oral health problem of the elderly narumanas korwanich department of community dentistry chiangmai...
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Oral Health Problem of the Elderly
Narumanas Korwanich
Department of Community Dentistry
Chiangmai University
WHO, 2002WHO, 2002
UN, 2001UN, 2001
Thailand age pyramid 2004
FemaleMale
โครงสร�างประชากรอ. ลอง จ. แพร� 2550
โครงสร�างประชากร ต. เกาะล�นตาน�อยอ. เกาะล�นตา 2549
Thailand Projection
WHO, 2002WHO, 2002
Active Ageing
HealthHealth
When the risk factors for chronic diseases and functional decline are kept low while the protective factors are kept high, people will enjoy both a longer quantity and quality of life
ParticipationParticipation
When labor market, employment, education, health and social policies and programs support their full participation in socio-economic, cultural and spiritual activities, people will continue to make a productive contribution to society
SecuritySecurity
When policies and program address the social, financial and physical security needs and rights of people as they age, elderly are ensured of protection, dignity and care in the event that they are no longer able to support and protect themselves
Oral health is an important component of ‘Active Ageing’ and is included in policy proposals related to health, one of the three basic pillars.
Petersen & Yamamoto, 2005Petersen & Yamamoto, 2005
Reduce risk factors associated with major diseases and increase factors that protect health throughout the life course
- Tobacco - Physical activity
- Nutrition - Healthy eating
- Oral Health - Psychological factors
- Alcohol and drugs - Medication
WHO, 2002WHO, 2002
Oral Health Problem in Elderly
Tooth loss1
Denture related condition2
Coronal and root caries3
Periodontal disease4
Xerostomia5
Cancer and precancer6
Petersen & Yamamoto, 2005Petersen & Yamamoto, 2005
Tooth Loss
Epidemiology of Edentulousness
WHO, 2005
National Oral Health Survey
กรมอนาม�ย 2551
Tooth Loss Predictors
• 201 participants (104 edentulous) in the Healthy Old People in Edinburg (HOPE) study
• Age
• Social Class
• National Adult Reading Test IQ
• Self Esteem Score
• Dietary Assessment Score
• Cognitive testing score
Starr et al., 2009
Association with Chewing Ability
Sarita et al., 2003
Association with Chewing Ability
Sarita et al., 2003
Association with Chewing Ability
• Shortened dental arched with intact premolar regions and at least one occluding pair of molars provide sufficient chewing ability
• Shortened dental arched with 3-4 pairs of occluding premolars and asymmetric arches with a long side result in impairment of chewing ability, especially of hard food
• In extremely shortened dental arches comprising 0-2 occluding premolars, chewing ability is severe impaired
Sarita et al., 2003
Cognitive Impairment
• 5 extracted molar versus 5 non-extracted molar rats were compared to each other in learning ability and acetylcholine release in parietal lobe brain
• To examine the effects of tooth loss on the central nervous system
Kato et al., 1997
5 Rats aged 11 weeks old kept in 23c, 50%humidity, 12 h light/dark
Extract all maxillary and mandibular molars
Test in radial arm maze
Test of Acetyl-choline releasing from parietal cortex
135 weeks
9 weeks
• It has been demonstrated that the neuronal activity in the brain and the cerebral blood flow were increased by mastication
• Thus, one possible explanation may be that the dysfunction of cholinergic neuronal system in the teethless aged rats is caused by the long term decrease of neuron activity of the brain and/or the cerebral blood flow by the loss of teeth
Tooth Loss and Quality of Life
OIDP index
Tooth Loss and Quality of Life
Denture Related Condition
Denture Related problems
• Plaque Stomatitis and Oral Candidiasis Malodor Reservoir of Infection Hygiene
• Denture Denture Hyperplasia Traumatic Ulcer
Denture Stomatitis
• 11-67% prevalence
• Correlate with Amount of denture plaque Use of denture at night Neglect of denture cleaning Use of defective or unsuitable denture
Denture Hyperplasia
• 4-26% prevalence of complete denture users
• Frequently in Ill fitting denture Unretentive denture
Dental Caries
Dental Caries
• Dental caries is an infectious, communicable disease resulting in destruction of tooth structure by acid-forming bacteria found in dental plaque, in the presence of sugar
• During the past few decades, changes have been observed not only in the prevalence of dental caries, but also in the distribution and pattern of the disease in the population
NIH, 2001NIH, 2001
Dental Caries
• It is identified a shift toward improved diagnosis of noncavitated, incipient lesions and treatment for prevention and arrest of such lesions
• Restorations repair the tooth structure, do not stop caries, have a finite life span and are susceptible to disease
Fontana and Zero, 2006Fontana and Zero, 2006
Fejerskov, 1997
Takahashi & Nyvaad, 2008
Periodontal Disease
Periodontitis as a risk for health
• Diabetes
• Cardiovascular disease
• Pulmonary disease
• Adverse pregnancy
Effect of systemic disease to periodontium
• Osteoporosis
• Renal dysfunction
• Immunodeficiency disease
• Pregnancy
Xerostomia
• Saliva affects all three of components of Keyes’ classic Venn Diagram of caries etiology
Dodd et al., 2005
Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000
Xerostomiasubjective report of
oral dryness related to gender
Salivary Flow Rate
Hyposalivation Objective salivary flow rate that is under 0.1 or 0.16 ml/min (or 0.1 ml/min; relate to medication and systemic disease
Lenander-Lumikari & Loimaranta, 2000Lenander-Lumikari & Loimaranta, 2000
Buffer Capacity
Guggenheimer & Moore, 2003
Diagnosis of Xerostomia
Bardow, 2001
Guggenheimer & Moore, 2003
Oral Cancer and Precancer
Global Perspective
WHO 2002
WHO 2002
Risk Factors
• Alcohol and Tobacco
• Dietary factors
• Human papilloma virus
• Other factors
WHO 2006
Thank You