Oral Health Care for Seniors & the Aging Mouth


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Presentation for the elderly and their caregivers regarding medical-dental challenges that the aging mouth undergoes and therapies that can be used at home or requested of their dentist..

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  • Hello and thank you for being on this online movie presentation discussing Real Solutions for People Who are Suffering From Missing Teeth. I am glad to be your host today. Let me introduce my self, I’m Dr. <Your Name> and I practice dentistry here in <Your Town>.
    I appreciate you taking part of your busy day to listen to options for you or maybe for someone you love who is struggling with the frustration and embarrassment of missing teeth. I think you will find this information beneficial in helping you make the right decisions for yourself.
  • Now since we are talking about “real” solutions, let’s start today talking about a “real” person and her true story.
    Let me introduce Phyllis.
    Phyllis had been hiding something. This busy grandmother ran the family business while taking care of her grandkids. On the outside, it looked like she “had it all”, she was struggling with a ever increasingly frustrating problem that plagued her for 20 years.
    Phyllis had lost her teeth at the early age . This caused her to be confined to the limitations of dentures. Not being able to eat the foods that she treasured and loved.
    Through time and nature, Phyllis had lost most of the bone that she was relying on to support those dentures. She was suffering from sores from her dentures due to the fact that they didn’t fit any more and this created excessive rubbing. Her constant fear that her teeth might pop out at any moment was paralyzing her in social settings.
    Her face was sagging from the lack of muscles support and she had deep wrinkles making her look years older than she really was. Phyllis would never complain; it wasn’t in her nature. But she was unhappy. Desperately trying to tell herself that she was still beautiful, but in her words, “dentures made me seem older than I was…both physically and emotionally!”
    Her husband commented that the hardest part for him was not the physical changes that immediately started to take place. There is nothing worse than to see your sweet heart lose the twinkle in her eyes or feel for one second that she wasn’t as beautiful or attractive as I know she is. The hard part is that my words didn’t matter. She ‘felt’ older, less attractive, and went from being extremely outgoing to now covering her mouth with a napkin when eating and hiding her smile in public settings.”
    Fortunately for Phyllis, startling advancements in dentistry provided her with options that weren’t available for her in the past 20 years Now Phyllis is laughing, smiling, and enjoying those grandchildren with the confidence and pleasure she desires. Her friends now admire her new beauty…and some have actually admitted gossiping about what plastic surgery she might. After all, “she is looking 10 years younger!”
  • Let’s talk about who else is missing teeth like Phyllis. Statistics show that over 240 million people in North America, Europe and Japan are missing at least one or more teeth. This is a world wide epidemic.
    Sixty percent of those people are treated with conventional dentures right now and only 3% are being treated with the advancement of dental implants.
    Even more shocking is as the baby boomers age, current research shows that within the year 2020 that almost 38 million adults in the US are going to be needing at least one or two complete dentures replacing all of the top or all of the bottom teeth if not both.
    I am going to show you today how these people won’t have to suffer the same fate as their parents and grandparents when it comes to options of replacing these teeth.
  • Just like Phyllis, if you or someone you care about is suffering with missing teeth, you are not alone.
    So lets compare the general population to a healthy mouth. If you look at a healthy mouth it has between 32 teeth with wisdom teeth and 28 teeth without wisdom teeth.
    At age 50-54, on average this group is already lost 10 teeth. Not counting those wisdom teeth I just mentioned. And these 10 teeth are usually the important back teeth responsible for the workload of the mouth.
    If you look at the average 60-64 year old only has 14.8 teeth, less than half of the teeth intended for their mouth.
    It very difficult for the mouth to do it’s intended job with so few teeth at this point.
  • Missing teeth not only have physical effects, but also have severe emotional effects. Depression and sadness for the loss of teeth is not unusual. People often report having lower self confidence, an altered self-image of themselves. We heard that in Phyllis’ story. They might not like their appearance.
    Common behaviors such as holding their hands over their mouth out of fear that their denture will fly out, and they will actually behave in ways that keep the tooth loss a secret and conceal it from others. It is not unusual for a spouse to conceal their appearance from their significant other when they are missing teeth.
    A lot of people will tend to avoid or decrease their social situations just to prevent embarrassing situations of not being able to eat the food they want they were being served or again fear that their denture is going to fly out. Physically also, along with the emotional effects, they have premature wrinkles and look years older than they actually are from the shrinkage in the bone. We will address all of these issues in more detail.
    We already talked about all of these things in Phyllis’ situation. Not only was she aware of it but her husband and her children could see the emotional effects in here also.
  • Because of tooth loss, missing teeth causes decreased nutritional intake. Think of the body like a car and if the car is not functioning properly you’re not getting the most out of your fuel. If the teeth are not there and functioning to capacity we as humans are not getting the most out of our food, which is our fuel, and we aren’t getting full nutritional value.
    People missing teeth lack key vitamins and minerals that are found in certain raw foods and nuts due to the ability just to chew them properly. Incomplete swallowing happens where you’re actually swallowing partially chewed food and not breaking it down completely for full nutritional value. Just the frustration and difficulty in general of chewing happens also. There is a 90% reduction in chewing force when you have loss of teeth and the use a denture.
    The whole digestion process is involves muscles and comfort. Severe gagging can result from the thick plastic denture causing not being able to taste the food and that’s not even mentioning being overwhelmed by that nasty denture adhesive.
  • The importance of teeth has been well documented and Dr. Charles Mayo, renowned researcher who the world known Mayo Clinic is named for, was a huge advocate for oral health and its impact on total body health.
    He stated way back in 1933, “The presence of dental health is important. Dentistry is distinctive health services and can extend human life ten years.”
    10 years!! 10 years we are cheated out of when dental disease is present in our mouths. 10 years we are cheated out of when we are missing teeth.
  • So lets look at what really is happening when we loose a tooth.
    If we look at the first diagram, the healthy tooth shows the tooth being supported in bone. There is an outside layer of bone that is hard called cortical bone. There is a softer spongier type of bone called cancellous bone on the inside.
    The green dot shows where the nerve that supplies the feeling to the tooth is. As teeth are lost that bone shrinks and that nerve becomes exposed. Dentures sit on top of the jawbone and put pressure on it. They can shrink when there is no tooth to keep the bone stimulated and keep it present.
    Eventually it shrinks so much you can see how the denture pink part has gotten thick to compensate for that, but now it is actually sitting on the nerve. The face looks collapsed in these people and they have no support. There is loss of muscle tone. There is pain and pressure often because it is sitting right on the nerve tissue.
  • The picture on the left is a healthy mouth with all it’s teeth and all its bone.
    The picture on the left shows how much bone is permanently lost and to exposing that tender nerve.
    A tissue supported appliance such as a denture or a partial when it replaces teeth it sits on those gums and it puts pressure on the bone where it actually reabsorbs and speeds up that reabsorption. As it reabsorbs the denture appliance needs to be relined and costing more money and time down the line.
    As the bone shrinks, the face collapses, the nerve is exposed, there is less support and the appearance of wrinkles increases showing the loss of mid face support.
  • Here is a look at an edentulous or missing teeth lower jaw. There is nothing to support a denture there. This person is suffering with sores. The denture won’t stay in. Every time they talk or chew their tongue displaces it and it is very embarrassing and uncomfortable. This person is suffering physically and emotioaln and no amount of denture adhesive is going to make this situation work.
  • We talked about bone reabsorption and this is a good illustration of how the face shrinks. Her head is shorter. It is not as long. She doesn’t have the support in the middle. The space between her chin and her nose has decreased.
    She looks prematurely old. The woman on the right looks 20 years older the healthily mouth.
    Remember in Phyllis’ story how she felt she looked so old and her husband said he could see the changes in her face too.
  • How does all of this really occur? To understand that lets talk about what a normal tooth looks like. The white part, of course, is the crown part of the tooth and that is what we see in the mouth. The root is the anchor, which goes inside that bone. When a tooth is lost you lose both parts of those components.
  • To replace a missing tooth there are several options. A removable appliance, which is a denture, partial or also something called a “flipper” restores the appearance of the tooth, but does not replace any of the function of that tooth and it is just the crown part that you can see. We are still missing the root portion.
    To replace the entire functional component of the tooth and get it back to 90% of the function a complete replacement with an implant would occur. We will talk more about that.
  • When we replace just the crown there are several options to do it. We discussed the first, which was the “flipper,” which is similar to a retainer with teeth on it. It is for cosmetic appearances only. There is a full denture that sits again on the tissue and sits on the bone but it is not supported or anchored to the jawbone. If you are fortunate enough to have some teeth to hold a partial that uses wire clasps that bind around the remaining teeth. It is again sitting on the tissue but it has not replaced the function of the teeth. It is a cosmetic option.
    When using a partial to replace some of the missing teeth, there are wires that clasp onto to remaining teeth. These wires can wear and damage those supporting teeth also so that is something to consider.
  • Another option is an implant supported bridge. We get the cosmetic appearance of the tooth, but we also get the benefit of restoring the ability to chew a complete diet and eat nutritional foods because it is anchored securely and retained by the bone. We will talk further about both of these in detail in just a minute.
  • So what is an implant.
    This picture is great at comparing an implant and a real tooth.
    This picture shows the tooth on the left and what an implant would replace on the right hand side. The implant is the same shape and size as the natural tooth and giving us back the stability to have a natural and healthy smile solution.
    That’s why implants work so well. They were designed to be like the whole tooth, the crown and the root.
  • We look at options of treating with a denture, of course, the benefits are it is the least costly approach and it is fast, but if you take long term considerations, in it is going to contribute further to bone loss because it is sitting on top of it. It often causes denture sores. The nerve is exposed and leads to pain and the older look and more wrinkles from the mid face collapse.
    Ongoing expenses are associated with dentures because it is a constant process as the body reabsorbs the bone and it shrinks. A reline is usually necessary into the denture base and the cost of daily maintenance with adhesives and cleansers just to keep the denture going. They tend to be loose fitting and difficult to eat or speak with because they do not function at the same level as our teeth.
    The top denture interferes with a normal sensation of food and also speech. The thick plastic and the denture adhesive the food cannot touch the pallet and is covered up with that plastic material.
     Research has well documented that there is a lower nutritional absorption because of the inability to chew and the alteration in diets. Psychologically and emotionally there is a lower self confidence and the social impact from the embarrassment associated with dentures and altered life patterns and just a general lower quality of life.
  • Here is a picture of a traditional denture. The one on the left is a top denture, covers the whole palate and interferes with the food and speech. The lower denture lacks stability because of the “U” shape for the tongue and the muscles which often are dislodged. It pops out very easily with chewing and speaking.
  • Let’s talk about options of an overdenture. Simply, an overdenture is a denture that is supported by implants. Anywhere from 2-4 implants are placed into the front of the mouth and it anchors the denture to it giving stability and confidence. It is the next least costly option. It is a much better option vs. a traditional denture and improves the ability to eat and chew. But, it only attaches in the front part of the mouth in just a few areas and the bone in the back which we called the posterior of the mouth is still going to shrink because there is nothing there to hold it like the implant can. Also, as that shrinks there is still going to be the ongoing expense of relines and denture cleaners to maintain it as it goes through.
  • The next option is a fixed implant bridge and by far this is the best option because it is the closest we can get you back to natural teeth. There are no dietary limitations because you get to eat anything you want because you’re have stability and comfort as you chew. The food tastes normal because you’re not dealing with a heavy plastic base or a denture adhesive. It is stable and supported by the implants. It actually preserves the bone in the face that was reabsorbed when we talked about what happens when we lose teeth and go with a denture instead of replacing teeth.
    You might have only recently heard about dental implants but they have been around and well researched for a long time.
    Another benefits is you’re not going to have the ongoing maintenance of a denture to reline and all of the cleaner solutions.
    Considerations for a fixed implant bridge is, of course, the financial investment and it does take longer than a conventional denture with a multiple visits, but the benefits far outweigh the considerations. Once again, it is 90% of the function of teeth.
  • Implants support the bridge so you can eat, chew and smile with confidence.
    That’s what I find everyone wants.
    They just want to do what they want to do.
    Eat what they want to eat. And smile when they want to smile without worrying.
    That’s what Phyllis wanted. She just got tired of hiding.
  • Let me share some other information with you before you make the right decision of yourself or for someone you care about dentures or implants.
  • As we look at this diagram, healthy natural teeth give us 100% of the function.
    On the opposite end--No teeth, no denture gives 0%.
    If you look the lower denture is only, and I am stressing only giving 10% of the function that you have with natural teeth.
    If you look at an implant retained bridge it can give you back up to 90% of the chewing function to eat, to smile and to improve the quality of your life. That’s 90% of the function you had when you were a healthy 18 year doing and eating what you wanted.
    It gives you back what was stolen from you.
  • The effects of implants in the general population has been well researched. Several studies have shown ratings from the patient that the quality of life is significantly higher when they receive a two implant overdenture vs. a traditional conventional denture.
    Another study found that those who receive lower implant supported overdentures modify their diets for the better. That’s fantastic.
  • What does that mean for you? Only you can decide. This woman shares her story how she couldn’t eat with her dentures before and now she is eating spare ribs, nuts and more. The quality of her life has greatly improved. Through the support and urging of her family she made choice to invest in the quality of her life.
  • What does this mean for you?
    What else can occur with the improvement of implants?
    Again, research indicates that the following implant treatment patients say, “their overall health significantly improves from their ability to eat the foods they need to be eating for proper nutritional.”
    Studies also reveal that implant related solutions for missing teeth have a more positive effect on many aspects of a patient’s leisure and sexual activities then conventional dentures.
    This is what was reported from patients themselves.
  • Here’s another study.
    Research has also found that overdenture supported implants compared to lower traditional dentures that the patients themselves reported that their quality of life improved by approximately 33%. Of course, beyond the function of being able to eat more they report their self confidence is higher. They are more socially active and they felt that the implants are a part of their body just like natural teeth.
    Here’s another success story with dental implants. Eugene was suffering with dentures and made the decision to make the investment in his life to replace them with dental implants. This gentleman didn’t have teeth for over 30 years. He thought at one point that he wouldn’t be a candidate for implants, but he found out it was never too late to be considered for implants and he made that assumption. Now he doesn’t care because he doesn’t have to wear dentures any more.
  • As we stated earlier, not everybody who is missing teeth is an older person. This young lady lost her teeth at age 21 in an automobile accident. Through the benefits of dental implants she has been able to enjoy her life and enjoy her children. She actually said the impact was double to triple what she expected. That is a very successful story.
  • Again, what is right for you? Is it the traditional denture an option for you or would you be a candidate for an implant supported bridge?
  • Just let me tell you a little bit more about implants before you make a final decision. Implants were originally invented and first done way back in 1965. These are very long well researched studies. In fact, the inventor of the modern day implant was a man named Dr. Branemark and the company was the Nobel Biocare Company.
    The research for this, just for a historic perspective was financed by Alfred Nobel, the man the Nobel Peace Prize is named after. Because of their commitment to dental implants, Nobel Biocare has pushed the research frontier of dental implants more than anybody and has twice as much clinical research as the next closest manufacturer.
    All implants go through strict regulations and are under the supervision of the US Food and Drug Administration. Over 7 million implants have been placed worldwide to create all of this research.
  • So here is even more extensive research into the benefits of implants. I just wanted to show you a few out of thousands of studies that have been conducted just to give you some perspective.
  • So lets talk about again what option might be right for you. I don’t know your situation, but I can tell you from our patients, these are the options they felt were right for them.
    An implant overdenture is partially tissue supported/ part implant supported. It does require adjustments and relines but you will get the benefit of dietary and being able to eat more of what you want. It is a denture that is supports by two to four implants in the front part of the mouth.
    A fixed implant bridge is as close as we can get you back to natural teeth. It is implant supported. It preserves the bone and keeps it there for years to come so it doesn’t shrink down to expose the nerve. It is most like natural teeth. It can be minimally evasive and the benefits of being able to eat what you want and smile with confidence is tremendous.
  • What’s right for you?
    Only you can make that choice.
    But when our patients are looking at what they want to do, they chose to make the investment in themselves to get back their comfort, their ability to eat, and their ability to be confident.
  • There are many financial options that might not have been available to you in the past. Here’s just a few.
    There are courtesy discounts for prepayment.
    In-house financing is available and also third party finances because this is such tremendous service and we want to make it available to all that want it.
    Many care providers and lenders want to be able to make that available to everyone to have access to dental implants.
  • Implant supported bridges replaces teeth.
    You want to eat what you want not what you can eat.
    It really changes your life.
  • As we wrap things up, I wanted to share yet another story.
    This young lady, Mary, began wearing a full lower denture at age 24 and suffered for years with it. Now she enjoys the confidence and convenience of dental implants.
    As you can see she has no trouble smiling now
  • I want to thank you for joining us today and I hope you enjoyed this presentation.
    As a thank you for spending some time with me today, I have a gift for you.
    I invite you or if you are listening for someone you care about, I invite that person into my office for a NO COST consultation to discuss further what options are available and to develop a plan to get back what has been stolen from you.
    Just like Phyllis who we started this presentation with, we can find an option that fits your situation.
    Please just pick up the phone and call my office at this number <Your Phone Number> within in the next 7 days to schedule your consultation. Just mention that you heard about the gift offer on the online movie presentation and we will get a special time set up for you ASAP.
    We expect a huge response to this offer, so we will have to limit it to the first 17 who call. So PLEASE don’t wait.
    I wish you health and happiness and look forward to our meeting.
    Good bye.
  • Oral Health Care for Seniors & the Aging Mouth

    1. 1. Presentation on Oral Health & Dental Implants Cotton wood Court August 26, 2009 by Dr. Treva D. Lee
    2. 2. And now for a little bit about myself:  Raised in Fresno  Graduated from Bullard High School  BS with Honors from CAL-UC Berkeley in Food Science, Nutrition, & Dietetics  DDS from UCLA School of Dentistry  Certificate in Hospital Dentistry from Valley Medical Center  Married, 14 yr old son, 12 yr old daughter
    3. 3. Grand Tetons National Park, Snake River
    4. 4. Oral health is a balance.  Balance between amount of good bacteria in your mouth and the bad bacteria.  Bad bacteria + food = bacterial “poop” products  These by-products are very acidic & toxic  Acids de-mineralize your teeth, they take away the calcium which makes it strong.  Decay forms cavities that can destroy teeth.  Toxins infect gums and cause periodontal disease or pyorrhea.
    5. 5. What can cause an imbalance in your oral health?  Lack of good oral hygiene (brushing, flossing, fluoride rinses)  Xerostomia, or dry mouth---decrease in amount of saliva  Acidic “attacks” from drinks such as sodas and sports drinks or GERD (gastroesophageal reflux disease)- heartburn  High sugar/simple carbohydate diet.  Compromised health: diabetes, smoking, cancer
    6. 6. Why is dry mouth or xerostomia such a big deal?  Decreased saliva means less of the protective fluid that helps keep the good vs bad bacteria in balance and also helps remineralize the teeth.  Dry mouth occurs with aging, prescription medications, chemotherapy or radiation therapy, Sjogren's syndrome.  See a lot of new cavities around existing fillings or crowns.  See a lot of gumline or root cavities
    7. 7. Medications that have the side effect of dry mouth  Are you taking any of these medications associated with dry mouth?  Anti-asthmatics, anti-anxiety(xanax, valium,buspar, librium)  Antibiotics, penicillins, etc  Antidepressants (prozac, wellbutrin, sinequan)  Antiseizure (tegretol, dilantin, konopin)  Anti-diarrheal (lomotil)  Antihistamines( benadryl, chlortrimeton, tavist, pepcid)
    8. 8. More medications...  Anti-nausea: dramamine, dimentabs  Anti-psychotics: thorazine, haldol, mellaril  Parkinsonian: symmetrel  Diuretics: diuril, lasix, hygroton  Gastric meds: prilosec  Heart meds: cardizem, vasotec, plendil, calan, procardia, cardilate  Muscle relaxers: flexeril, cycoflex  NSAID's: lodine, dolbid, ansaid
    9. 9. What can we do to help keep oral health in good balance?  Besides brushing and flossing?  And regular dental visits to detect cavities when they are tiny...before they hurt?  More frequent care with the hygienist?  Drink less acidic or acid causing beverages?  Other hygiene helpers?
    10. 10. The ONLY varnish formulated to deliver ACP (Amorphous Calcium Phosphate) Deposits ACP (Amorphous Calcium Phosphate) ACP stimulates remineralization of tooth enamel ACP prevents the loss of enamel Desensitizes Dentin Desensitizes by depositing ACP and fluoride into the tubules ACP crystallizes and forms apatite - tooth-like mineral Delivers More Fluoride Provides 3x more available fluoride to all tooth surfaces Delivers 2x more fluoride uptake into the enamel 8
    11. 11. Fluoridex Daily Renewal 0.63% Stannous Fluoride Rinse is ideal for post-periodontal surgery, perio maintenance, and patients with brushing sensitivity. This rinse may be used daily or in an irrigator to help remineralize the teeth and assist with treating root surface sensitivity. Each bottle includes a convenient metered pump and mixing cup (10-fl.oz). Fluoridex Daily Renewal 0.63% Stannous Fluoride Rinse 10-oz bot$25.00 (online retailer price, my patients pay $12.00)
    12. 12. Teeth need calcium, phosphate and fluoride. Healthy saliva contains these minerals, and in conjunction with certain salivary proteins is able to deliver bio-available calcium and phosphate to the tooth surface during the demineralization/remineralization process. Calcium and phosphate are known to help: Strengthen tooth enamel Reduce sensitivity Buffer plaque acid
    13. 13. CariScreen Caries Susceptibility Testing Meter Because your patients deserve to be cavity-free! Simple, painless test to identify whether your patients have excess decay-causing bacteria Instant results to understand your patients' risk for decay today For the first time ever . . . a way to tell if what you are recommending is working
    14. 14. Treatment Kit Because your patients deserve to be cavity-free!   The Treatment Kit is great for Individuals with cavities or at risk for decay Patients who brush and floss and still get decay Anyone looking to protect their healthy teeth
    15. 15. An easy-to-dispense kit for your high risk patients.  Includes all products to initiate the 3-month treatment course which will kill the caries infection and then allow the biofilm to repopulate while supporting the regrowth of healthy, non-acid-producing strains of bacteria. Included in Treatment Kit: Instruction Card 2 boxes of Treatment Rinse 2 bottles of Mint Oral Neutralizer Gel 2 bottles of Maintenance Rinse, choice of mint or citrus 1 bottle of Boost Mouth Spray 1 pack of Sugarfree Xylitol Gum
    16. 16. The Prevention Kit is great for Individuals who have completed the 3-month Treatment Kit Protocol Those at risk for cavities but may not have cavities present Patients desiring a complete homecare routine that will maintain long-term oral health
    17. 17. The Prevention Kit is a 3-month supply kit for your high-risk patients that have successfully completed active treatment, have lowered risk, and would benefit from staying on the maintenance products. It can also be recommended for your low risk patients that would benefit from products designed to promote long-term health. This kit is easy-to- dispense and comes complete with instructions for use for all of the products
    18. 18. Oral Neutralizer Gel Because your patients deserve to be cavity-free!   Oral Neutralizer Gel is great for Reducing risk for decay Use with either a manual or electric toothbrush Patients with dry mouth Patients with bad breath Orthodontics or Invisalign patients
    19. 19. CariFree Oral Neutralizer Gel is a completely non-abrasive, fluoride-free, refreshing tooth gel that combines the proven benefits of xylitol with CariFree's patent-pending pH+ technology. The result is a minty, foaming gel that leaves your breath fresh and your teeth feeling clean and smooth. Designed to be use twice daily in place of toothpaste.
    20. 20. Boost Mouth Spray Because you too can be cavity- free!   Boost is great for Anyone experiencing dry mouth Those who snack or drink acidic beverages frequently On-the-go teens who don't think brushing after lunch is hip
    21. 21. Is xerostomia causing a caries problem? CariFree Boost is a xylitol containing mouth spray that can be used liberally throughout the day or night as needed to relieve symptoms of dry mouth, or to help neutralize decay-causing acids after eating and drinking. Each box contains four .405 fl oz (12 mL) spray bottles, with approximately 100 sprays per bottle. Alcohol-free Mild, pleasant mint flavor Safe-to-swallow, fluoride-free Clinically proven xylitol technology with 15% xylitol pH+ patent pending technology Can be used as a saliva substitute Freshens breath Easy to carry in purse or pocket
    22. 22. Biotene Dry Mouth Products : Biotene Mouthwash Imagine a mouthwash with a soothing gentle feel containing beneficial enzymes - a mouthwash that cleans, refreshes and relieves minor irritations associated with dry mouth. That mouthwash is Biotene. Only Biotene contains beneficial Bio-Active enzymes found in saliva to help maintain the oral environment and help provide protection against dry mouth. Product Features Bio-Active enzyme system Alcohol-free Refreshes without burning
    23. 23. Biotene Dry Mouth Products : Biotene Moisturizing Mouth Spray Biotene Moisturizing Mouth Spray For Dry Mouth Relief Refreshes & moistens instantly and helps keep mouth odor-free Experience a source of moisture for the comfort and health of your mouth! Supplements Mouth Moisture Protection Refreshes and Moistens Instantly Sugar Free & Alcohol Free Helps keep mouth odor-free Sweetened with Xylitol
    24. 24. Moisturizing Mouthwash & Mouth Spray for a Dry Mouth If you're serious about doing something for a dry mouth, try Oasis. Unlike water or candy, it can keep your mouth feeling moist for up to two hours when used as directed. Oasis utilizes Tri-Hydra® Technology that not only moisturizes your mouth, but also locks in moisture while helping to protect your mouth from feeling dry later on. And Oasis tastes refreshingly cool. Now that there's Oasis, you can get serious about a dry mouth
    25. 25. This tool allows people with arthritis or limited grasp to floss their teeth easily and effectively. The fork-shaped handle of the Floss Aid makes it possible to reach all teeth and keeps floss taut when in use
    26. 26. Oral hygiene care and cleaning is easier with Toothette® disposable swabs. Soft foam with ridges for stimulation and gentle cleaning. Individually wrapped package of 20. Choose from Treated with peppermint-flavor or Untreated
    27. 27. A unique feature of the Easy Out Tube Squeezer allows the last drop to be squeezed from the nozzle of the tube after the tube has been expelled up to the collar. Ideal for toothpastes, lotions, salves, silicones, and other household products. Package of 2.
    28. 28. The Gripit Floss Holder holds floss very tightly so users don't have to pinch their fingers or put fingers in their mouth when flossing. Gripit Floss Holders are the only flossing tool to pop open and allow a fresh length of floss to be advanced in seconds. Gripits are also ergonomically designed to help people with weak hand or finger conditions floss more easily. Gripit Floss Holders make flossing an effortless routine
    29. 29. with SmartGuide—provides extraordinary cleaning and improves brushing habits. Its innovative wireless display provides while- you-brush feedback to promote optimal brushing habits.  Improves gum health: Helps prevent and reverse gingivitis Provides ultimate plaque removal Delivers superior teeth whitening and polishing action in 21 days* Penetrates between teeth to sweep away plaque for a floss-like clean** Helps reduce excessive brushing force, which can lead to gum recession, by up to 88% in only 30 days† Guaranteed better checkups, or your money back Helps you brush for two minutes
    30. 30. Ideal for cleaning hard-to-reach spaces between teeth and around bridges.
    31. 31. Denture Tooth brush: removes debris from inner & outer aspects of the denture. The larger soft-grip handle is easier to grasp.
    32. 32. Treva D.Lee, DDS, MAGD
    33. 33. • Greater than 240 million people are missing one or more teeth throughout North America, Europe and Japan1 • The adult population in need of 1 or 2 complete dentures will increase from 33.6 million US adults in 1991 to 37.9 million US adults in 20202 • WHO and Nobel Biocare estimates • Chester W. Douglass, DMD, PhD, et al, “The Journal of Prosthetic Dentistry,” January 2002 • US Department of Health and Human Services, 2000 ~ 60 million patients treated dentures ~ 8 million patients treated with dental implants (penetration ~3%) Current Statistics
    34. 34. You’re not alone!
    35. 35. Age Group No. of Teeth Overall 21.1 50-54 18.7 55-59 15.8 60-64 14.8 65-69 14.2 70-74 12.6 75+ 7.0 Marcus SE, et al. J Dent Res 1996;75:684 1 16 17 32 United States 1988-1991
    36. 36. • Sadness or Depression associated with the loss • Lowered self-confidence • Poor self-image, dislike of appearance • Holding hands over mouth out of fear your dentures will fly out • Hiding the secret of having tooth loss • Decrease or total avoidance of social situations • WRINKLES and LOOKING YEARS OLDER than you really are J.Fiske, et al, The emotional effects of tooth loss in edentulous people, British Journal, Vol 184, No. 2, January 24, 1998
    37. 37. •Lacking key vitamins and minerals found in certain raw foods and nuts due to inability to chew properly. •Incomplete chewing that results in soft diets or swallowing partially chewed foods •Difficulty chewing- 90% reduction in biting forces for chewing is lost with missing teeth. •Increased gag reflex from thick dentures on the palate and the use of nasty tasting denture adhesives. Hartsook, 1974; Wayler and Chauncey, 1983; Chauncy et al., 1984; Sheihan et al., 2001 Poor Nutrition and Eating Problems
    38. 38. “The presence of dental health is important. Dentistry is a distinctive health service and can extend human life ten years”. April 1933 in the publication Dental Survey
    39. 39. • The jawbone consists of two types of bone • Cortical bone (hard, outer bone) • Cancellous bone (softer, inner bone) Healthy Tooth Partial Denture nerve Bone Resorption exposed • Bone supports teeth but will resorb, or atrophy, when there is no tooth root to stimulate the bone • Bone resorption can lead to changes in facial appearance and potential exposure of the lower nerve – Loss of “mid face” support - look older
    40. 40. Lower jaw with teeth Lower jaw with denture • Tissue supported appliance for replacing teeth, such as partials or dentures, sit directly on the gums and will contribute to bone resorption • Bone resorption requires periodic denture relines, costing money and time • Changes in facial appearance and nerve exposure can result Resorption
    41. 41. • Bone resorption can change the facial appearance causing a drawn or hard appearance
    42. 42. Crown Root • Teeth consist of two basic components • When one loses a tooth, one loses both parts
    43. 43. 1. Removable appliances (flipper, partial or full denture) 2. Replace the crown only (traditional bridge) 3. Replace root and crown – complete replacement with implants Crown Root Three primary approaches:
    44. 44. • Main emphasis: – Cosmetics • restore the appearance of teeth Full Dentures Partial Dentures Flippers
    45. 45. • Main emphases: – Cosmetics • restore the appearance of teeth – Function • restore the ability to eat a complete diet and eat nutritional foods – Health • preserve bone structure Implant-retained overdentures Implant-supported bridges
    46. 46. Replacing all components of the missing tooth with an implant provides the most natural and most healthy solution!
    47. 47.  Least costly approach  Fast  Contributes to further bone loss  Tissue supported (sore spots)  Nerve exposure may lead to pain  Older look / wrinkles  Ongoing expense to maintain  Relines  Denture adhesives/cleaners  Loose fitting, difficult to eat and speak  Palatal coverage interferes with normal sensation of food  Studies reveal1  Lower nutritional state  Lower self confidence/social impact  Lower quality of life Benefits Consideratio ns
    48. 48. • Next least costly approach • Fast • Better fixation of teeth vs. denture • Improved chewing ability • Contributes to bone loss in the back – Tissue supported, implant retained • Ongoing expense to maintain: – Relines – Cleaners Benefits Consideratio ns
    49. 49. • Best fit - most like natural teeth • No dietary limitations – Maximize nutritional intake • Food tastes normal • Implant supported, implant retained • Preserves bone and facial structure • Over 40 years of clinical use and research • Permanent solution – No ongoing maintenance – saves cost and time • Can be a larger financial investment • Longer treatment time – Multiple clinical visits Benefits Consideratio ns
    50. 50. Upper fixed bridge contains no palatal cover, thus ensuring foods taste natural
    51. 51. All natural teeth ---------------------100 No teeth, no denture ------------------ 0 Lower denture ---------------------- 10 Implant overdenture ---------------- 60 (tissue supported) Implant retained bridge ------------- 90 50 40 30 20 80 70
    52. 52. – “Studies of several populations have shown that ratings of quality of life are significantly higher for patients who receive two implant overdentures versus conventional dentures.” – “There is emerging evidence that those who receive lower overdentures modify their diets… There is also preliminary evidence that this improves their nutritional state.” McGill Consensus Statement on Overdentures
    53. 53. Noriko replaced all of her teeth with implants after her daughter received a college scholarship and convinced her mother to spend the money on herself.
    54. 54. •Studies have indicated that following implant treatment, patients’ overall nutritional state improved significantly •Research also revealed that implant related solutions for missing teeth have a more positive impact on leisure and sexual activities than do conventional dentures.
    55. 55. •Researchers found that with an overdenture supported by implants compared to a lower conventional denture that patients reported their quality of life improved by approximately 33%1 . • G. Heydecke, et al, J Dent Res 84(9):794-799, 2005 1. Stig Blomberg, MD, Psychiatrist Beyond the functional physical advantages, people with implant bridges reported2 : • increased self-confidence • increased social activities • Implants were accepted as “part of themselves”
    56. 56. Eugene was the unfortunate victim of early and complete tooth loss. To make matters worse, he couldn’t wear dentures.
    57. 57. At age 21, Kim lost her six lower front teeth in an automobile accident. An implant retained fixed bridge has enabled Kim to once again enjoy everyday life.
    58. 58. • Innovator of modern-day dental implant system (Professor P.I. Brånemark) Nobel Biocare Company – First patient: 1965 – Originally financed by Alfred Nobel – Nobel Peace Prize • Nobel Biocare has pushed the research frontier with dental implants with almost twice the clinical research as the next closest implant manufacturer • Implants are Certified according to the EU Directive on Medical Devices • Subscribe to ongoing US Food & Drug Administration review • Over 7 million implants placed in patients around the world
    59. 59. • Bocklage R, Rehabilitation of the edentulous maxilla and mandible with fixed implant supported restorations applying immediate functional loading: A treatment concept – Implant Dentistry (11; 2; 154-158) • Krekmanov L, Placement of posterior mandibular and maxillary implants in patients with severe bone deficiency: A clinical report of procedure – Int J Oral Maxillofac Implants 2000; 15; 5; 722-730 • van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definite prosthesis allowing immediate implant loading in the maxilla: A clinical report. - Int J Oral Maxillofac Implants 2002; 17: 663-670. • van Steenberghe D, Ericsson I, Van Cleynenbreugel J, Schutyser F, Brajnovic I, Andersson M. High precision planning for oral implants based on 3D CT scanning. A new surgical technique for immediate and delayed loading. - Appl Osseoint Res 2004; 4; 27-30. • Wendelhag I, van Steenberghe D, Blombäck U, Glauser R. Immediate function in edentulous maxillae with flapless surgery including a 3-D CT-scan based treatment planning procedure. - Clin Oral Implants Res 2004. Abstract. Poster #144 • van Steenberghe D, Glauser R, Blombäck U, Andersson M, Schutyser F, Pettersson A, Wendelhag I. A 3-D CT-scan derived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae. A prospective multicenter study. Submitted to Clin Impl Dent Rel Res Dec 2004 • Parel SM, Triplett RG. Interactive imaging for implant planning, placement, and prosthesis construction. - J Oral Maxillofac Surg 2004;62 (suppl 2):41-47 • Antonio Rocci, Massimiliano Martigonini, Jan Gottlow. Immediate Loading in the Maxilla Using Flapless Surgery, Implants Placed in Predetermined Positions and Prefabricated Provisional Restorations: A Retrospective 3-Year Clinical Study. - Clinical Implant Dentistry and Related Research 2003;5 (suppl 1):29-36
    60. 60.  Partially tissue supported  Requires adjustments/ relines  Improves dietary flexibility  Implant-supported  Preserves bone  Most like natural teeth  Minimally-invasive  Eat what you want Implant overdenture Fixed implant bridge
    61. 61.  Many financial options are available  Courtesy discounts for pre-payment  In-house financing *  Third party financing 12-60 months* *With Approved Credit
    62. 62. Eat what you want, not what you can!
    63. 63. “As you can see, I have no trouble smiling now” Mary began wearing a full lower denture at age 24. Today, she enjoys the confidence and convenience of dental implants.
    64. 64. Questions? Thank you! Treva D. Lee, DDS, MAGD www.DrTrevaLee.com 559-921-4627