Santa Fe GroupSanta Fe Group

Oral Health For the Elderly:Challenges and Opportunities

28 June 2007Santa Fe, NM

Oral Health For the Elderly:Challenges and Opportunities

28 June 2007Santa Fe, NM

Jocelyne FeineMcGill University

Percent Edentulous Among U.S. Adults, by Age Group: 1960-2002Percent Edentulous Among U.S.

Adults, by Age Group: 1960-20028.

0

20.0

36.3

49.4

60.3

9.0

16.0

33.4

45.8

2.8

9.3

20.1

28.6

37.0

7

1.5 5.

0

13.5

23.9 28

.58

0

10

20

30

40

50

60

70

35-44 45-54 55-64 65-74 75-79

HES I (1959-62)

NHANES I (1971-74)

NHANES III (1988-94)

NHANES 1999-2002

NCHS, National Health and Nutrition Examination Surveys

The Impact of EdentulismThe Impact of Edentulism

General Health and Quality of Life

• Comfort • Nutrition

• Ability to chew• Food choice

• Ability to socialize• Intimate activities

General Health and Quality of Life

• Comfort • Nutrition

• Ability to chew• Food choice

• Ability to socialize• Intimate activities

Edentulism and General HealthEdentulism and General Health

1. Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999).

2. Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation).

3. Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).

1. Edentulous individuals have poorer nutrition than those who are dentate (Lee at al, 2004; Sheiham et al, 2001; Joshipura et al, 1996; Krall et al, 1998; Fontijn-Tekamp et al, 1996; Papas et al, 1998; Greksa et al 19995; Mojon et al; 1999).

2. Edentulous elders have an increased risk of systemic diseases (Johansson et al, 1994; Joshipura et al, 1996; Hamasha et al, 1998; Elter et al, 2003; Morais et al, In preparation).

3. Edentulous elders have significantly greater morbidity and earlier mortality than dentate elders (Shimakazi et al, 2001; Hamasha et al, 1998; Joshipura et al, 1996).

Edentulous Denture-Wearing Elders are at Risk for DiseaseEdentulous Denture-Wearing Elders are at Risk for Disease

1.Prevention of tooth loss2.Therapy to improve

chewing ability and nutrition.

1.Prevention of tooth loss2.Therapy to improve

chewing ability and nutrition.

OSSEOINTEGRATED INTRAORAL IMPLANTSOSSEOINTEGRATED INTRAORAL IMPLANTS

Societal

Preference

Ethics & Equity

Economic Evaluation

Clinical Efficacy

Effectiveness

Meso (i.e. hospital

administrators)

Micro (i.e. Patients &

physicians)

Macro (i.e. government)

Health Policy

Health Technolog y Assessment

Decision-Making

From Health Technology Assessment to Health Policy From Health Technology Assessment to Health Policy

Reducing Cost of CareReducing Cost of Care

• Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press).

• Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007).

• Complex traditional prosthetic techniques are no better than simplified techniques to fabricate high quality conventional dentures (Kawai et al, 2005; Carlsson, In Press).

• Inexperienced new dentists are able to provide equally effective and satisfactory simple mandibular implant overdentures than experienced prosthodontists (Esfandiari et al, 2007).

Healthcare Professional

Cost-Effectiveness AssessmentsCost-Effectiveness Assessments

Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost-effective (OHQoL) on the long term than are complete conventional dentures (Heydecke et al, 2005).

Mandibular 2-implant overdentures opposing maxillary conventional dentures are more cost-effective (OHQoL) on the long term than are complete conventional dentures (Heydecke et al, 2005).

Technology TransferMicro Level

Technology TransferMicro Level

Peer-reviewed journals

Continuing education / courses

Legal precedent

Professional schoolsPeer practice

Health supply company

Advertisements Hospital policies

Clinical practice guidelines

Dis

sem

inatio

nof

kn

ow

led

ge

TECHNOLOGY

Healthcare Professional

“I got a bone to pick with you,

girlie!”

“I got a bone to pick with you,

girlie!”

McGill Consensus Conference:

Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients

McGill Consensus Conference:

Mandibular Overdentures on 2 Implants: Minimal Standard of Care for Edentulous Patients

At what point does our canine colleague have an obligation:

1) To inform his patients of new effective therapies?2) To provide such therapies to his patients?

At what point does our canine colleague have an obligation:

1) To inform his patients of new effective therapies?2) To provide such therapies to his patients?

Technology TransferTechnology Transfer

Health Care Professional

Treatment Plan (alternative therapies)

Informed consent

Treatment of choice

Patient

Duty of care

Economic Economic factorsfactors

Standard of Standard of carecareSocial factorsSocial factors

Access to care

Ethical and moral issues

Legal and professional

issues

Negligence

Malpractice

You may stop the postman

from delivering the message, but, at some

point, ignorance of the evidence is no defense!

You may stop the postman

from delivering the message, but, at some

point, ignorance of the evidence is no defense!

1. Demonstrate improved health and QoL2. Demonstrate cost-effectiveness3. Apply political and social pressure

Meso and Macro Levels

WHO WILL SPEAK FOR ME?