On the last neuroethics seminar before our unexpected hiatus, Yvonne Kapila and Ahmed Alsaleh joined us to discuss informed consent guidelines for dental and periodontology care in older, cognitively impaired adults. Periodontal disease is often overlooked in patients with dementia and Alzheimer’s Disease, yet the prevalence of both cognitive impairments and periodontal diseases increases with age. Yvonne and Ahmed introduced several case studies where patients with varying degrees of cognitive impairments underwent care for dental implants and dental infections. In these cases, informed consent procedures created challenges for clinicians who wondered if patients with impairments could adequately understand and consent to invasive procedures, some of which must occur over the span of several months and years.
The discussion focused on the risks and benefits of ongoing dental and periodontal care in older populations. As oral hygiene becomes more difficult, elder adults become susceptible to issues like root decay, dry mouth, osteonecrosis, and infection. However, dental restorations themselves can negatively impact quality of life in these same individuals, as dentures and dental prostheses require extensive maintenance and can come with a number of complications like infection. By the end of the discussion, the group wondered about the feasibility of implementing bioethical consults for dentistry or documents like dental directives. The discussion also underscored the importance of ethical frameworks of care for patients whose clinical indications require treatment regardless of cognitive status, as well as ongoing interdisciplinary collaborations between neurologists, geriatricians, and dentists.