I would like to relate a case in which I was personally involved where a geriatric center did not administer proper patient care to the elderly.
My father-in-law is 89 years old. He had a mild stroke in November and was admitted to a hospital. He was out of danger after a few days but, due to subsequent debilitation brought about by his recent stroke, he was released to a nearby geriatric center for "rehabilitation."
My wife went to see him there and noticed he wasn’t eating anything, but taking only liquid nourishment. He was losing weight and getting weaker. I went to visit him the following day and examined his mouth. He had a large buccal abscess on his upper right second bicuspid, which was engaged by a clasp from his upper removable partial denture.
In addition, his lower jaw revealed a deep 2-centimeter-long ulceration on the anterior mandibular ridge. This "denture sore" was between his lower cuspids, due to an ill-fitting lower partial appliance.
I mentioned this to the attending physician, but she told me that since my father-in-law was a "short-timer," he was not entitled to dental care. When I informed her that it was an emergency, she responded that no dentist was available and, by the time he would get to see one, he already would have been discharged.
So here was my dilemma: my father-in-law was not eating and the physician had failed to diagnose the reason why. He was in pain, but no one understood him. I couldn’t leave him to suffer in silence, and I decided to intervene on his behalf only after I realized that no dental therapy was going to be made available to him.
The following day, I took instruments and supplies from my own dental office to treat him at the center. We brought him down to the vacant dental examination room in the building. I gave him some local anesthetic and extracted tooth no. 4. Then I trimmed the anterior flange of his lower removable partial denture with a Dremel drill I had taken along with me.
When I returned the following week, his ulceration was healed and his mouth was free of infection. He was eating solid foods again, and his entire demeanor had improved.
My questions are as follows: Had I not made the proper diagnosis as to why he wouldn’t eat, would anyone else have known? What would have been the consequences of not rendering the necessary treatment in a timely manner? Why does a center have this policy of not supplying dental care to patients who are not "long-term"?
I love my profession, but my dental degree was never more rewarding than when I went back to the center and saw my father-in-law able to eat his Thanksgiving dinner with delight.
