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

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

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

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

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

Mojon et al. Int J Proshodont (2004)

Prognosis for the decline in edentulism4 countries with reliable data

Prosthodontic Restoration and Age

Data from 2002 cited after Zitzmann et al. European J Oral Sciences 2008

Age Prostheses fixed removable C/C

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

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

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)

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)

tooth loss ↑

calcium and vit D and protein intake ↓

BMD ↓

altered food choice

(von Wovern 2001; Geuers 2000;Millwood 2000)

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

chewing capacity

nutritional state

food choice psychosocialfactors

psychologicalfactors

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

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

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

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 )

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

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

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

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

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)

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)

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)

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

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

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)

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

Thank you very much for your kind attention

Département de Médecine Interne, de Réhabilitation et de GériatrieDivision de Gérodontologie et Prothèse Adjointe, CUMD

HôpitauxUniversitairesGenève