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Oral Health for an Ageing PopulationTooth loss and importance of retaining teeth for
vitality, quality of life and longevityMartin Schimmel on behalf of Frauke Müller
Département de Médecine Interne, de Réhabilitation et de GériatrieDivision de Gérodontologie et Prothèse Adjointe, CUMD
HôpitauxUniversitairesGenève
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Lost structures teeth/ periodontium alveolar bone tm-joints gingiva / mucosa muscles nerves / vessels
Functions mastication orale perception occlusion speech aesthetics / physiognomy psycho-social aspects
physical retention
occlusion
motor skills
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Prevalence of edentulousness in the elderly reported for selected countries
The global burden of oral disease and risks to oral health.
PE Petersen, D Bourgeois, H Ogawa, S Estupian-Day, C Ndiaye Bulletin of the World Health Organisation 83 (9) 2005
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Dental Health of the Elderly Population
0,1 %0,1 %of 65-74 yr olds have a sound dentition and no caries experience
Schiffner U: Krankheits- und Versorgungsprävalenzen bei Senioren (65-74 Jahre)In: Institut der Deutschen Zahnärzte: DMS V, Deutscher Ärzte Verlag, Köln 2016
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Mojon et al. Int J Proshodont (2004)
Prognosis for the decline in edentulism4 countries with reliable data
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Prosthodontic Restoration and Age
Data from 2002 cited after Zitzmann et al. European J Oral Sciences 2008
Age Prostheses fixed removable C/C
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Oral Health of Patients with Dementia
Syrjälä, H et al. Dementia and oral health among subjects aged 75 years or older. Gerodontology (2010)
Patients with dementia had an increased likelihood of having carious teeth, teeth with deep periodontal pockets, and poor oral and denture hygiene, compared with non-demented persons
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Prevalence of Malnutrition in Institutionalized Persons
Pauly L et al. Nutritional situation of elderly nursing home residents. Z Gerontol Geriat 40:3 3-12 (2007)
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Edentaten=287
1-10 teethn=131
21+ teethn=123
Energy (Kcal) 1583 1700 1842
Protein (g) 60 66 71
Fat (g) 64 67 67
Non-starch Polysaccharide (g) 11 13 16
Calcium (mg) 722 825 884
Vitamin A (μg) 1036 1374 1268
Vitamin C (mg) 60 82 83
Niacin (mg) 27 33 32
Vitamin E (mg) 8 10 12
SHEIHAM A et al.: The Relationship among Dental Status, Nutrient intake and Nutritional Status in Older People. J Dent Res 80: 408-413 (2001)
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tooth loss ↑
calcium and vit D and protein intake ↓
BMD ↓
altered food choice
(von Wovern 2001; Geuers 2000;Millwood 2000)
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Transformation of a complete denture to an implant-overdenture : effect on nutrition
RCT with 255 participants aged 65 years or older
RandomisationConventional complete dentures (n=114)Conventional upper and lower implant-overdentures (n=103)
Outcome parameters (1-year observation period) fibre intakemacro- and 9 micro-nutriments total energy (kcal)
Hamdan N, Albuquerque R, Gray-Donald K, Feine J: A Mandibular Implant Overdenture: Is It A Nutritionally Significant Choice? J Dent Res 92(Spec Iss A):231, 2013
Implant-overdentures cannot improve the nutritional intake of edentulous persons
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chewing capacity
nutritional state
food choice psychosocialfactors
psychologicalfactors
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BMI and Mortality in Elderly PatientsWeiss A. et al. Journal of General Internal Medicine, 23(1) 19-24 (2007)
n = 470 hospitalized patients
age 81.5 yearsobservation period 4.2
years
In elderly patients, a high BMI is associated with a reduced mortality
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Social Aspectscommunication
social interactions
Signs of Age:functional impairment
Oral Health related Quality of Life (OHRQOL)
Psychologicalappearanceself-esteem
Pain / Discomfortacute / chronic
modified after INGLEHART 2002
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32-25 24-21 20-17 16-9 8-10
1
2
3
4
5
6
7
8
<30 Jr 30-49 50-69 70+0
1
2
3
4
5
6
7
8
age [ years]
Data from Steele et al.: How do age and tooth loss affect oral health impacts and qulaity of life? Community Dent Oral Epidemiol 32:107-14 (2004)
OH
IP s
core
no of teeth present
Oral Health Related Quality of Life (OHRQoL) evaluated by OHIP-14 ( Oral Health Impact Profile )
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Tooth Loss, Dementia and Neuropathology- the Nun Study -
Sample144 participants of the Nun Study, age 75-98 years
Observation period10 years with annual follow-up examinations
Outcome measurenumber of teethneuropathologic findings at autopsy (n=118)
Participants with the fewest teeth had the highest risk of prevalence and incidence of dementia
Edentulism or very few (1-9) teeth may be predictors of dementia late in life
Sparks Stein P et al. (2007) Tooth loss, dementia and neuropathology in the Nun Study JADA 138: 1314-22
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Interplay of Mastication, Nutrition, Cognition & ADL
Weijenberg et al. (2011) Neuroscience and Biobehavioral Reviews 35: 438-497
ADLNutrition
Mastication Cognition
CORRELATION
CAUSAL /-longitudinally observed-chance and bias eliminated -consistent associations-cause precedes effect-dose-response gradient-association is specific
The results of animal and human experimental studies suggest a causal relationship between mastication and cognition
These findings have compelling implications for the care for the frail and elderly, suffering from dementia
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Presence of Natural Teeth and 21-Year Mortality
Holm-Pedersen P. et al. Tooth Loss and Subsequent Disability and Mortality in Old Age J Am Geriatr Soc 56: 429-35 (2008)
573 nondisabled 70-year old Danes, medical and dental examination, interviewMortality obtained from the National Death Register
Being edentulous or having 1-9 teeth was
associated with onset of disability at age 75 and
80 years
Persons being edentulous at age 70 were sign. higher at risk of mortality 21 years later(Hazard ratio 1.26, 95% CI 1.03-1.55)
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Number of Teeth – a Predictor of Mortalityin 70-year old Subjects
0 1-9 10-19 ≥ 20 No of teeth
7-year mortality
Osterberg T, Carlsson GE, Sundh V, Mellström DNumber of teeth – a predictor of mortality in 7’-year old subjects. Community Dent Oral Epidemiol 36(3): 258-68 (2008)
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Preventive Effect of Oral Hygiene on Pneumonia in Elderly People in Hospitals and Nursing Homes
Approximately 1 in 10 cases of death 1 in 10 cases of death from pneumonia in institutionalised elderly may be prevented by improving oral hygiene
Absolute Risk Reduction (ARR) from 6.6% to 11.7%
Relative Risk (RR) 0.30 to 0.61
Number Needed to Treat (NNT) from 9 to 15
Sjögren et al. Journal of the American Geriatric Society 56: 2124-2130 (2008)
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Current status of tooth loss
Why retaining and restoring teeth is important ? Diet and teeth
Quality of life and teeth
Cognition and teeth
Longevity and teeth
Standards and priorities Standard indicators
Standard set of «perception» data from patients
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Standard Indicators for Oral HealthStructural IndicatorsNumber of teethPrevalence of fixed and removable prosthesesAttachment lossRidge resorption
Functional IndicatorsChewing efficiencyPlaque Index (PI), Denture Plaque Index
Indicators of PathologyDMFTCPITNSBIPrevalence of oral individual diseases
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Clinical Oral Assessment ToolsReproducible, reliable, proven validity, simple, quick, requiring minimal
dental equipment, without necessity for chairside assistance
Dental professionals / *Nurses/HygienistsOHX Oral Health Index Burke et al. 1995
CODE Clinical Oral Disorder in Elders Index McEntee et al. 1999
*OAG Oral Assessment Guide Isaksson et al. 2000
*THROAT THROAT Dickinson et al. 2001
*ROAG Revised Oral Assessment Guide A.Dept Health&Ageing
2003
Also applicable in demented patients*ADOH Activities of Daily Oral Hygiene Bauer et al. 2001
*MPS Mucosal Plaque Score Index Henriksen et al. 1999
*BOHSE Brief Oral Health Status Examination Kayser-Jones et al. 1995
List after Chalmers (2005)
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Standard set of «perception» data from patients
Quality of lifeOHIP 49, OHIP 20, OHIP 14, OHIP-EdentGOHAI
Denture satisfaction DSI (McGill)
Self reported disease / problems with teeth or dentures
Prevalence
Participation in leisure and social interactions
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Thank you very much for your kind attention
Département de Médecine Interne, de Réhabilitation et de GériatrieDivision de Gérodontologie et Prothèse Adjointe, CUMD
HôpitauxUniversitairesGenève