Two dramatic demographic changes in geriatric dentistry: 1900 - 2000
1. Increased numbers of adults surviving into older age.
2. Increased numbers of older adults retaining natural teeth.
The “curve” of preventive dentistry!

Factors in keeping natural teeth:
 Education
 Nutrition
 Medicine
 Professional dental care
 Genetic predisposition
 Efficient home care

Consequences of poor oral care
Tooth decay Gum infection
Inability to chew food
Loss of teeth
Break down of teeth
And supportive tissue
Inflammatory bacterial toxins
Systemic infection
Cyclic fever

Consequences of poor oral care
 Bad breath
 Loss of self esteem
 Social isolation

Reasons dependent elderly don’t receive sufficient oral care:
 Major illness
 Medication that masks dental disease
 Cognitive and/or physical decline
 Income decline/uninsured
 Inability to get to dentist

 Reduction of pain/sensitivity
 Dry mouth
 Antibiotics may mask origin of dental plaque disease
 Sedation

Top 10 causes of death in adults age
65 and over:
(1966 - US)
1: Heart Disease* 6: Diabetes Mellitus*
2: Malignant Neoplasms
3: Cerebrovascular
Diseases*
7: Accidents and Adverse
Effects
8: Alzheimer's Disease
4: Chronic Obstructive 9: Renal Diseases**
Pulmonary Disease**
10: Septicemia*
5: Pneumonia and Influenza**
» Chronic dental plaque disease*
(Source: Peter KD, Kochanec KD, Murphy SL.
Deaths: Final data for 1996. National Center for
Health Statistics. National Vital Statistics Rep
1998: 47: 27.)
* Strong co-factor
** Possible link

Top 10 chronic conditions in adults age 65 and over:
(1994 - US)
1: Arthritis
2: Hypertension
3: Heart Disease*
4: Chronic Sinusitis**
5: Diabetes Mellitus*
6: Allergic Rhinitis
7: Varicosities
8: Hernia
9: Hemorrhoids
10: Chronic Bronchitis**
» Chronic dental plaque disease*
(Source: Adams PF, Movano MA. Current estimates from the National Interview Survey.
1994. National Center for Health Statistics. Vital
Health Statistics 1995: 10: 83-84.
* Strong co-factor
** Possible link

Risks of Dental Plaque Disease on
(DPD) Dependent Elderly Health:
 Aspiration pneumonia
 Sepsis
 Cardiac (co-factor)
 Diabetes (co-factor)
 Stroke (co-factor)
These conditions also have an impact on the progression of dental plaque disease.

Healthy
Tooth
Dental Plaque
Disease

Thick protective enamel
Healthy DPD

Healthy DPD
Decay of enamel
Plaque & root decay

Healthy
Tight membrane normal passage of fluids
DPD

Healthy DPD
Loss of membrane
Bacterial toxins enter mouth and body
Inflammatory reaction

Healthy
Strong attachment of fibers to bone
DPD

Healthy DPD
Loss of support structure
Inflamed infected gums

Oral Health Maintenance Elements
 Mechanical
 Tooth brushing, flossing
 Chemical
 Fluoride, anti-bacterial, peroxide
 Nutritional
 Healthy diet, fiber
 Regular dentist visits

Oral Hygiene Management Program
 Manual toothbrushes
 Small head
 Soft/medium bristles
 Children’s brushes work well for older mouths
 Replace brushes routinely

Oral Hygiene Management Program
 Battery spin brushes
 Inexpensive
 Easy to operate
 Gentle movement
* choose an easy-to-hold handle (kid’s brush perhaps)
* check for comfortable switch operation

Oral Hygiene Management Program
 Cordless, rechargeable toothbrushes, including ultrasonics
 Strong, effective action
 Ultrasonic action may bother some seniors
 Replace brushes routinely
* See Consumer Reports evaluations and recommendations

Oral Hygiene Management Program
 Intradental Cleaning
 Daily flossing recommended
 Proxabrush may be helpful
 Stimudents or toothpicks may be needed
 Ultrasonics

Oral Hygiene Management Program
 Prescription products
 Fluoride gels*; brush on teeth at bedtime without rinsing
 Chlorhexidine* (Peridex, Perioguard); brush on morning after cleaning, do not rinse
* Remove excess fluids by spitting or by sponge

Oral Hygiene Management Program
 Nutritional considerations
 Avoid sugars
 Healthy diet
 Regular dental visits

Oral Hygiene Management Program
 Final thoughts
 Consistent oral care is the key
 DPD can be silent, painless
 Healthy mouth and healthy body go together
 Resource list follows

Resources
 “Providing Oral Care” (videotape),
Medcom Trainex (CNA #506), call 1-
800-877-1443
 “Oral Care for the Dependent
Patient” (videotape), West Virginia
University Health Sciences School of
Dentistry and Geriatric Program, call
304-293-5912

Resources
 “Assuring Dental Health for
Nursing Home Residents” (web cast), Centers for Medicare and
Medicaid Services, see http://cms.distributedclassroom.org

Resources
 Oral Care in a Long-Term Care
Facility” (videotape), University of Washington Instructional
Media Services, call 866-791-
1278 or see http://www.dental.washington.edu/
 conted/cdestore/longterm.htm

Resources
 “A Beautiful Smile is Ageless”
(videotape) and “Oral Health
Assessment of Nursing Home
Residents: An In-Service Training
Guide for Nursing Staff” (videotape),
Greater Houston Dental Society, call
713-961-4337 or see www.ghds.com/videos.htm