Oral Health Problem of the Elderly

Narumanas Korwanich

Department of Community Dentistry

Chiangmai University

WHO, 2002WHO, 2002

UN, 2001UN, 2001

Thailand age pyramid 2004

FemaleMale

โครงสร�างประชากรอ. ลอง จ. แพร� 2550

โครงสร�างประชากร ต. เกาะล�นตาน�อยอ. เกาะล�นตา 2549

Thailand Projection

WHO, 2002WHO, 2002

Active Ageing

HealthHealth

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

ParticipationParticipation

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

SecuritySecurity

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

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, 2005Petersen & Yamamoto, 2005

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

WHO, 2002WHO, 2002

Oral Health Problem in Elderly

Tooth loss1

Denture related condition2

Coronal and root caries3

Periodontal disease4

Xerostomia5

Cancer and precancer6

Petersen & Yamamoto, 2005Petersen & Yamamoto, 2005

Tooth Loss

Epidemiology of Edentulousness

WHO, 2005

National Oral Health Survey

กรมอนาม�ย 2551

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

Association with Chewing Ability

Sarita et al., 2003

Association with Chewing Ability

Sarita et al., 2003

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

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

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

• 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

Tooth Loss and Quality of Life

OIDP index

Tooth Loss and Quality of Life

Denture Related Condition

Denture Related problems

• Plaque Stomatitis and Oral Candidiasis Malodor Reservoir of Infection Hygiene

• Denture Denture Hyperplasia Traumatic Ulcer

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

Denture Hyperplasia

• 4-26% prevalence of complete denture users

• Frequently in Ill fitting denture Unretentive denture

Dental Caries

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, 2001NIH, 2001

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, 2006Fontana and Zero, 2006

Fejerskov, 1997

Takahashi & Nyvaad, 2008

Periodontal Disease

Periodontitis as a risk for health

• Diabetes

• Cardiovascular disease

• Pulmonary disease

• Adverse pregnancy

Effect of systemic disease to periodontium

• Osteoporosis

• Renal dysfunction

• Immunodeficiency disease

• Pregnancy

Xerostomia

• Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology

Dodd et al., 2005

Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000

Xerostomiasubjective 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

Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000

Buffer Capacity

Guggenheimer & Moore, 2003

Diagnosis of Xerostomia

Bardow, 2001

Guggenheimer & Moore, 2003

Oral Cancer and Precancer

Global Perspective

WHO 2002

WHO 2002

Risk Factors

• Alcohol and Tobacco

• Dietary factors

• Human papilloma virus

• Other factors

WHO 2006

Thank You