1. Tooth loss over time results in decreased masticatory function and potential psychosocial effects due to loss of facial support and muscle tone. 2. While the rate of tooth loss has decreased since the 1960s, the number of edentulous patients is increasing as the population ages. 3. Elderly edentulous patients require special consideration due to compromised oral anatomy, medical conditions, and reduced adaptive capacity. Dentists must have technical skills as well as strong interpersonal and communication skills to help elderly patients adapt to dentures.

1. 1. Introduction Eleni Roumanas, DDS and Michael Hamada, DDS Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry UCLA School of Dentistry This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.

2. 10 11 12 13 14 1960 1970 1980 1990 Percent 30 40 50 60 1960 1970 1980 1990 Percent Edentulous 18+ yrs old Percent Edentulous 65+ yrs old Since the 1960’s there has been a dramatic decrease in the rate of tooth loss in our population. Trends In Tooth Loss Vital & Health Statistics

3. Estimates of U.S. Total Adult & Edentulous Adult Population 0 50 100 150 200 250 300 350 Millions < 18 yrs . Adult Edentulous Adults However, due to the exponential growth of our population the actual number of edentulous patients is slightly increasing over time . Because the age at which patients are becoming edentulous is older they may have greater adaptation difficulties. Vital & Health Statistics 1970 1980 1990 2000 2010 2020

4. Estimates of U.S. Total Elderly(65+yrs.) & Elderly Edentulous in One or Both Jaws 0 10 20 30 40 50 60 1970 1980 1990 2000 2010 2020 Dentate One Arch Both Arches Millions By the year 2020 approx. 30 million elderly adults will be edentulous in one or both arches. Edentulous Vital & Health Statistics

5. This chart reveals all the possible combinations of completely edentulous and partially edentulous prostheses in our present population. Denture Users in the Adult Population Redford et al(1996) NHANES Data

6. Answers to the question, “what is your lab specialty?” Type 1999 2002 % change Partial dentures 8% 24% +16% Complete dentures 18% 23% +5% Orthodontics 2% 3% +1% Implants 3% 3% 0 Full Service 16% 16% 0 Crown & Bridge 51% 49% -2% Trends in the Laboratory Industry Cornerstone Research & Marketing 2002 study of 601 laboratories Trends in the laboratory industry are showing a significant increase in the demand for complete and partial removable services. In fact the increase in removable is outpacing the growth patterns of the other restorative areas.

10. The technical details of denture fabrication are only one aspect of treatment. Of equal importance is the dentist-patient interactions or rapport. A dentist must understand denture function and its limitations and be able to guide the patient through the treatment and adaptation process. Technical ability Interpersonal Management Skills Understanding of Denture Function and Denture Limitations D E N T I S T Denture Function and Limitations

11. Consequences of tooth loss

23. Dentures- Pt. Satisfaction 66.7 % 25.6 % 7.7 % Fully Satisfied Moderately Satisfied Dissatisfied Berg E (1998); Smedley TC et al (1989); Kapur KK et al (1997) Patient satisfaction also depends upon expectations and some patients may have very unrealistic expectations. For this reason it is important to guide and educate the patient .