Santa Fe Group Oral Health For the Elderly: Challenges and Opportunities 28 June 2007 Santa Fe, NM Oral Health For the Elderly: Challenges and Opportunities 28 June 2007 Santa Fe, NM Jocelyne Feine McGill University

Percent Edentulous Among U.S. Adults, by Age Group: NCHS, National Health and Nutrition Examination Surveys

The Impact of Edentulism General Health and Quality of Life Comfort Nutrition Ability to chew Food choice Ability to socialize Intimate activities General Health and Quality of Life Comfort Nutrition Ability to chew Food choice Ability to socialize Intimate activities

Edentulism and General Health 1.Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999). 2.Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation). 3.Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996). 1.Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999). 2.Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation). 3.Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).

Edentulous Denture-Wearing Elders are at Risk for Disease 1.Prevention of tooth loss 2.Therapy to improve chewing ability and nutrition. 1.Prevention of tooth loss 2.Therapy to improve chewing ability and nutrition.

OSSEOINTEGRATED INTRAORAL IMPLANTS

From Health Technology Assessment to Health Policy

Reducing Cost of Care Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press). Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007). Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press). Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007). Healthcare Professional

Cost-Effectiveness Assessments Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost- effective (OHQoL) on the long term than are complete conventional dentures ( Heydecke et al, 2005 ).

Technology Transfer Micro Level Peer-reviewed journals Continuing education / courses Legal precedent Professional schools Peer practice Health supply company Advertisements Hospital policies Clinical practice guidelines Dissemination of knowledge TECHNOLOGY Healthcare Professional

“I got a bone to pick with you, girlie!” McGill Consensus Conference: Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients McGill Consensus Conference: Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients

At what point does our canine colleague have an obligation: 1) To inform his patients of new effective therapies? 2) To provide such therapies to his patients?

Technology Transfer Health Care Professional Treatment Plan (alternative therapies) Informed consent Treatment of choice Patient Duty of care Economic factors Standard of care Social factors Access to care Ethical and moral issues Legal and professional issues Negligence Malpractice

You may stop the postman from delivering the message, but, at some point, ignorance of the evidence is no defense!

1.Demonstrate improved health and QoL 2.Demonstrate cost-effectiveness 3.Apply political and social pressure Meso and Macro Levels

WHO WILL SPEAK FOR ME?