Oral Health Problem of the Elderly

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Oral Health Problem of the Elderly

• Narumanas Korwanich
• Department of Community Dentistry
• Chiangmai University

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WHO, 2002
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UN, 2001
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Thailand age pyramid 2004
Female
Male
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Thailand Projection
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WHO, 2002
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Active Ageing
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• 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
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• 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

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WHO, 2002
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Oral Health Problem in Elderly
Petersen Yamamoto, 2005
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Tooth Loss
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Epidemiology of Edentulousness
WHO, 2005
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National Oral Health Survey
????????? 2551
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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
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Association with Chewing Ability
Sarita et al., 2003
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Association with Chewing Ability
Sarita et al., 2003
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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
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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
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5 Rats aged 11 weeks old kept in 23c,
50humidity, 12 h light/dark
Extract all maxillary and mandibular molars
135 weeks
Test in radial arm maze
9 weeks
Test of Acetyl-choline releasing from parietal
cortex
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• 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

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Tooth Loss and Quality of Life
OIDP index
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Tooth Loss and Quality of Life
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Denture Related Condition
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Denture Related problems

• Plaque
• Stomatitis and Oral Candidiasis
• Malodor
• Reservoir of Infection
• Hygiene
• Denture
• Denture Hyperplasia
• Traumatic Ulcer

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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

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Denture Hyperplasia

• 4-26 prevalence of complete denture users
• Frequently in
• Ill fitting denture
• Unretentive denture

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Dental Caries
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Dental Caries

• 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
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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
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Fejerskov, 1997
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Takahashi Nyvaad, 2008
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Periodontal Disease
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Periodontitis as a risk for health

• Diabetes
• Cardiovascular disease
• Pulmonary disease
• Adverse pregnancy

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Effect of systemic disease to periodontium

• Osteoporosis
• Renal dysfunction
• Immunodeficiency disease
• Pregnancy

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

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Lenander-Lumikari Loimaranta, 2000
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Buffer Capacity
Lenander-Lumikari Loimaranta, 2000
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Guggenheimer Moore, 2003
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Diagnosis of Xerostomia
Bardow, 2001
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Guggenheimer Moore, 2003
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Oral Cancer and Precancer
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Global Perspective
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WHO 2002
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WHO 2002
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Risk Factors

• Alcohol and Tobacco
• Dietary factors
• Human papilloma virus
• Other factors

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WHO 2006
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Thank You