A few thoughts on oral A few thoughts on oral health and aging (mostly health and aging (mostly

aging)aging)Edward L. Schneider, MDEdward L. Schneider, MD

Dean Emeritus Dean Emeritus

USCUSC

Note: The Census Bureau has consistently underestimated the growth of the older population

Demography 101

Once again, these figures are probably underestimates

Again, Census is probably way off the mark, by 2050, the number will be closer to 30 million

A couple of findings from the 2006 A couple of findings from the 2006 Census reportCensus report

The health of older Americans is improving. The health of older Americans is improving. The proportion with a disability fell The proportion with a disability fell significantly from 26.2 percent in 1982 to 19.7 significantly from 26.2 percent in 1982 to 19.7 percent in 1999. percent in 1999.

The financial circumstances of older people The financial circumstances of older people have improved dramatically. have improved dramatically. The proportion of The proportion of people aged 65 and older in poverty decreased people aged 65 and older in poverty decreased from 35 percent in 1959 to 10 percent in 2003. from 35 percent in 1959 to 10 percent in 2003.

Some Additional Interesting DataSome Additional Interesting Data

The quality of health in later life may be determined The quality of health in later life may be determined more by your perinatal and prenatal environment than more by your perinatal and prenatal environment than by your health habits (What about oral health?)by your health habits (What about oral health?)

Socioeconomic status is a better predictor of poor Socioeconomic status is a better predictor of poor health in old age than exercise or nutrition health in old age than exercise or nutrition

Oral health may be a predictor of Alzheimer Disease Oral health may be a predictor of Alzheimer Disease and other conditions related to chronic inflammationand other conditions related to chronic inflammation

Transportation which equates with independence will Transportation which equates with independence will be a major issue for tomorrow's seniors be a major issue for tomorrow's seniors

Political IssuesPolitical Issues

Social Security will need only minor Social Security will need only minor adjustments to surviveadjustments to survive

Medicare will need major attention and will Medicare will need major attention and will probably not survive in its current stateprobably not survive in its current state

Medicaid will need radical surgery to survive Medicaid will need radical surgery to survive as long term care costs soaras long term care costs soar

But remember, all the political decisions will But remember, all the political decisions will be made by a Congress and a President elected be made by a Congress and a President elected largely by older voterslargely by older voters

The future of Aging: Your The future of Aging: Your Replacement Part Store is OpenReplacement Part Store is Open

• All joints: wrists, ankles, shoulders, All joints: wrists, ankles, shoulders, elbows, elbows, hands, jaws?hands, jaws?

• Most organs: heart, liver, kidney, pancreas, Most organs: heart, liver, kidney, pancreas, lungslungs

• Stem cells will be available to make bone Stem cells will be available to make bone marrow, immune cells, brain cells, artificial marrow, immune cells, brain cells, artificial bladders, skin, teeth?bladders, skin, teeth?

The future of Aging: Current causes of The future of Aging: Current causes of disability and death will be eliminateddisability and death will be eliminated

The focus of prevention will shift to perinatal and prenatal careThe focus of prevention will shift to perinatal and prenatal care Prenatal genetic screening will pinpoint specific lifetime Prenatal genetic screening will pinpoint specific lifetime

preventive strategies preventive strategies Arteriosclerotic Cardiovascular Disease will be treated with Arteriosclerotic Cardiovascular Disease will be treated with

periodic mechanical (nanorobotic) and chemical cleansingsperiodic mechanical (nanorobotic) and chemical cleansings Cancers will have specific molecular targeted therapiesCancers will have specific molecular targeted therapies Satiety pills will be used to treat the metabolic syndromeSatiety pills will be used to treat the metabolic syndrome Drinking water will contain chemicals that prevent cognitive Drinking water will contain chemicals that prevent cognitive

impairment and other conditions that affect the majority of the impairment and other conditions that affect the majority of the populationpopulation

Smokers will be forced to pay exorbitant health insurance rates Smokers will be forced to pay exorbitant health insurance rates (wishful thinking?)(wishful thinking?)

The future of AgingThe future of Aging

Life expectancy at birth will reach 100Life expectancy at birth will reach 100 People will take mid-life sabbaticalsPeople will take mid-life sabbaticals Social Security retirement ages will be a Social Security retirement ages will be a

sliding scale of benefits from 65 to 85sliding scale of benefits from 65 to 85 80 will be the new 60, 60 will be the new 4080 will be the new 60, 60 will be the new 40 The main causes of death will be accidents, The main causes of death will be accidents,

homicides and suicideshomicides and suicides Twinkies will probably not be the new health Twinkies will probably not be the new health

food (sorry, Woody Allen)food (sorry, Woody Allen)

What this means for DentistsWhat this means for Dentists

More Older People + More Older People +

Less Edentulism =Less Edentulism =

More Teeth More Teeth

Consequence of the Aging of Consequence of the Aging of America on DentistryAmerica on Dentistry

Unless you are a Pediatric Dentist Unless you are a Pediatric Dentist or an Orthodontist, you will be a or an Orthodontist, you will be a Geriatric DentistGeriatric Dentist

Not unique to Dentisty, all Not unique to Dentisty, all Physicians except Obstetricians Physicians except Obstetricians and Pediatricians with be and Pediatricians with be GeriatriciansGeriatricians

Things you should know as a Things you should know as a Geriatric DentistsGeriatric Dentists

Additional care is needed with medications due to Additional care is needed with medications due to polypharmacy, adverse drug responsespolypharmacy, adverse drug responses

Incidence of oral cancers increase with agingIncidence of oral cancers increase with aging Cutbacks of Medicare and Medicaid will lead to Cutbacks of Medicare and Medicaid will lead to

poorer seniors who may skimp on their dental care poorer seniors who may skimp on their dental care Dentists are the health care provider seen most often Dentists are the health care provider seen most often

by many seniors and therefore can play a key role in by many seniors and therefore can play a key role in health promotion and disease preventionhealth promotion and disease prevention

Now that you feel comfortable about Now that you feel comfortable about being a Geriatric Dentist, lets look at being a Geriatric Dentist, lets look at

Nutrition and AgingNutrition and Aging

Most of what you learned about Nutrition in Most of what you learned about Nutrition in Dental School is wrong:Dental School is wrong:

Department of Agriculture Food PyramidDepartment of Agriculture Food Pyramid MultivitaminsMultivitamins SupplementsSupplements

Multivitamins for All AgesMultivitamins for All Ages

Mini to MaxiMini to Maxi

Various Multivitamin Products Various Multivitamin Products

Multivitamins for Our Faithful Multivitamins for Our Faithful CompanionsCompanions

The Case Against VitaminsRecent studies show that many vitamins not only

don't help. They may actually cause harm.By TARA PARKER-POPE

Wall StreetJournal, March 20, 2006; Page R1

MultivitaminsMultivitamins

Contain 100% RDAs of many vitamins, some Contain 100% RDAs of many vitamins, some minerals and today’s hot supplementminerals and today’s hot supplement

Contain Iron, Copper, and Vitamin A in the form Contain Iron, Copper, and Vitamin A in the form of Retinolof Retinol

Contain very small amounts of needed vitamin D Contain very small amounts of needed vitamin D or enough Vitamin B12 for those who need it or enough Vitamin B12 for those who need it

Popular SupplementsPopular Supplements

Beta Carotene Beta Carotene Vitamin CVitamin C Vitamin EVitamin E Vitamin AVitamin A SeleniumSelenium CalciumCalcium Folic Acid Folic Acid Resveratrol Resveratrol

What is left?What is left?

Vitamin D (1000 IU) to prevent fractures, Vitamin D (1000 IU) to prevent fractures, reduce your risk of arthritis and certain cancersreduce your risk of arthritis and certain cancers

Vitamin B12 (1 mg) for many seniors who are Vitamin B12 (1 mg) for many seniors who are achlorhydric achlorhydric

I can’t take all this bad news, what I can’t take all this bad news, what can we eat to age well!can we eat to age well!

lots of fruits and veggieslots of fruits and veggies nutsnuts 1 to 2 servings of fatty fish each week1 to 2 servings of fatty fish each week lots of fiber lots of fiber monounsaturated fats (olive oil)monounsaturated fats (olive oil) Cabernet SauvignonCabernet Sauvignon Chocolate Chocolate

Benefits of ChocolateBenefits of Chocolate

Decreases Blood ClottingDecreases Blood Clotting

Relaxes and Dilates Blood VesselsRelaxes and Dilates Blood Vessels

Fat in Chocolate, Stearic Acid does not Fat in Chocolate, Stearic Acid does not

elevated cholesterol levelselevated cholesterol levels

1/3 of Fat is monounsaturated1/3 of Fat is monounsaturated

Flavonoids prevent LDL oxidationFlavonoids prevent LDL oxidation

If you invite me back, I will tell you If you invite me back, I will tell you that most of what you learned about that most of what you learned about

the following is wrongthe following is wrong Hormone replacementHormone replacement InsomniaInsomnia Prevention of hip fracturesPrevention of hip fractures Alternative medicine Alternative medicine