work with elderly or special care patients. Whether working under the National Health Service or under a private contracting arrangements, vulnerable patients have a right to treatment that will not cause more undue distress. 

BDA Indemnity covers you for legal representation, and in the case of practice owners, nurses are indemnified against negligence claims and GDC investigations. We provide an occurrence based product insurance backed product with no requirement to purchase separate run off cover. Find out more and get an indicative quote today.


1. Walsh L J. Minimal intervention management of the older patient. Br Dent J 2017; 223: 151-161.

This blog has been written as a summary of the article, entitlted. "Minimal intervention management of the older patient" which originally appeared in the British Dental Journal

Len D’Cruz 
Senior dento-legal Advisor
Len is the BDA’s senior dento-legal advisor, a general dental practitioner, foundation trainer and practice owner testing the NHS prototypes. He has 21 years’ experience as a dento-legal advisor supporting dentists with complaints, clinical and regulatory issues, and clinical negligence claims.