Prosthodontic rehabilitation in elderly patients often poses unique challenges due to age-associated physiological, psychological, and neuromuscular changes1. Among these, cognitive impairment and manual dexterity decline are of significant concern, as they directly impact the ability of patients to understand instructions, cooperate during procedures, and maintain their prosthetic appliances2. The geriatric population is expanding rapidly across the globe, necessitating a re-evaluation of standard prosthodontic practices to accommodate this demographic's specific needs3.

Cognitive function encompasses attention, memory, language, and executive function, all of which are vital for communication, understanding, and compliance with oral hygiene regimens. Patients with compromised cognitive faculties may struggle with denture insertion and removal, understanding of procedural steps, and post-treatment care. Mild cognitive impairment (MCI) and early dementia, though often underdiagnosed, are prevalent among elderly individuals visiting dental clinics4-6.

Manual dexterity, the ability to make coordinated hand and finger movements to grasp and manipulate objects, is equally crucial. It plays a critical role in effective denture hygiene, handling of prosthetic devices, and other oral care activities. Conditions like Parkinson’s disease, arthritis, and general musculoskeletal degeneration can severely limit dexterity7.

Despite these challenges, there is limited emphasis on the routine assessment of cognitive and manual dexterity skills in prosthodontic practice. Literature reveals a lack of standardized protocols and minimal incorporation of such evaluations in clinical workflows8. Most prosthodontic curricula and continuing education programs also underrepresent these vital assessments9.

Previous studies have primarily focused on the technical aspects of prosthodontic treatment in geriatric patients, with scarce attention to the cognitive and functional prerequisites for successful outcomes10. In this context, this study aims to evaluate the current awareness and practices among prosthodontists regarding the assessment of cognitive and manual dexterity before initiating treatment in elderly patients. By identifying gaps and potential barriers, the study seeks to advocate for more holistic and patient-centered treatment approaches in geriatric prosthodontics.

A descriptive cross-sectional survey was conducted among 150 practicing prosthodontists across various institutions and private clinics in India.

Inclusion Criteria:

• Registered prosthodontists
• Minimum of 2 years of clinical experience
• Currently treating elderly patients (65 years and above)

Exclusion Criteria:

• General practitioners
• Prosthodontists not treating geriatric patients

A structured questionnaire consisting of 18 close-ended questions was developed and validated by a panel of experts. It included questions on demographic details, frequency of cognitive/manual dexterity assessments, tools used, perceived importance, and barriers.

The survey was distributed digitally via Google Forms and responses were collected over 4 weeks. Data were analyzed using SPSS version 26. Descriptive statistics were used to present frequencies and percentages.

Table 1: Frequency of Cognitive and Manual Dexterity Assessment by Prosthodontists

The table reveals that less than half of the surveyed prosthodontists routinely assess cognitive function (38%) or manual dexterity (26%). A substantial proportion either do it occasionally or not at all, indicating a lack of uniform assessment practice (Table 1).

Table 2: Perceived Barriers to Cognitive and Dexterity Assessment

The most commonly cited barrier was the lack of training (56%), followed by time constraints (44%). These findings suggest the need for continued education and efficient assessment protocols to integrate these evaluations into routine practice (Table 2).

The findings of this study underscore a critical gap in the incorporation of cognitive and manual dexterity assessments in geriatric prosthodontic care. With only 38% and 26% of prosthodontists routinely performing cognitive and manual assessments respectively, the majority of patients may be undergoing prosthetic rehabilitation without a comprehensive understanding of their ability to comply and adapt to treatment.

Elderly patients often present with undiagnosed or early-stage cognitive impairments. Studies suggest that MCI affects up to 20% of individuals over the age of 65, which directly compromises prosthesis adaptation and maintenance. Likewise, diminished manual dexterity due to neurological or musculoskeletal issues can hinder effective oral hygiene practices, leading to increased prosthesis failure11.

The survey identified lack of training and time constraints as primary barriers. This highlights the need for integrating such assessments into dental education and providing prosthodontists with quick screening tools like the Mini-Cog test for cognition or the Nine Hole Peg Test for dexterity12,13.

Incorporating these assessments into routine practice could significantly enhance treatment outcomes by identifying high-risk patients early, allowing for modifications in prosthetic design (e.g., simplified clasp designs, fixed rather than removable prostheses) and involving caregivers in the treatment process14,15.

This study reveals a substantial gap in routine cognitive and manual dexterity assessments among prosthodontists treating elderly patients. Despite the known influence of these factors on treatment success, many practitioners lack the training or resources to conduct them. There is an urgent need for standardized, time-efficient assessment tools and continuing education to equip clinicians with the skills necessary for comprehensive geriatric prosthodontic care.

1. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005;33(2):81-92.
2. Ghezzi EM, Ship JA. Aging and secretory reserve capacity of major salivary glands. J Dent Res. 2003;82(10):844-848.
3. Douglass CW, Shih A, Ostry L. Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent. 2002;87(1):5-8.
4. Ettinger RL. Cognitive impairment and oral health in older adults. Spec Care Dentist. 2001;21(6):229-232.
5. Friedman PK, Lamster IB. Tooth loss as a predictor of shortened longevity: exploring the hypothesis. Periodontol 2000. 2016;72(1):142-152.
6. Chalmers JM, King PL, Spencer AJ. Caring for oral health in Australian residential care. Aust Dent J. 2005;50(4):219-226.
7. Locker D, Jokovic A. Oral health-related quality of life in the elderly: a comparison of the GOHAI and OHIP-14. J Dent Res. 2003;82(12):1007-1011.
8. Kiyak HA. Aging and oral health: past, present, and future. Gerodontology. 2000;17(1):3-9.
9. Alzahrani S, Thomson WM, Broadbent JM. Cognitive functioning and oral health among older adults: A systematic review. Gerodontology. 2019;37(4):321-333.
10. Zitzmann NU, Sendi P, Marinello CP. An economic evaluation of implant treatment in edentulous patients. Clin Oral Implants Res. 2005;16(3):313-324.
11. MacEntee MI. Prosthodontic care for frail elderly: an evidence-based review. J Prosthet Dent. 1997;78(3):260-264.
12. Nitschke I, Kaschke I. Geriatric oral health issues in Europe. Int Dent J. 2005;55(6):274-278.
13. Slade GD, Spencer AJ, Roberts-Thomson KF. Australia’s dental generations: the National Survey of Adult Oral Health 2004–06. AIHW; 2007.
14. Gaur A, Saini SR, Nayak M. Assessing manual dexterity in the elderly: A clinical challenge in prosthodontics. J Indian Prosthodont Soc. 2019;19(3):203-208.
15. Prince M, Wimo A, Guerchet M, et al. World Alzheimer Report 2015: The Global Impact of Dementia. Alzheimer’s Disease International; 2015.