2. Two dramatic demographic changes in geriatric dentistry: 1900 - 2000 1. Increased numbers of adults surviving into older age. 2. Increased numbers of older adults retaining natural teeth. The “curve” of preventive dentistry!

3. Factors in keeping natural teeth: çEducation çNutrition çMedicine çProfessional dental care çGenetic predisposition çEfficient home care

4. Lifetime investment in maintaining natural teeth can be lost in a few months Cost of dental plaque disease

5. Consequences of poor oral care Tooth decayGum infection Break down of teeth And supportive tissue Inability to chew food Loss of teeth Inflammatory bacterial toxins Cyclic fever Systemic infection

6. Consequences of poor oral care çBad breath çLoss of self esteem çSocial isolation

7. Reasons dependent elderly don’t receive sufficient oral care: çMajor illness çMedication that masks dental disease çCognitive and/or physical decline çIncome decline/uninsured çInability to get to dentist

8. Impact of some medications on awareness and progression of oral disease: çReduction of pain/sensitivity çDry mouth çAntibiotics may mask origin of dental plaque disease çSedation

9. Top 10 causes of death in adults age 65 and over: (1966 - US) 1: Heart Disease* 2: Malignant Neoplasms 3: Cerebrovascular Diseases* 4: Chronic Obstructive Pulmonary Disease** 5: Pneumonia and Influenza** 6: Diabetes Mellitus* 7: Accidents and Adverse Effects 8: Alzheimer's Disease 9: Renal Diseases** 10: Septicemia* (Source: Peter KD, Kochanec KD, Murphy SL. Deaths: Final data for 1996. National Center for Health Statistics. National Vital Statistics Rep 1998: 47: 27.) * Strong co-factor ** Possible link » Chronic dental plaque disease*

10. Top 10 chronic conditions in adults age 65 and over: (1994 - US) 1: Arthritis 2: Hypertension 3: Heart Disease* 4: Chronic Sinusitis** 5: Diabetes Mellitus* » Chronic dental plaque disease* 6: Allergic Rhinitis 7: Varicosities 8: Hernia 9: Hemorrhoids 10: Chronic Bronchitis** * Strong co-factor ** Possible link (Source: Adams PF, Movano MA. Current estimates from the National Interview Survey. 1994. National Center for Health Statistics. Vital Health Statistics 1995: 10: 83-84.

11. Risks of Dental Plaque Disease on (DPD) Dependent Elderly Health: çAspiration pneumonia çSepsis çCardiac (co-factor) çDiabetes (co-factor) çStroke (co-factor) These conditions also have an impact on the progression of dental plaque disease.

12. Healthy Tooth Dental Plaque Disease

13. HealthyDPD Thick protective enamel

14. HealthyDPD Decay of enamel Plaque & root decay

15. HealthyDPD Tight membrane normal passage of fluids

16. HealthyDPD Loss of membrane Bacterial toxins enter mouth and body V Inflammatory reaction

17. HealthyDPD Strong attachment of fibers to bone

18. HealthyDPD Loss of support structure Inflamed infected gums

19. Oral Health Maintenance Elements çMechanical äTooth brushing, flossing çChemical äFluoride, anti-bacterial, peroxide çNutritional äHealthy diet, fiber çRegular dentist visits

20. Oral Hygiene Management Program çManual toothbrushes äSmall head äSoft/medium bristles äChildren’s brushes work well for older mouths äReplace brushes routinely

21. Oral Hygiene Management Program çBattery spin brushes äInexpensive äEasy to operate äGentle movement * choose an easy-to-hold handle (kid’s brush perhaps) * check for comfortable switch operation

22. Oral Hygiene Management Program çCordless, rechargeable toothbrushes, including ultrasonics äStrong, effective action äUltrasonic action may bother some seniors äReplace brushes routinely * See Consumer Reports evaluations and recommendations

23. Oral Hygiene Management Program çIntradental Cleaning äDaily flossing recommended äProxabrush may be helpful äStimudents or toothpicks may be needed äUltrasonics

24. Oral Hygiene Management Program çPrescription products äFluoride gels*; brush on teeth at bedtime without rinsing äChlorhexidine* (Peridex, Perioguard); brush on morning after cleaning, do not rinse * Remove excess fluids by spitting or by sponge

25. Oral Hygiene Management Program çNutritional considerations äAvoid sugars äHealthy diet çRegular dental visits

26. Oral Hygiene Management Program çFinal thoughts äConsistent oral care is the key äDPD can be silent, painless äHealthy mouth and healthy body go together äResource list follows

27. Resources ç“Providing Oral Care” (videotape), Medcom Trainex (CNA #506), call 1- 800-877-1443 ç“Oral Care for the Dependent Patient” (videotape), West Virginia University Health Sciences School of Dentistry and Geriatric Program, call 304-293-5912

28. Resources ç“Assuring Dental Health for Nursing Home Residents” (web cast), Centers for Medicare and Medicaid Services, see http://cms.distributedclassroom.org

29. Resources çOral Care in a Long-Term Care Facility” (videotape), University of Washington Instructional Media Services, call 866-791- 1278 or see http://www.dental.washington.edu/ çconted/cdestore/longterm.htm

30. Resources ç“A Beautiful Smile is Ageless” (videotape) and “Oral Health Assessment of Nursing Home Residents: An In-Service Training Guide for Nursing Staff” (videotape), Greater Houston Dental Society, call 713-961-4337 or see www.ghds.com/videos.htm