Transcript Oral Health Problem of the Elderly

Oral Health Problem of the Elderly
Narumanas Korwanich
Department of Community Dentistry
Chiangmai University
WHO, 2002
UN, 200
Thailand age pyramid 2004
Male
Female
โครงสร้ างประชากรอ.ลอง จ.แพร่ 2550
โครงสร้ างประชากร ต.เกาะลันตาน้ อย อ.เกาะลันตา 2549
Thailand Projection
WHO, 2002
Active Ageing
Health
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
Participation
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
Security
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, 2005
Reduce risk factors associated with major
diseases and increase factors that protect
health throughout the life course
- Tobacco
- Nutrition
- Oral Health
- Alcohol and drugs
- Physical activity
- Healthy eating
- Psychological factors
- Medication
WHO, 2002
Oral Health Problem in Elderly
1
Tooth loss
2
Denture related condition
3
Coronal and root caries
4
Periodontal disease
5
Xerostomia
6
Cancer and precancer
Petersen & Yamamoto, 2005
Tooth Loss
Epidemiology of Edentulousness
WHO, 2005
National Oral Health Survey
กรมอนามัย 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
135 weeks
Test in radial arm maze
9 weeks
Test of Acetyl-choline
releasing from parietal
cortex
• 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, 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, 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, 2000
Salivary Flow Rate
Xerostomia
subjective report of oral
dryness
related
to
gender
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
Buffer Capacity
Lenander-Lumikari & Loimaranta, 2000
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