International Journal of Medical Dentistry 117
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Abstract
Geriatrics is a discipline that combines multiple inter‑ disciplinary collaboration, dealing with problems of somatic, psychological, and social functioning in both acute and chronic care, preventive or recovery and, not in the least, terminal care of the elderly ones. [1‑2] Therefore, the concept promoted by Acad. Ana Aslan since 1957: “Not every old is old”, is considered extremely actual. Most peo‑ ple aged over 65 have a relatively good health status and may carry an autonomous existence within the family and community in which they live. In this context, it is appro‑ priate to consider geriatrics as a discipline with multiple interrelations with other medical specialties, frequently including part of the large group of internal medicine and also of dentistry.
Keywords: geriatrics, interdisciplinarity, atherosclerosis.
INTRODUCTION
Nowadays, geriatrics is viewed as and it really illustrates a modern concept of multidiscipli‑ narity, aimed at preventing aging and the already installed diseases in the elderly population. In 1909, Ilia Metschnikov introduces the term
“geron tology”, which deines the science of
aging, after which Nasher Ignatus puts forward the term “geriatrics”, namely study of “para‑ sites” aging diseases. [3‑4]
The process of aging has been studied for hundreds of years. It is said that Ponce de Leon discovered Florida while seeking the fountain of youth. However, slowing down aging appeared
as a concern for the scientiic world especially in
the 60’ies, when the current medical interven‑ tions decreased death rates and considerably increased life expectancy. Nowadays, anyone can hope that he/she will live another 15‑20 years over the age of 65. Aging has gained momentum in Europe, as the aging population
GERIATRICS – MULTIDISCIPLINARY COLLABORATION –
AN IMPERATIVE
Rodica GHIURU1, Ana Minodora GROZDAN2, D. MUNTEANU3
1. Prof. PhD., Dept. Semiology, Faculty of Medical Dentistry “Gr.T. Popa” U.M.Ph. Iasi 2. Psychiatry resident, U.M.Ph. Timisoara
3. Assist. Prof., PhD, Dept. Semiology, Faculty of Medical Dentistry “Gr.T. Popa” U.M.Ph. Iasi
Contact person: Dragoş Munteanu, [email protected]
is an important community that requires special programs for prevention of diseases, health assessment – oro‑dental care at home included – nursing at home, social reintegration programs and psycho‑social support. [5‑8]
MATERIALS AND METHOD
The present study represents a comprehen‑ sive analysis of the elderly population, which is continually subject to progressive losses, often manifested as early as adulthood (even if com‑ pensatory mechanisms, balancing losses, occur in this stage).
With age, resilience to stress is reduced, with implications for the endocrine functions, and also for the cardiovascular, renal etc., stomatog‑ nathic systems. A clear‑cut distinction should be made between “normal aging” and the patho‑ logical changes seen in the elderly population, permitting the geriatrist to avoid unnecessary medical treatment for manifestations inherent to natural aging.
In this respect, the observations made by the authors, along a 3‑5 year period, on patients who presented for dental checkup and required col‑ laboration with specialists in internal medicine and geriatrics, might be especially important for illustrating the phasic development of athero‑ sclerosis in various organ systems.
GA, aged 70 years, retired, former clerk with responsible jobs, addressed the Clinic of Geron‑
tology and Geriatrics, irst in March 2011, for
118 volume 3 • issue 2 April / June 2013 • pp. 117-119
Rodica Ghiuru, Ana Minodora Grozdan, D. Munteanu
symptoms, such as dizziness, manifested ascri‑ ses for several hours, accompanied by intracra‑ nial tightness (“feeling claw”). Simultaneously, he noticed decreased chewing ability and the
occurrence of signiicant changes in the dental
unit (chronic marginal periodontitis, dental car‑ ies, dental hyperlaxity). The medical history of the family records the death of his mother, caused by a hypertensive stroke and the myocardial infarction of a sister, also suffering from severe hypertensive cardiovascular problems.
Personal history: nothing to report.
Negative clinical examination: T.A. 105/80 mm Hg, eg. FO: normal aspect, central retinal artery pressure 45 mm Hg; electrocardiogram with normal appearance. ENT examination shows vestibular tests in normal relationships. Cervicodorsale spine radiography: spondilartro‑ sis type, discrete changes induced by age. [9‑10] Biochemical evidence for dyslipidemia syn‑ drome and aging: serum latescent, cholesterol: 240 mg/dl, total lipids: 1150 mg/dl, beta‑lipo‑ protein: 90%.
At present, the etiological conditions (age, heredity charge, psychological trauma), the vas‑ cular symptoms and tests of dyslipidemia, respectively atherosclerosis, suggest a systemic
diagnosis, with consecutive modiications at
oro‑dental level. Subsequently, some of the symptoms are less obvious, until total disappear‑ ance, while the dyslipidemia tests get normal‑ ized. The patient observes no hygienico‑dietetic diet. 6 months later, the same subjective symp‑ toms reappear, accompanied by higher serum lipids level, and impairment of the oro‑dental level.
If a fractionated heparin treatment was applied for three weeks, it would continue with anti‑ platelet agents, which normalize the lipid bio‑ chemical syndrome and eliminate completely the subjective complaints. Simultaneously, the patient is instructed to avoid high or low surgical intervention (e.g. dental surgery), because of the increased risk of bleeding.
Later on, between May‑August 2012, the patient addressed a dental specialist for the recurrence of symptoms and pathology. Further clinic laboratory investigations revealed a new syndrome ‑ biochemical alteration of atheroscle‑ rosis ‑ which made us believe that we are facing
a new evolutionary stage of the atheromatosis process. This time, regression of atherosclerosis occurred without any treatment or any subjec‑ tive complaints, while the biochemical syndrome remained in the normal range.
The case illustrates the irregular evolution ‑ with progression and regression phases ‑ of both general and dental clinical symptomatology, and of the laboratory tests, three such outbursts being surprisingly recorded during the two years of observations. The role of trauma and mental ten‑ sion stress in triggering progression is also out‑ lined.
RESULTS AND DISCUSSION
The long observation of this case showed that, sometimes, evolution and regression occurs
spontaneously, a situation decisively inluenced
by the alternative therapeutical (hygienico‑die‑ tetic or drug) measures taken.
Clinical characterization of the evolutive phases involves, on one side, exacerbation of the subjective and objective symptomatology of ath‑ erosclerosis with systemic manifestations, or the occurrence of complications, such as, for exam‑ ple, the mouth syndrome highlighted in the pre‑ sent study, and, on the other, by the increased serum lipid values, the general observation to be made being that the general clinical symptoms and, particularly the oro‑dental ones, evolve in parallels.
Analysis of the conditions of emergence and extinction of the evolutive processes shows that psychological trauma, endocrine disorders, diets rich in animal fats, infections and so on, can deci‑
sively inluence the development of atheroscle‑ rosis. Equally, it can be concluded that the gradual development of the disease is a sponta‑
neous phenomenon that can be inluenced by the
therapeutic means applied.
As shown in most of the recent studies, and also as evidened by our own observations, the tests highlighting the atherogenic/aging process
relect the dynamics evolution of atherosclerosis,
International Journal of Medical Dentistry 119
GERIATRICS – MULTIDISCIPLINARY COLLABORATION – AN IMPERATIVE
CONCLUSIONS
To conclude with, the multidisciplinary character is based on the fact that atherosclerosis is a systemic disease, therefore with implications at oro‑dental level, chronic evolution, a back‑ ground against which evolutive phases, followed by regression phases, may occur from time to
time, under the inluence of certain internal or
external environmental factors. Latest studies show that recognition of the two – progressive and regressive – phases of the atherosclerotic
process is not suficient as such, the really impor‑ tant idea being to have constantly in mind the fact that the pathological condition may have, at some point of its evolution, a more or less stable character. [11,13]
For the clinician, particularly important is the
inding that the evolutive phases of the disease
can be recognized by biochemical evidence which, generally, as shown by our observations, evolve in parallels with the clinical symptoms
and with the morphological modiications (in
our case, of oro‑dental nature), so that medical
practice is not suficient for establishing the diag‑ nosis of atherosclerosis and for its localization, its evolution being especially important for the settlement of the therapeutical targets.
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