A guide to treatment planning in complex older adults

There are a growing number of older patients who are retaining their natural teeth. Though the majority of these patients remain independent, many are affected by frailty, multi-morbidity or dementia. The complexities associated with dementia have led to guidelines being produced by the FGDP, Dementia friendly dentistry, although other features of ageing can similarly increase the risk of dental disease and the consequent complexity, safety and suitability of providing treatment. Prevention of dental disease is crucial for older patients as the features of ageing may make the risk of treatment greater than that of younger patients. Conscious sedation or general anaesthesia, typically provided by a specialist dental service, may be required to facilitate treatment, though these approaches may have significant short and long-term impacts on older patients. Clinical guidelines and legislation are available to assist in decision-making for patients who may lack mental capacity, yet for patients who are able to consent for treatment, a comprehensive discussion as part of an informed consent process remains crucial to determine the most appropriate approach to care provision.