1. Oral Health Problem of the Elderly Narumanas Korwanich Department of Community Dentistry Chiangmai University

2. WHO, 2002

3. UN, 2001

5. Thailand age pyramid 2004 FemaleMale

6. โครงสร้างประชากรอ.ลอง จ.แพร่ 2550

7. โครงสร้างประชากร ต.เกาะลันตาน้อย อ.เกาะลันตา 2549

8. Thailand Projection

11. WHO, 2002

12. Active Ageing Health When the risk factors for chronic diseases and functional decline are kept low while the protective factors are kept high, people will enjoy both a longer quantity and quality of life Participation When labor market, employment, education, health and social policies and programs support their full participation in socio-economic, cultural and spiritual activities, people will continue to make a productive contribution to society Security When policies and program address the social, financial and physical security needs and rights of people as they age, elderly are ensured of protection, dignity and care in the event that they are no longer able to support and protect themselves

13. Oral health is an important component of ‘Active Ageing’ and is included in policy proposals related to health, one of the three basic pillars. Petersen & Yamamoto, 2005

14. Reduce risk factors associated with major diseases and increase factors that protect health throughout the life course - Tobacco- Physical activity - Nutrition- Healthy eating - Oral Health- Psychological factors - Alcohol and drugs- Medication

15. WHO, 2002

16. Oral Health Problem in Elderly Tooth loss 1 Denture related condition 2 Coronal and root caries 3 Periodontal disease 4 Xerostomia 5 Cancer and precancer 6 Petersen & Yamamoto, 2005

17. Tooth Loss

18. Epidemiology of Edentulousness WHO, 2005

19. National Oral Health Survey กรมอนามัย 2551

20. Tooth Loss Predictors 201 participants (104 edentulous) in the Healthy Old People in Edinburg (HOPE) study Age Social Class National Adult Reading Test IQ Self Esteem Score Dietary Assessment Score Cognitive testing score Starr et al., 2009

21. Association with Chewing Ability Sarita et al., 2003

22. Association with Chewing Ability Sarita et al., 2003

23. Association with Chewing Ability Shortened dental arched with intact premolar regions and at least one occluding pair of molars provide sufficient chewing ability Shortened dental arched with 3-4 pairs of occluding premolars and asymmetric arches with a long side result in impairment of chewing ability, especially of hard food In extremely shortened dental arches comprising 0-2 occluding premolars, chewing ability is severe impaired Sarita et al., 2003

24. Cognitive Impairment 5 extracted molar versus 5 non-extracted molar rats were compared to each other in learning ability and acetylcholine release in parietal lobe brain To examine the effects of tooth loss on the central nervous system Kato et al., 1997

25. 5 Rats aged 11 weeks old kept in 23c, 50%humidity, 12 h light/dark Extract all maxillary and mandibular molars Test in radial arm maze Test of Acetyl-choline releasing from parietal cortex 135 weeks 9 weeks

28. It has been demonstrated that the neuronal activity in the brain and the cerebral blood flow were increased by mastication Thus, one possible explanation may be that the dysfunction of cholinergic neuronal system in the teethless aged rats is caused by the long term decrease of neuron activity of the brain and/or the cerebral blood flow by the loss of teeth

32. Tooth Loss and Quality of Life OIDP index

33. Tooth Loss and Quality of Life

34. Denture Related Condition

35. Denture Related problems Plaque  Stomatitis and Oral Candidiasis  Malodor  Reservoir of Infection  Hygiene Denture  Denture Hyperplasia  Traumatic Ulcer

36. Denture Stomatitis 11-67% prevalence Correlate with  Amount of denture plaque  Use of denture at night  Neglect of denture cleaning  Use of defective or unsuitable denture

37. Denture Hyperplasia 4-26% prevalence of complete denture users Frequently in  Ill fitting denture  Unretentive denture

38. Dental Caries

39. Dental caries is an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, in the presence of sugar During the past few decades, changes have been observed not only in the prevalence of dental caries, but also in the distribution and pattern of the disease in the population NIH, 2001

40. Dental Caries It is identified a shift toward improved diagnosis of noncavitated, incipient lesions and treatment for prevention and arrest of such lesions Restorations repair the tooth structure, do not stop caries, have a finite life span and are susceptible to disease Fontana and Zero, 2006

57. Fejerskov, 1997

59. Takahashi & Nyvaad, 2008

60. Periodontal Disease

61. Periodontitis as a risk for health Diabetes Cardiovascular disease Pulmonary disease Adverse pregnancy

62. Effect of systemic disease to periodontium Osteoporosis Renal dysfunction Immunodeficiency disease Pregnancy

63. Xerostomia

64. Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology Dodd et al., 2005

65. Lenander-Lumikari & Loimaranta, 2000

66. Xerostomia subjective report of oral dryness related to gender Salivary Flow Rate Hyposalivation Objective salivary flow rate that is under 0.1 or 0.16 ml/min (or 0.1 ml/min; relate to medication and systemic disease

67. Lenander-Lumikari & Loimaranta, 2000 Buffer Capacity

69. Guggenheimer & Moore, 2003

70. Diagnosis of Xerostomia Bardow, 2001

71. Guggenheimer & Moore, 2003

72. Oral Cancer and Precancer

73. Global Perspective

74. WHO 2002

76. Risk Factors Alcohol and Tobacco Dietary factors Human papilloma virus Other factors

77. WHO 2006

78. Thank You