DEALing with the TSUNAMI of
DISINTEGRATING Dentistry in the
Dr. Jon Strom, DDS, FACD
Transition from Edentulous to Dentate Seniors
1800’s to 1st
half of 1900’s Surgical Extraction
Dentures for Young Adults (Wales, Que.)
Post WW II . Preventative Dentistry Prevails
Baby Boomers :Schools 1950’s- Health 2020’s
Geriatrics and FRAIL ELDERLY!
Over 65’s outnumber Children and Young Adults as
Polypharmacy and Xerostomia impact Oral Hygiene
Lack of mobility of Frail Elders inhibits Dental Visits
50 years of 20th
Antibiotics changes the next 50 years
Dentists acquire hi-speed rotor, flourides and
hygienists. Population becomes more Dentulous.
Peripheral Seal on Full Dentures loses importance.
Implants lock Dentures in place.
Increased Dentate Population needs extra care
Numbers of Frail Elderly about 22 per Dentist
3,000 Dentists in BC, so 66,000 patients need more
oversight to maintain good oral health!
Many are not accessing Dental Care. Need for
education and special protocol.
Average patient over 65 visits Dentist every Two
Years. Inadequate supervision if General Health is
Dentition Retained for a lifetime
longer and Living
Good Oral Hygiene
as Chronic Health
Who is A FRAIL ELDER?
Slow Walkers:10 Seconds to walk 3 Meters!
Unable to Stand from Seated Position with
Arms crossed over Chest!
Hard of Hearing
Comprehension and Memory Difficulty
Bette Davis said OLD AGE IS NOT FOR
SISSIES! THE GOOD NEWS IS: IT DOESN’T
LAST THAT LONG!
MEDICAL / DENTAL DISCONNECT
MEDICARE and Dental Care disconnect
MEDICARE :Coverage from Tonsils on Down
POLYPHARMACY : Oral Side Effects ignored
DENTISTRY: Out of Pocket Expense. Value?
LONG TERM CARE: Not Cognizant of Problem
Dental Health and Aging
No relationship with age and Oral Health
Relationship between Chronic Diseases and Hygiene
Dissociation of Medical Profession from implications
of Oral Health and Medical Prognosis.
Dental Care restricted to Dental Clinics.
Need for Outreach Protocol becomes obvious!
Gingival Sulcus infection source of Bacteremia
Pneumonia if inspiration occurs!
Affects 4% of 75 Year Olds, 16% over 75, and 32%
over 95 years of Age
This still means over 70% of over 90’s are mentally
Need some autonomy in Oral Hygiene Care
In Future Robotics may assist!
Parkinson’s and Chronic Disease
Polypharmacy. Overuse of Drug Therapy
Lack of Information about side effects of drugs
Xerostomia (Dry Mouth). Saliva production and pH
not often Considered.
The Players Involved
A frail ELDER with Cognitive Problems may have
Decision makers involved
Such as: Trustee, Spouse,Family Facilitator, Doctor,
Nursing Aide,Assigned Caretaker, Long Term Care
Facility Protocol must be considered
Privacy Laws and Security Regs add Red Tape and
Complicate Treatment decisions
26 % of Elders access Dental Office every Two Years
Only 50% see value in maintaining Oral Health
Perception is: will lose teeth anyway
Do not perceive General Health Status and Healthy
Mouth are related
Family, caregiver and Trustees not engaged
Can this destructive perception be overcome?
BY WHOM? -----PRACTICING DENTIST!
Inform, Inform, Inform
Modern Information SYSTEMS
E-mail: Text & Photos
Office Ambassador for Frail Elders
Oral Science -Courses& Products
PHOTO, SHARE, INTERNET
Oral Condition emailed for analysis
A picture is worth 1,000 words
Early Education on Importance of Oral Health if
General Health is Compromised
Present implications to patient before health is
compromised. Age 60 is suggested
Provide healthy Patient with information in an
Introductory Brochure. Provide Website Links.
Assure him that your Dental Clinic wishes to provide
him appropriate care for his Lifetime
Have a Staff Member trained to so instruct on your
Areas of Special Concern
Diet changes needed of special significance
List of drugs being used.Need for Hydration and Oral
rinses to mitigate Xerostomia.
Effective Tooth Brushes and Toothpastes for each
stage of inhibited physical ability.
Use of Xylitol Lozenges to inhibit Caries.
Proper use of Chlorihexidrine Gels and Flouride
Pilocarpine Lollipops to stimulate Saliva Production.
Other Oral Hygiene Aids
Chewstick Irony of toothbrush technology!
Sanitation Issues.Bacterial exposure.Ultraviolet,etc.
Spending on Pets in US.$61 Billion.$6.5 in Canada
55-64 Year Olds spent most of any Age Group.
Need to ENROLL ALL PLAYERS
Need to Co Ordinate Health Care protocol for the
All need to be on Same Song Sheet
Provide as much Autonomy as possible for Patient
Special needs in Nutrition, Drug Side effects,Oral
Hygiene instruments and Oral Hygiene Aids.
Regular supervision and Updates for all Players
Who will oversee this Co-ordinated Care?
DIET & NUTRITION
Affects Oral Environment: pH of saliva, amount of
saliva, Oral Flora, Calculus deposits, Bacterial
Refined Carbohydrates detrimental. WHO position.
Sweden has AdoptedNew Nutritional Guidelines
(FAT GOOD_REFINED CARBS BAD)
Instruction and inception of a strict protocol needed
Patient Retention skills listed in Courses for Dentist
Keeping an on-file Patient beats enrolling a new one!
Enroll all 65+ Patients into Lifetime Program
Prepare them for Special Needs Your clinic Provides!
3,000 Dentists in BC. Each G.P. has 22 Frail Elders.
They often disappear from the Practice.
Be prepared for Aging Dental Special needs
Inform them beforehand that Your office has a
Retention Protocol for FUTURE NEEDS!
USERS are Patients, Dental Staff, Family, MD,
ACCESS LEVELS to Info and Protocols: Dentist,Staff,
Patients, Ambassador, Family Support, Caretakers
RETENTION, RETENTION, RETENTION
THE MESSAGE IS THIS:
The DENTIST is the SOURCE to RETAIN
PATIENTS FOR A LIFETIME
SO the PATIENT is ENABLED to RETAIN THEIR
TEETH AND DENTAL HEALTH FOR THEIR
HOW: BY USING NEW TECHNOLOGY TO REACH
OUT AND KEEP THE PATIENT INFORMED FOR