Impact on General Functionality of an Immediate Prosthetic Functionalization Protocol in People Over 70 Years of Age With Deficient Removable Prostheses

In the public health system, older adults who need new dental prostheses are referred from primary health care to the rehabilitation specialty at the secondary care level. In many cases, they wear old, fractured, non-functional prosthetic devices and enter waiting lists for several months at the hospital level. During that time, they continue a process of oral hypofunction, a stage that gradually progresses to a process of oral dysfunction and decreased systemic function. Once they are called from the secondary level to enter treatment, they must wait for the rehabilitation process time that takes about two months, a period in which they continue with oral hypofunction, a functional pathophysiological condition that closely maintains the negatively impact in nutrition. Our proposal consists of carrying out a dental intervention, competence of the general dentist, when the patient begins the conventional treatment process, once you enter secondary care. This intervention is intended to immediately recover bilateral, homogeneous and simultaneous occlusal contacts, in addition to recovering the prosthetic biomechanical characteristics, by improving prosthetic support, retention and stability. All of this will be made with supplies commonly used in the dental clinic in health services and university teaching clinics. To evaluate the effect that this intervention will have at the muscular level, the patient's manual grip strength and gait speed will be measured, before the intervention and fifteen days later. Subsequently, once the new prostheses have been made, a new measurement will be made. A quality of life survey related to oral health will be applied to both groups, before and after the intervention and treatment. Based on international scientific evidence and on an investigation carried out by this research team (presented at the Chilean National Congress of Geriatrics and Gerontology), between October 2018 and April 2019 in 60 octogenarian older adults not wearing prostheses in whom dental prostheses were built - whose objective was to determine if there was an association between the use of prostheses that return the premolars and molars and the gripping force of the hand. Hand tightening force was measured before and 15 days after prosthetic rehabilitation with a manual hydraulic dynamometer (Jamar MR). For the cohort in study the use of prostheses increased the gripping force of the hand by a statistically significant value. This research aims to be a contribution for the Chilean population and for geriatrics, since the immediate recovery of oral functionality will eliminate a risk factor in older people, reducing conditions that increase frailty, which in cases of entering long-term lists is expected to have a greater impact at the systemic level and higher health costs. In some cases, out-of-pocket spending on dental supplies will also be reduced, because by recovering prosthetic biomechanical conditions, older people will not have to invest resources in creams and/or adhesive powders to "improve" prosthetic adhesion. With this, it would also be possible to contribute to the improvement of the quality of life of these patients as a result of the recovery of functions: masticatory and social. It will also allow a better integration of dentists into the multidisciplinary team in the care model proposed by the Health Ministry and will allow the development and implementation of a care protocol in primary health care, considering that the intervention will contemplate actions that are the responsibility of general dentists.

Without the development of this research, care system will maintain its long waits for this age group for treatment, a situation that will continue to increase considering that global projections related with a greater increase in older inhabitants, and also of the costs already described.