Luciana Bento

Odontogeriatria oferece atendimento especializado para idosos | Longevidade: modo de usar

São 25 anos de formado e uma lembrança inesquecível dos tempos de universidade: quando frequentou uma disciplina sobre atendimento a pacientes especiais, o dentista Almir Oliva Filho descobriu o que queria fazer pelo resto da vida, certeza que se cristalizou ao se especializar em cuidados paliativos na sua área. Sua trajetória o levou a se tornar especialista em odontogeriatria pelo Conselho Federal de Odontologia e em gerontologia pela Sociedade Brasileira de Geriatria e Gerontologia, e agora também ocupa o cargo de diretor científico da Associação Brasileira de Odontologia para Pacientes Especiais (Abope). “Quando o paciente está numa situação de fragilidade, o simples deslocamento até um consultório pode significar um transtorno”, diz. “A situação se agrava se a pessoa estiver acamada. Não se trata de um luxo, e sim de uma necessidade”.

Na verdade, o doutor Almir tem um consultório portátil, com tudo o que é necessário para o atendimento, e costuma reservar algumas horas do seu dia para chamadas de emergência. Como explica, no caso do idoso é como se a boca se tornasse “invisível”, mesmo quando ele dispõe de diversos especialistas: “geralmente, o dentista só é procurado quando o incômodo é muito forte”, lamenta. Uma fratura do dente ou a queda de uma restauração antiga, por exemplo, podem provocar cortes na língua, porque deixam os bordos cortantes. Também é comum que tratamentos oncológicos com quimioterapia e radioterapia provoquem sequelas, sendo que o efeito colateral mais frequente são as mucosites (inflamações na parte interna da boca, conhecidas como sapinho). “A odontogeriatria trabalha para que o idoso coma bem, fale bem e garanta sua higiene bucal”, resume, acrescentando que quem utiliza dentadura deve trocá-la entre cinco e dez anos de uso.

A grande inimiga dos mais velhos é a doença periodontal, que ocorre quando a placa bacteriana vai aderindo às margens das gengivas, causando infecção que ataca primeiro essa região e depois os ossos que sustentam os dentes. O doutor Almir afirma que outra alteração comum é a retração da gengiva, aumentando o risco de cárie na raiz do dente. Ele enfatiza que a diminuição da saliva é uma das questões cruciais para a saúde da boca: “ela tem efeito direto na produção de cáries, na dificuldade de deglutição e no preparo do bolo alimentar. A interação medicamentosa é a principal responsável pela diminuição do fluxo salivar, por isso é tão importante que o idoso, que quase certamente faz uso de diferentes medicações, se hidrate bem”.

Há cuidados especiais para o atendimento de idosos com demência, que podem necessitar inclusive de sedação. Seu conselho é que, quando já há um diagnóstico da doença – mesmo que em seus estágios iniciais – o tratamento odontológico seja feito o mais rapidamente possível, para contar com uma participação ativa da pessoa. A Abope tem uma cartilha para seus profissionais lidarem com a situação:

1. Seja paciente, tenha bom humor.

2. Não infantilize o paciente, fale olhando nos olhos dele, de forma clara evitando termo técnico.

3. Evite perguntas complexas.

4. Responda quantas vezes for necessário.

5. Avisar sobre cada procedimento antes de iniciar, como uso de turbinas, seringa tríplice, posição da cadeira e demais.

6. Evitar sons estridentes como instrumental jogado na bandeja metálica.

7. Tenha sempre um acompanhante do paciente presente na consulta, preferencialmente no campo de visão dele.

8. O tempo de consulta deve ser o suficiente para atender o paciente com calma, porém o tempo de intervenção deve ser otimizado, atento ao limite do paciente.

9. Avaliar e reavaliar o plano de tratamento e a necessidade de sedação.

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Luciana Bento

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